Renal Cancer Metastatic

Metastatic renal cell carcinoma is kidney cancer that has spread beyond the kidneys to other parts of the body, most commonly to the lungs, bones, brain, or liver. Though it cannot usually be cured, many treatments can help control the disease and manage symptoms, allowing patients to maintain quality of life.

Table of contents

• What is metastatic renal cell carcinoma?
• How kidney cancer spreads
• Common sites where kidney cancer spreads
• Signs and symptoms
• Risk factors
• Testing and diagnosis
• Treatment options
• Living with metastatic kidney cancer
• Outlook and prognosis

What is metastatic renal cell carcinoma?

Metastatic renal cell carcinoma is a type of kidney cancer that has spread from the kidney to other parts of the body. It is also called stage IV kidney cancer or advanced kidney cancer^[1][4]. Renal cell carcinoma is the most common type of kidney cancer in adults, accounting for about 90% of all kidney cancers^[2]. It starts when cancer cells form in the small tubes (tubules) inside the kidney^[3].

When doctors call kidney cancer “metastatic,” it means the cancer cells have traveled from the kidney to distant organs or tissues in the body. This is different from earlier stages of kidney cancer that remain in or near the kidney^[1]. Approximately 33% of patients with renal cell cancer develop metastatic spread^[5].

Treatment for metastatic kidney cancer typically focuses on slowing the disease down and managing symptoms to help patients feel as good as possible^[1]. While advanced kidney cancer is unlikely to be cured, treatment can often control the cancer and help relieve symptoms^[14].

How kidney cancer spreads

As the kidney tumor grows, it spreads into the fat or major blood vessels around the kidney. It may also spread into the adrenal gland, which sits right on top of the kidney^[1].

From there, cancer cells can travel to other parts of the body through two main pathways^[1]:

• Blood vessels: Cancer cells that get into a blood vessel can travel to many body parts through veins and arteries.
• Lymph system: This is a network that runs throughout the body, much like blood vessels. It helps fight disease. Cancer cells that get into lymph nodes can travel to other organs.

Because kidney cancer often has no symptoms early on, it can spread before a person even knows they have it. If treatment doesn’t get rid of all the cancer cells, the disease can come back in the kidney or somewhere else in the body^[1].

Common sites where kidney cancer spreads

Kidney cancer most often spreads to the lungs and bones. However, it can also spread to the brain, liver, ovaries, testicles, and adrenal gland^[1][5]. In fact, renal cell cancer has the capacity to appear almost anywhere in the body, and more than one organ system is often involved in the metastatic process^[5].

Advanced kidney cancer means the disease has spread beyond the lymph nodes to other areas of the body such as the lungs or bones^[4].

Signs and symptoms

The symptoms of metastatic kidney cancer are different for each person. In most cases, you’ll see blood in your urine. You may feel generally sick, tired, and like you don’t want to eat much^[1].

Common symptoms include^[1]:

• A fever that comes and goes
• A lump in your belly
• Night sweats, so much that you need to change your clothes or sheets
• Pain in your back or side that won’t go away
• Weight loss for no reason

You might also get symptoms where the cancer has spread. If the cancer is in one of your bones, you might feel pain there. In your lungs, it can give you a cough or trouble breathing^[1].

Metastatic kidney cancer can cause physical changes inside your body that affect how you feel. These can depend on where the cancer has spread. They might include feeling very tired (fatigue) and lacking energy a lot of the time, weight loss, pain, or feeling short of breath or having trouble breathing^[14].

Risk factors

A risk factor is anything that increases the chance of getting a disease. There are many risk factors for renal cell cancer, but many do not directly cause cancer. Instead, they increase the chance of changes in cells that may lead to kidney cancer^[3].

Risk factors for renal cell cancer include^[3]:

• Smoking tobacco
• Misusing certain pain medicines, including over-the-counter pain medicines, for a long time
• Having excess body weight
• Having high blood pressure
• Having a family history of renal cell cancer
• Having certain genetic conditions, such as von Hippel-Lindau disease or hereditary papillary renal cancer

Having one or more of these risk factors does not mean you will get renal cell cancer. Many people with risk factors never develop cancer^[3].

Testing and diagnosis

Doctors can do different tests to find out how much cancer is in your body. These tests can also help you and your doctor create your treatment plan^[6].

Tests or exams may include^[6]:

• Physical exam to check your overall health, including vital signs like blood pressure, temperature, weight, and pulse
• Complete medical and family history
• Blood tests to check how well your kidneys are working and your overall health
• Urinalysis — a test of your urine that looks for blood, extra proteins, or infection
• Computed Tomography (CT) Scan — an imaging test that uses X-rays to create detailed images of certain areas of your body
• Magnetic Resonance Imaging (MRI) — an imaging test that uses radio waves and powerful magnets to take pictures of your body, used to check if kidney cancer has spread to major blood vessels or the brain
• Bone scan — an imaging test that can show if the cancer has spread to your bones
• Chest X-ray — an imaging test to see if the cancer has spread to your lungs
• Biopsy — a procedure where a doctor removes a small piece of tissue to examine under a microscope

After renal cell cancer has been diagnosed, tests are done to find out if cancer cells have spread within the kidney or to other parts of the body^[3].

Treatment options

When cancer is at the metastatic stage, it’s not curable. But you and your doctor still have many options. Treatments for metastatic renal cell cancer include surgery, immunotherapy, targeted therapy, radiation therapy, chemotherapy, and ablation therapy^[12].

Surgery

Surgery is the main treatment for cancer that hasn’t grown outside of the kidneys, yet it can still be an option if your cancer has spread. Radical nephrectomy is one of the main operations for this type of cancer. During this procedure, the surgeon removes the kidney that has the tumor, the adrenal gland on top of that kidney, lymph nodes nearby, and fat around the organ^[12].

You may be offered surgery before you start targeted therapy. The surgeon will remove the kidney with the tumor and as much of the cancer as possible. This surgery is called a cytoreductive nephrectomy. It may improve how well you respond to targeted therapy^[13].

If kidney cancer spreads to the brain or lungs, surgery is sometimes used to treat it^[13].

Targeted therapy

Targeted therapy is the main treatment for stage 4 kidney cancer^[13]. Targeted therapy uses drugs to target specific molecules (such as proteins) on cancer cells or inside them. By targeting these molecules, the drugs stop the growth and spread of cancer cells and limit harm to normal cells^[13].

Several types of targeted therapy drugs work for metastatic kidney cancer, including those that target vascular endothelial growth factor (VEGF), a protein that helps build a blood supply for tumors. Drugs that work on mTOR (mammalian target of rapamycin), a protein that helps cells grow and divide, are also available^[13].

Immunotherapy

Immunotherapy helps strengthen or restore the immune system’s ability to find and destroy cancer cells^[13]. Several newer immunotherapies, in particular PD-1/PD-L1 and CTLA-4 checkpoint inhibitors, have become an integral part of the management of advanced or metastatic kidney cancer^[11].

You might have a targeted cancer drug, an immunotherapy drug, or both together to treat advanced kidney cancer. Your doctor looks at a number of factors to decide which treatment is best for you^[4].

Radiation therapy

Radiotherapy uses high energy X-rays to kill cancer cells. It’s most often used for advanced kidney cancer. The aim is to control the cancer and help relieve symptoms^[4].

Chemotherapy

Kidney cancer tends to be resistant to chemotherapy, so it is not commonly used as a primary treatment^[11]. However, some targeted therapy drugs may be combined with chemotherapy in certain cases.

Living with metastatic kidney cancer

Even if metastatic kidney cancer can’t be cured, you may be able to slow it down and manage your symptoms with surgery, medicine, and other treatments. You can also do a lot on your own to feel better physically and emotionally^[1].

Practice self-care

Pace yourself. Cancer, and even some of its treatments, can wipe you out. Try to keep your days simple and save your energy for the important activities. Don’t be shy about resting when you need to^[1].

Self-care doesn’t have to be complicated or expensive — it’s about prioritizing your needs, care, and comfort so you can feel as well as possible. This might include having a massage or taking a long bath, meditating, getting enough sleep, spending quality time with loved ones or friends, or setting aside time for activities you enjoy^[17].

Eat healthy

A healthy diet is always good for you. But after cancer treatment, it’s one of the best things you can do for yourself. In general, you don’t need to eat anything special. Just choose plenty of fresh fruits and vegetables, along with whole grains and lean proteins, like chicken and fish^[15].

Eating a well-balanced diet with lots of fruits and vegetables can support your overall health, help preserve your strength, and reduce your risk of infection^[17]. Your doctor can advise you on specific foods you may need to avoid due to your kidney function^[17].

Stay active

Exercise lifts your energy and helps you fight off anxiety, depression, and stress. Ask your doctor what’s safe for you to do^[1]. Incorporating light physical activity into your daily routine, like walking or yoga, can improve your energy levels, mood, and overall well-being^[18].

Manage symptoms and side effects

Speak your symptoms. Your doctor can help with all kinds of common problems from cancer and its treatments, like constipation, upset stomach, and pain. But only if you say something about them. Check in with your doctor often to get the care you need^[1].

Before considering a new treatment, make sure to discuss potential side effects with your oncologist. Every treatment has a risk of side effects, and they can often be effectively managed. Let your doctor know if you’re having unpleasant side effects. Keeping a journal can help you track side effects — when they happen, what you’re doing, and the time of day^[17].

Find emotional support

Tend to your body and find ways to relax. It’ll keep your mood and energy up^[1]. Coping with advanced cancer can be extremely difficult. As well as family and friends, there are people at the hospital and in your community who can help support you^[14].

Your family and friends might be able to support you and talk to you about your cancer. If you find it easier to talk to someone other than your family and friends, you may prefer to speak to a counselor^[14].

Finding out that you can’t be cured is distressing and can be a shock. It’s common to feel uncertain and anxious. It’s normal to not be able to think about anything else. Lots of information and support is available to you, your family and friends^[14].

Outlook and prognosis

The outlook for metastatic kidney cancer depends on many factors. When distant metastases are present, disease-free survival is poor; however, some patients survive after surgical resection of all known tumor^[8].

A critical first step in understanding prognosis for patients with metastatic renal cell carcinoma is risk stratification. The IMDC (International Metastatic Renal Cell Carcinoma Database Consortium) classification is a prognostic tool based on six criteria that provides an estimate of survival^[7].

Approximately 20% to 50% of patients may have metastases that are found at diagnosis or at some interval after nephrectomy (kidney removal)^[5]. Because most patients are diagnosed when the tumor is still relatively localized and amenable to surgical removal, approximately 75% of all patients with renal cell cancer survive for 5 years^[8].

Certain factors affect prognosis (chance of recovery) and treatment options. Occasionally, patients with locally advanced or metastatic disease may exhibit indolent courses lasting several years. Late tumor recurrence many years after initial treatment also occasionally occurs^[8].

While advanced kidney cancer is unlikely to be cured, treatment can often control the cancer and help to relieve symptoms. Your doctors and nurses can talk to you about what treatment options are available and what the aim of the treatment is^[14].