Renal cell carcinoma (RCC), also called renal cell cancer or renal cell adenocarcinoma, is the most common type of kidney cancer, which occurs when cells in the kidneys grow abnormally and out of control. Renal cell carcinomas account for about 90% of all kidney cancers.
There are several subtypes of renal cell carcinoma:
- Clear cell renal cell carcinoma
- The most common form of renal cell carcinoma
- About 70% of patients with RCC have this type
- Non-clear cell renal cell carcinomas
- Papillary renal cell carcinoma
- Second most common subtype
- About 10% of RCCs are this type
- Chromophobe renal cell carcinoma
- Accounts for about 5% of RCCs
- Papillary renal cell carcinoma
- Rare types of renal cell carcinoma
- Subtypes are very rare, each making up less than 1% of RCCs
- Collecting duct RCC
- Multilocular cystic RCC
- Medullary carcinoma
- Mucinous tubular and spindle cell carcinoma
- Neuroblastoma-associated RCC
- Subtypes are very rare, each making up less than 1% of RCCs
- Unclassified renal cell carcinoma
- Renal cell cancers may be labeled unclassified if they don’t fit into other categories or when there is more than one type of cancer cell present
Life Expectancy of Renal Cell (Kidney) Cancer
Life expectancy for kidney cancer is often expressed in five-year survival rates, that is, how many people will be alive five years after diagnosis.
- The five-year survival rate for localized kidney cancer (cancer that has not spread outside the kidney) is 93%
- The five-year survival rate for regional kidney cancer (cancer has spread outside the kidney to nearby structures or lymph nodes) is 70%
- The five-year survival rate for distant kidney cancer (cancer has spread to distant parts of the body, such as the lungs, brain, or bones) is 13%
What Are Symptoms of Renal Cell Carcinoma?
Early kidney cancers usually do not cause any signs or symptoms, but larger ones might. Some possible signs and symptoms of kidney cancer include:
- Blood in the urine
- Low back pain on one side
- A mass (lump) on the side or lower back
- Fatigue
- Loss of appetite
- Unexplained weight loss
- Fever
- Not caused by infection
- Doesn’t go away on its own
- Low red blood cell counts (anemia)
What Causes Renal Cell Carcinoma?
The cause of renal cell carcinoma is unknown though it may be due to genetic changes (mutations).
Risk factors that may increase the chance of developing kidney cancer include:
- Smoking
- Obesity
- High blood pressure (hypertension)
- Family history of kidney cancer
- Workplace exposures to certain substances, such as trichloroethylene
- Gender
- RCC is about twice as common in men as in women
- Race
- African Americans have a slightly higher rate of RCC than whites
- Certain medicines
- Acetaminophen (Tylenol) use may be linked to an increased risk of RCC
- Advanced kidney disease
- Genetic and hereditary risk factors
- von Hippel-Lindau disease
- Hereditary papillary renal cell carcinoma
- Hereditary leiomyoma-renal cell carcinoma
- Birt-Hogg-Dube (BHD) syndrome
- Familial renal cancer
- Cowden syndrome
- Tuberous sclerosis
How Is Renal Cell Carcinoma Diagnosed?
In addition to a patient history and physical examination, tests used to diagnose renal cell carcinoma include:
- Blood tests
- Complete blood count (CBC)
- Blood chemistry tests
- Urinalysis (urine testing)
- Imaging tests
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI) scan
- Ultrasound
- Angiography
- Chest X-ray
- Bone scan
- Kidney biopsy
- Fine needle aspiration (FNA)
- Needle core biopsy
What Is the Treatment for Renal Cell Carcinoma?
Treatment for renal cell carcinoma may involve local and/or systemic therapies.
Local therapies treat the tumor without affecting the rest of the body. These treatments are often used for earlier stage (less advanced) cancers and may include:
- Active surveillance
- Some small kidney tumors are benign and about 75% of small kidney cancers are slow growing
- This approach involves no treatment and watching the tumor carefully with imaging tests every 3 to 6 months to see if it grows
- Often used for elderly or frail patients to avoid the risks of treatment
- Surgery
- Removal of the entire kidney including the tumor (radical nephrectomy)
- Removal of the cancer alone along with some of the surrounding kidney tissue (partial nephrectomy)
- Lymph node dissection (regional lymphadenectomy)
- Removal of an adrenal gland (adrenalectomy)
- Removal of metastases
- Surgery to relieve symptoms (palliative surgery)
- Ablation and other local therapy
- Cryotherapy (cryoablation): uses extreme cold to destroy the tumor
- Radiofrequency ablation (RFA): uses high-energy radio waves to heat the tumor
- Radiation therapy
- External beam therapy (EBRT)
Systemic treatments are medications taken orally or injected directly into the bloodstream that can reach cancer cells almost anywhere in the body. Depending on the type of kidney cancer, a number of different types of drugs might be used, such as:
- Targeted drug therapy
- Drugs that target tumor blood vessel growth (angiogenesis)
- Sunitinib (Sutent)
- Sorafenib (Nexavar)
- Pazopanib (Votrient)
- Cabozantinib (Cabometyx)
- Lenvatinib (Lenvima)
- Bevacizumab (Avastin)
- Axitinib (Inlyta)
- Tivozanib (Fotivda)
- Belzutifan (Welireg)
- Drugs that target the mTOR protein
- Drugs that target tumor blood vessel growth (angiogenesis)
- Immunotherapy
- Immune checkpoint inhibitors
- PD-1 inhibitors
- Pembrolizumab (Keytruda)
- Nivolumab (Opdivo)
- PD-L1 inhibitors
- Avelumab (Bavencio)
- CTLA-4 inhibitors
- Ipilimumab (Yervoy)
- PD-1 inhibitors
- Cytokines
- Interleukin-2 (IL-2)
- Interferon-alfa
- Immune checkpoint inhibitors
- Chemotherapy
- Not a standard treatment for kidney cancer
- Often only used after targeted drugs and/or immunotherapy have been tried
- May include:
- Cisplatin
- 5-fluorouracil (5-FU)
- Gemcitabine
