Renal Cell Carcinoma Stage IV

Stage 4 renal cell carcinoma is the most advanced form of kidney cancer, where cancer has spread beyond the kidney to other parts of the body. Although this stage is challenging, treatment options including targeted therapy, immunotherapy, and surgery can help control the disease and manage symptoms.

Table of contents

• What is Stage 4 Renal Cell Carcinoma?
• Symptoms
• How is it Diagnosed?
• Treatment Options
• Prognosis and Survival
• Living with Stage 4 Renal Cell Carcinoma

What is Stage 4 Renal Cell Carcinoma?

Renal cell carcinoma is the most common type of kidney cancer in adults. It forms in the tiny tubes (tubules) inside your kidneys that filter and clean the blood^[1]. Stage 4 is the most advanced stage of this cancer, meaning it has spread beyond where it started^[1].

In stage 4 renal cell carcinoma, one of the following has occurred: the cancer has grown outside the tissue layer 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, brain, or lymph nodes^[4]. When cancer spreads to other areas of the body, these are called secondary cancers or metastases^[4].

• Kidneys
• Renal tubules
• Adrenal glands
• Lymph nodes
• Lungs
• Bones
• Brain

Symptoms

Many people with renal cell carcinoma don’t notice symptoms in the early stages. When symptoms do appear in stage 4, they are usually related to how the tumor growth affects nearby tissues or organs, or how the cancer that has spread affects other parts of the body^[3].

Common symptoms of stage 4 renal cell carcinoma include:

• Blood in your urine (hematuria), which may make urine appear pink, red, or cola-colored^[3]
• Pain in your flank, which is the area on the sides of your body between your hips and ribs^[3]
• A firm lump in your abdomen, lower back, or flank that you can feel^[3]
• Fever that comes and goes^[3]
• Night sweats^[3]
• Unexplained weight loss^[3]
• Feeling very tired (fatigue)^[1]
• Shortness of breath^[3]

Interestingly, some people have no pain or discomfort from the cancerous kidney itself. One patient described having “absolutely no pain or discomfort” with the kidney tumor, even though the cancer had spread to multiple places in the spine^[5].

How is it Diagnosed?

Tests used to diagnose and determine the stage of renal cell cancer examine the abdomen and kidneys to find out if cancer cells have spread within the kidney or to other parts of the body^[2].

Doctors use imaging tests to see inside your body and determine how far the cancer has spread. These may include:

• CT scans (computed tomography), which create detailed 3D images of your body^[6]
• MRI scans (magnetic resonance imaging), which use magnets and radio waves to create pictures of soft tissues^[3]
• X-rays to look at bones and the chest^[5]
• Ultrasound imaging^[3]

Your doctor may also order blood tests and a bone biopsy to determine the origin and type of cancer^[5]. After renal cell cancer has been diagnosed, these tests help doctors understand if cancer cells have spread and to which parts of the body^[2].

Treatment Options

Treatment for stage 4 renal cell carcinoma depends on several factors, including where the cancer has spread, your overall health, and how you respond to different therapies^[7]. Your healthcare team will work with you to develop a treatment plan that fits your needs^[10].

Targeted Therapy

Targeted therapy is the main treatment for stage 4 kidney cancer^[10]. These drugs 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 while limiting harm to normal cells^[10].

Common targeted therapy drugs include sunitinib (Sutent), pazopanib (Votrient), cabozantinib (Cabometyx), and axitinib (Inlyta)^[10]. Sunitinib is usually the first drug used because it has been shown to be the most effective^[10].

Immunotherapy

Immunotherapy helps strengthen or restore your immune system’s ability to find and destroy cancer cells^[10]. Immune checkpoint inhibitors have become part of standard first-line treatments for stage 4 renal cell carcinoma^[15].

Nivolumab (Opdivo) may be offered if the kidney cancer is no longer responding to other targeted therapy drugs. Sometimes it is combined with ipilimumab (Yervoy)^[10].

Surgery

Surgery may be offered before starting 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^[10]. It may improve how well you respond to targeted therapy^[10].

If kidney cancer has spread to the brain or lungs, surgery is sometimes used to treat those areas as well^[10].

Radiation Therapy

Radiation therapy may be used to help control symptoms or treat areas where the cancer has spread, such as to bones or the brain^[7].

Clinical Trials

Clinical trials test new treatments or new combinations of treatments. Your doctor may recommend a clinical trial as a treatment option^[7].

Prognosis and Survival

The outlook for stage 4 renal cell carcinoma depends on several factors. Your treatment plan and outlook depend on where the cancer has spread, the type of kidney cancer cells, your overall health, and how well you respond to treatment^[1].

While stage 4 kidney cancer is unlikely to be cured, treatment can often control the cancer and help relieve symptoms^[21]. Survival rates for stage 4 kidney cancer are lower than other stages of the condition, but treatments are available and the outlook varies according to each individual^[6].

Thankfully, many new treatments have been developed in recent years. Even if it’s not possible to cure a patient, doctors now have the tools to significantly extend life^[22].

Certain factors affect your chance of recovery and treatment options. These include the type of kidney cancer, whether it’s the first time you’ve had cancer or if it has come back, your age and general health, and how you respond to treatment^[2].

Living with Stage 4 Renal Cell Carcinoma

Coping with the Diagnosis

Finding out that you have stage 4 cancer can be extremely difficult. It’s common to feel uncertain and anxious, and it’s normal to not be able to think about anything else for a while^[21]. Many people describe going through stages of emotions including shock, denial, anger, sadness, and eventually acceptance^[24].

Talking to others can help. As well as family and friends, there are many people at the hospital and in your community who can support you^[21]. Specialist nurses can help if you’re finding it difficult to cope or if you have any problems. Make sure you know who your specialist nurse is and have their contact number^[21].

Healthy Lifestyle Choices

No matter which treatments you receive, healthy lifestyle choices can help you make the most of them. Before making any big changes to your diet or exercise routine, check with your doctor to make sure it’s safe for you^[20].

Eating well: 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^[19]. Getting enough calories to stay at a good weight is especially important during treatment^[19].

If you had a kidney removed and your remaining kidney is healthy, you may not need to avoid specific foods. However, if your kidney function is affected, you may need to limit salt, protein, potassium, and phosphorus^[20]. A registered dietitian can help you plan a healthy diet that’s suitable for you^[19].

Staying active: Moving your body is key to getting your energy back, even when treatment makes you feel tired^[20]. Talk to your doctor or a physical therapist to come up with an exercise routine that works for you^[18].

Managing Symptoms and Side Effects

It’s 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^[21]. Always attend follow-up appointments to ensure your doctor knows if you’re having side effects or any new or worsening symptoms^[19].

Keeping a journal can help you track side effects—when they happen, what you’re doing, and the time of day^[19]. Don’t make changes to your treatment plan without medical advice^[19].

Self-Care and Support

Self-care is an essential part of managing your condition. It’s about prioritizing your needs, care, and comfort so you can feel as well as possible^[19]. This might include getting enough sleep, spending quality time with loved ones, setting aside time for activities you enjoy, or trying relaxation techniques like meditation^[19].

Many people find that knowing more about their situation makes it easier to cope. Talk to your doctor or specialist nurse to understand what your diagnosis means, what is likely to happen, what treatment is available, and how treatment can help you^[21].

Some people find great comfort in connecting with others who understand what they’re going through. Support groups, counseling services, and online communities can provide emotional support and practical advice^[21].