Renal Cell Carcinoma
Renal cell carcinoma is the most common type of kidney cancer in adults, accounting for up to 85% of all kidney cancers. Often it causes no symptoms in early stages, making it difficult to detect until it grows larger or spreads to other parts of the body.
Table of contents
- What is renal cell carcinoma?
- Types of renal cell carcinoma
- How common is this cancer?
- Symptoms
- Causes and risk factors
- Diagnosis
- Treatment options
- Living with renal cell carcinoma
- Outlook and prognosis
What is renal cell carcinoma?
Renal cell carcinoma (RCC) is a type of cancer that forms in the lining of very small tubes inside your kidneys called tubules. These tubules are responsible for filtering your blood, directing substances your body needs like water and nutrients to your bloodstream, while filtering waste products into your urine[1]. RCC is the most common type of kidney cancer in adults, making up more than 9 out of 10 kidney cancers[3].
RCC usually starts as a single clump of cancer cells, called a mass or tumor, inside one kidney. However, you may have multiple tumors in one or both kidneys[1]. The cancer can remain in your kidney and nearby structures, which doctors call localized RCC, or it can spread to other parts of your body, which is known as advanced or metastatic RCC. Treatments and outcomes differ depending on whether the cancer has spread[1].
Types of renal cell carcinoma
Clear cell renal cell carcinoma is the most common type of RCC. Scientists have identified more than 50 different types of RCC, and they classify them based on how tumor cells look under a microscope and their genetic material[1].
The main types of RCC include:
- Clear cell renal cell carcinoma (ccRCC): Up to 85% of RCCs are this type. It gets its name from the way tumor cells look underneath a microscope — they appear clear-colored[1].
- Papillary renal cell carcinoma: About 10% to 15% of RCCs are papillary renal cell carcinoma. It gets its name from the finger-like projections visible on most tumors[1].
- Chromophobe renal cell carcinoma: Between 5% and 10% of RCCs are chromophobe renal cell carcinoma. The cells are usually light-colored but tend to be larger than clear cells[1].
- Unclassified RCC: Up to 6% of RCCs don’t fit into any category. Scientists are increasingly discovering new ways to classify this group based on the characteristics of cancer cells[1].
How common is this cancer?
Healthcare providers diagnose approximately 80,000 new cases of RCC each year in the United States and 400,000 new cases worldwide[1]. Anyone can develop RCC, but it’s most common in men aged 60 to 80[1]. The cancer occurs most often in people between the ages of 50 and 70[7].
Symptoms
Most people don’t notice symptoms in the early stages of renal cell carcinoma. Often, RCC doesn’t cause symptoms, and healthcare providers find tumors during imaging tests done for other reasons[1]. When symptoms do appear, they usually relate to how tumor growth impacts nearby tissue or organs[1].
Renal cell carcinoma symptoms include:
- Blood in your urine (hematuria)[1]
- Pain in your flank (the sides of your body between your hips and ribs)[1]
- A firm lump in your abdomen, low back or flank[1]
- Fever[1]
- Night sweats[1]
- Unexplained weight loss[1]
- Fatigue[1]
- Swelling of the veins around a testicle[7]
You may also experience symptoms of anemia, like shortness of breath and fatigue. Or you may experience symptoms of paraneoplastic syndromes, which occur when tumors release substances, like hormones, that cause changes in your body[1].
Causes and risk factors
RCC develops when abnormal cells multiply out of control inside kidney tubules. Exact causes are unknown[1]. Renal cell cancer is caused by certain changes to the way kidney cells function, especially how they grow and divide into new cells. Many risk factors do not directly cause cancer, but they increase the chance of DNA damage in cells that may lead to renal cell cancer[4].
Risk factors for renal cell carcinoma include:
- Smoking: The more you smoke, the greater your risk. Smoking is the strongest risk factor for developing kidney cancer[1][3].
- Obesity: The higher your body mass index (BMI), the greater your risk. Obesity is another major risk factor, especially in women[1][3].
- High blood pressure (hypertension)[1][4]
- Chronic kidney disease, which may include long-term dialysis treatment[1]
- Chronic hepatitis C infection[1]
- Long-term use of certain pain medicines, including over-the-counter pain medicines[1][4]
- Family history of renal cell cancer[4]
- Having certain genetic conditions, such as von Hippel-Lindau disease or hereditary papillary renal cancer[4]
- Occupational exposure to certain chemicals, such as trichloroethylene[3]
Having one or more of these risk factors does not mean you will get renal cell cancer. Many people with risk factors never develop renal cell cancer[4].
Diagnosis
Your healthcare provider will want to find out more about your symptoms through a physical exam and questions about when you first noticed a problem, whether there’s blood in your urine, if you’re having pain, and if anyone in your family has had kidney cancer[9].
Tests that may be ordered include:
- Urine tests[9]
- Blood tests[9]
- Ultrasound, which uses sound waves to make a picture of the organs inside your body[9]
- CT scan, a test that uses a powerful X-ray to make detailed pictures inside your body[9]
- MRI (magnetic resonance imaging) scan[7]
- Biopsy, where doctors remove a small piece of tissue to check for cancer[9]
- Tests to see how well your liver is working[9]
If the results show that you have renal cell carcinoma, your doctor will find out what stage it’s in, so you can decide on the best treatment options. The stage of cancer depends on how large your tumor is and whether the cancer has spread to other parts of your body[9].
Treatment options
Treatment for kidney cancer depends on individual factors, including the exact location of the tumor, stage of the tumor, and the person’s general health[12].
Surgery
Surgery to remove all or part of the kidney (nephrectomy) is usually recommended. This may include removing the bladder, surrounding tissues, or lymph nodes. A cure is unlikely unless all of the cancer is removed with surgery[7].
There are two types of nephrectomy:
- Partial nephrectomy: Removes just the part of the kidney that contains the tumor and some of the tissue around it[14].
- Radical nephrectomy: Removes the whole kidney and often the adrenal gland above the kidney, the tissue around it, and the lymph nodes next to the kidney[14].
Most people do fine living with one remaining kidney, but close monitoring may be needed[14].
Systemic treatments
Systemic treatments are medicines that treat the entire body to kill cancer cells. They travel through the bloodstream to treat cancer cells wherever they are in the body[14].
The two main types of systemic treatments for kidney cancer are:
- Targeted therapies: Medicines that target specific molecules on or in cancer cells. Most targeted therapies work by blocking the process of how new blood vessels grow and feed the cancer, or by blocking certain proteins in cancer cells that help them grow[14].
- Immunotherapies: Treatments that take advantage of a person’s own immune system to help kill cancer cells. Several newer immunotherapies, particularly PD-1/PD-L1 and CTLA-4 checkpoint inhibitors, have become an integral part of the management of advanced or metastatic kidney cancer[15].
Other treatments
Additional treatment options include:
- Radiation therapy: Usually done only when the cancer spreads to the bone or brain[7]
- Ablation therapy: Uses extreme heat or cold to destroy tumors[14]
- Active surveillance: For some patients, careful monitoring without immediate treatment may be appropriate[14]
Chemotherapy is generally not effective for treating kidney cancer in adults. Kidney cancer tends to be resistant to chemotherapy[7][9].
Living with renal cell carcinoma
Living with one kidney
You can live a normal and healthy life with one working kidney or with only part of a kidney. Your remaining kidney tissue can still filter waste and extra water from the blood[24].
To help keep your kidney working properly:
- Quit smoking if you smoke[24]
- Talk to a dietitian about your diet, especially about protein, salt, phosphorus, and fluid intake[24]
- Limit alcohol consumption[24]
Self-care and lifestyle
Self-care is an essential part of managing the discomfort you may be experiencing with RCC. It’s about prioritizing your needs, care, and comfort so you can feel as well as possible[23].
Ways to practice self-care include:
- Getting enough sleep and rest[16]
- Exercising if possible, or doing light physical activity such as walking or gardening[23]
- Eating a well-balanced diet with lots of fruits and vegetables to support your overall health and help preserve your strength[16][23]
- Taking time for activities you enjoy, such as reading, listening to music, or a hobby[23]
- Spending quality time with loved ones or friends[23]
- Practicing meditation or other relaxation techniques[23]
Managing symptoms and side effects
It’s important to work with your healthcare team to manage treatment side effects. Before considering a new treatment, discuss potential side effects with your doctor. 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[23].
Don’t make changes to your treatment plan without medical advice. Always attend follow-up appointments to ensure that your doctor knows if you’re having side effects or any new or worsening symptoms[23].
Emotional support
Coping with advanced cancer can be extremely difficult. Finding out that you can’t be cured is distressing and can be a shock. It’s common to feel uncertain and anxious[20].
Sources of support include:
- Specialist nurses who can help if you’re finding it difficult to cope or if you have any problems[20]
- Family and friends who may be able to support you and talk to you about your cancer[20]
- Counselors if you find it easier to talk to someone other than your family and friends[20]
- Support groups where you can connect with others living with kidney cancer[22]
Outlook and prognosis
How well someone with kidney cancer does depends on how much the cancer has spread and how well treatment works[7].
If kidney cancer is diagnosed while the cancer is still local (has not spread beyond the kidney), the five-year survival rate is 93%. Like most cancers, kidney cancer is difficult to treat once it has spread to other parts of the body. Metastatic kidney cancer has a five-year survival rate of 12%[15].
The survival rate is highest if the tumor is in the early stages and has not spread outside the kidney. If it has spread to the lymph nodes or to other organs, the survival rate is much lower[7].
Even if some cancer is left behind after surgery, there may be a benefit from the procedure. With improvements in technology and treatment options, including immunotherapy and targeted therapies, kidney cancer has never been more treatable than it is today[2].
