Renal Cancer Stage IV

Stage 4 kidney cancer is the most advanced form of the disease, where cancer that started in the kidney has spread beyond the organ to other parts of the body. While this diagnosis is serious, treatments are available that can often control the cancer and help relieve symptoms.

Table of contents

• What is stage 4 renal cancer
• Where the cancer can spread
• Treatment options
• Living with advanced kidney cancer

What is stage 4 renal cancer

Stage 4 kidney cancer means the cancer has grown and spread significantly from where it started. At this stage, one of the following has happened: the cancer has grown outside the layer of tissue around the kidney (called the fascia) or into the adrenal gland on top of the kidney, or the cancer has spread to other parts of the body such as the lungs, bones, liver, or brain^[1][5].

This stage is also called advanced or metastatic kidney cancer. When cancer spreads to other areas of the body, these are called secondary cancers or metastases^[5]. The cancer may have already spread when first diagnosed, or it may come back and spread after earlier treatment^[19].

The kidneys are two fist-sized organs on either side of your spine beneath your ribcage. They filter waste products and fluid from your blood, which then get flushed out as urine^[1]. Stage 4 kidney cancer is the most difficult stage to treat, though survival rates and outlook vary according to each individual^[7].

Where the cancer can spread

In stage 4 kidney cancer, tumors may have grown outside the kidney and into nearby tissues. The cancer may also have spread to nearby lymph nodes — small bean-shaped organs that are part of the immune system^[7][5].

The cancer can spread to distant organs in the body. Common places where kidney cancer spreads include the lungs, bones, liver, and brain^[3][5]. When kidney cancer spreads to the brain or lungs, surgery is sometimes used to treat it^[3].

Treatment options

Stage 4 kidney cancer is unlikely to be cured, but treatment can often control the cancer and help to relieve symptoms^[19]. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. Several factors affect which treatment is best for you, including the type of kidney cancer, any other treatments you’ve already had, where the cancer has spread, and your overall health^[3][6].

Targeted therapy

Targeted therapy is the main treatment for stage 4 kidney cancer^[3]. These drugs target specific molecules such as proteins on cancer cells or inside them. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells^[3].

Several types of targeted therapy drugs are used. Some work on a protein called VEGF (vascular endothelial growth factor), which helps build a blood supply that small tumors need to grow larger. These include drugs like sunitinib, pazopanib, sorafenib, cabozantinib, and axitinib. Sunitinib is usually the first drug used because it has been shown to be the most effective^[3].

Other targeted drugs work on a protein called mTOR (mammalian target of rapamycin), which helps cells grow and divide. These include temsirolimus and everolimus^[3].

Immunotherapy

Immunotherapy helps strengthen or restore the immune system’s ability to find and destroy cancer cells^[3]. While not usually used as a first treatment in some countries because targeted therapies work better, immunotherapy may be used in specialized centers or for kidney cancer that no longer responds to targeted therapy^[3].

Immunotherapy drugs used to treat stage 4 kidney cancer include nivolumab, which may be offered if the kidney cancer is no longer responding to a VEGF targeted therapy drug. A combination of nivolumab and ipilimumab may also be used^[3][8].

Surgery

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^[3].

During surgery, the doctor may perform a radical nephrectomy, which removes the whole kidney and often the adrenal gland above the kidney, the tissue around it, and the lymph nodes next to the kidney. A partial nephrectomy removes just the part of the kidney that contains the tumor and some tissue around it^[13].

Most people do fine living with one remaining kidney, but close monitoring may be needed^[13]. The surgery can be done through open surgery with one large cut, or through laparoscopic surgery using several small cuts with a camera, which is also called minimally invasive surgery^[13].

Radiation therapy

Radiation therapy uses high-energy rays to kill cancer cells. It may be used to treat areas where the cancer has spread, especially to relieve symptoms^[6].

Living with advanced kidney cancer

Coping with advanced cancer can be extremely difficult, both physically and emotionally. It’s common to feel uncertain and anxious when you learn that the cancer cannot be cured. Many people find it hard to think about anything else^[19].

Advanced kidney cancer can cause physical changes inside your body. Symptoms might include feeling very tired and lacking energy, weight loss, pain, or feeling short of breath. It is important that you feel as well as you possibly can. If you have any symptoms, tell your doctor or nurse so they can help you get the treatment you need to relieve them^[19].

Emotional support

Talking about your cancer can help. Your family and friends might be able to support you, though some may find it difficult to discuss because they worry about the emotions it could bring up. You can help them by letting them know you would like to discuss what’s happening and how you feel^[19].

Specialist nurses can help if you’re finding it difficult to cope or if you have any problems. They can get you the help you need, give you information, and connect you to support in your local area. Make sure you know who your specialist nurse is and have their contact number^[19].

If you find it easier to talk to someone other than your family and friends, you may prefer to speak to a counselor. Some people find great comfort in religion and may want to talk to a hospital chaplain or religious leader^[19].

Self-care and daily life

Practicing self-care is essential for managing discomfort with kidney cancer. Self-care means prioritizing your needs, care, and comfort so you can feel as well as possible. This can include having a massage or taking a long bath, meditating, taking quiet time by yourself, getting enough sleep, spending quality time with loved ones, or setting aside time for activities you enjoy such as reading, listening to music, or a hobby^[18][21].

If possible, light physical activity such as walking or gardening can help improve your energy levels and mood. Your doctor can give you a referral for a physical therapist if you need help with exercises appropriate for your condition^[18][21].

Eating well

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. Getting enough calories to stay at a good weight is especially important during treatment^[21].

Your doctor can advise you on specific foods you may need to avoid depending on your kidney function. If you had a kidney removed and your remaining kidney is healthy, you won’t need to eat or avoid specific foods. If your remaining kidney is not working as well, you may need to go easy on protein, skip the salt, watch out for phosphorus, and limit potassium^[25].

Your cancer care team can refer you to a registered dietitian who can help you plan a healthy diet that’s suitable for you^[21].

Managing treatment side effects

Before considering a new treatment, make sure to discuss potential side effects with your doctor. Every treatment has a risk of side effects, but they can often be effectively managed. Let your doctor know if you’re having unpleasant side effects. Keeping a journal can help you track when they happen^[21].

Always attend follow-up appointments to ensure your doctor knows if you’re having side effects or any new or worsening symptoms. Don’t make changes to your treatment plan without medical advice^[21].