Renal cell carcinoma

What is renal cell carcinoma?
Nearly 58,000 new cases of renal cell carcinoma (RCC) occur in the United States each year, according to the American Cancer Society. More than 100,000 RCC survivors live in the United States today. RCC comprises over 90 percent of all malignancies of the kidney that occur in adults. RCC arises from the convoluted tubule or collecting duct – portions of the kidney that have excretory and absorptive function.

Who is most likely to have RCC?
RCC develops most commonly in people over age 40, with males at higher risk. Factors that may increase the risk of kidney cancer include smoking, obesity, high blood pressure, and long-term dialysis. Also, coke-oven workers in the iron and steel industry and workers exposed to asbestos or cadmium may be at higher risk. RCCs occur at a younger age and may be multiple or bilateral when associated with autosomal dominant familial syndromes, such as von Hippel-Lindau, Birt-Hogg-Dube, hereditary papillary RCC, and hereditary leiomyomatosis and RCC.

What characterizes RCC?
RCC has few symptoms at its early stages and is often diagnosed incidentally. At later stages, common symptoms include blood in the urine, chronic side pain, a lump or mass in the side or abdomen, weight loss, fever, and anemia. Also, people with kidney cancer often feel tired.

How does the pathologist make the diagnosis?
The pathologist reviews the results of a physical examination and blood and urine tests performed or ordered by the primary care physician. Tests that help evaluate the kidney include intravenous pyelogram (IVP), computed tomography (CT), ultrasound, magnetic resonance imaging (MRI), and angiography. These tests allow physicians to view kidney area images to determine if biopsy or surgery is necessary.

What else does the pathologist look for?
If a tumor is found, the patient’s physician or radiologist may obtain a fine needle aspiration biopsy specimen–a small sample of the tumor–to allow the pathologist to examine under a microscope and make a diagnosis. The doctor typically uses ultrasound or a CT scan to guide the placement of the needle.

What is meant by the stage and grade of the cancer?
The pathologist and primary care doctor determine the cancer’s stage to plan the best treatment. Stage I RCCs are small (7 cm or less) and confined to one area of the kidney. Stage II tumors are larger (more than 7 cm) and limited to the kidney. Stage III tumors extend into major veins or directly invade the adrenal gland or perinephric tissue but not beyond Gerota fascia. Stage IV cancers directly invade beyond Gerota fascia and more frequently have spread to other parts of the body.

The cancer’s grade is also rated from 1 to 4 based on nuclear features of the malignant cells. Grade 1 cancers are slow-growing and represent a better prognosis for patients than Grade 4 tumors. Higher-grade tumors are more challenging to treat successfully.

How do doctors determine what treatment will be necessary?
The recommended treatment will depend on the type of RCC, the size and location of the tumor, the stage of the cancer, and the patient’s age and general health. The pathologist consults with the primary care physician or specialist to aid in the appropriate selection of therapy. Together, using their combined experience and knowledge, they determine treatment options most appropriate for the condition. It’s important to learn as much as possible about treatment options and make the decision that’s right for you.

What kinds of treatments are available for RCC?
RCC is treated with surgery, arterial embolization, radiation therapy, biological therapy, or chemotherapy. These options can be used individually or in combination.

Surgery, the most common treatment for RCC, involves removing all or part of the kidney, depending upon the stage of the tumor. In some cases, nearby tissue is also removed. For stage 1 cancer, the surgeon may remove only the kidney in a procedure called a simple nephrectomy, or only the part of the kidney containing the tumor in a procedure called a partial nephrectomy. A partial nephrectomy may be used when the patient has only one kidney, has cancer in both kidneys, or has a tumor less than 4 centimeters in size (stage 1a). For cancers beyond stage I, the surgeon may perform a radical nephrectomy, removing the entire kidney and a margin of healthy tissue around the kidney. The adrenal gland and lymph nodes in the area may also be removed.

At some medical centers, a laparoscopic nephrectomy may be performed. This is a minimally invasive procedure that can result in decreased blood loss, a shorter hospital stay, less need for pain medication, and a shorter recovery time compared to traditional, or open, nephrectomies. Laparoscopy has also been successfully combined with cryosurgery and radiofrequency ablation (RFA) to destroy small kidney tumors. Cryosurgery uses freezing temperatures (by using liquid nitrogen or carbon dioxide) to destroy diseased tissue. RFA destroys tumors with heat energy.

Sometimes used before surgery, arterial embolization shrinks the tumor. This therapy also relieves the symptoms of RCC when surgery is not possible. Arterial embolization blocks blood flow into the tumor, preventing it from receiving the oxygen and nutrients it needs to grow.

Radiation therapy uses pinpointed, high-energy beams to kill cancer cells. It can be used prior to surgery to shrink the tumor, as well as to relieve pain and other problems for patients who cannot have surgery.

Biological therapy and chemotherapy are systemic therapies used to treat metastatic RCC. Systemic therapies travel through the bloodstream to reach and affect cells throughout the body. Biological therapy uses natural substances found in the body’s immune system, such as interferon alpha or interleukin-2, in larger amounts than normal to fight cancer. Chemotherapy kills cancer cells through the use of anti-cancer drugs but has limited use against RCC.

In addition, people with RCC may receive other treatments to control pain and other symptoms, relieve side effects, or to ease emotional problems. After nephrectomy, RCC receive frequent check-ups. The frequency of the check-ups and the ongoing treatment depends upon the stage and grade of the tumor. It’s very important for the patient and doctor to be vigilant, even if the prognosis is excellent.

Clinical trials of new treatments for RCC may be found at www.cancer.gov/clinicaltrials. These treatments are highly experimental in nature but may be an option for advanced cancers. For more information about clinical trials, talk to your doctor or call the National Cancer Institute’s Cancer Information Service at 1–800–4–CANCER.

For more information, go to www.cancer.gov (National Cancer Institute) or www.kidneycancer.org (Kidney Cancer Association). Type the keywords kidney cancer into the search box.

What kinds of questions should I ask my doctors?

Ask any question you want. There are no questions you should be reluctant to ask. Here are a few to consider:

    • Please describe the type of cancer I have and what treatment options are available.
    • What is the stage of my cancer?
    • What are the chances for full remission?
    • What treatment options do you recommend? Why do you believe these are the best treatments?
    • What are the pros and cons of these treatment options?
    • What are the side effects?
    • Should I receive a second opinion?
    • Is your medical team experienced in treating the type of cancer I have?
    • Can you provide me with information about the physicians and others on the medical team?
    • If I want a second opinion, could you provide me with the names of physicians and/or institutions that you would recommend?

DEFINITION OF TERMS

Lymph nodes: Small, immune system organs that help fight infections and other diseases. Lymph nodes are found in the underarm, neck, abdomen, and groin along the channels of the lymphatic system.

Malignant: Cancerous and capable of spreading.

Metastatic: Spreading beyond the original tumor location to lymph nodes and other parts of the body.

Pathologist: A physician who examines tissues and fluids to diagnose disease in order to assist in making treatment decisions.

 

Images

Kidney cancer cells  NORMAL

Kidney cancer cells
Normal kidney cells
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This information was developed by the College of American Pathologists’ Public Affairs Committee in conjunction with the College’s Cancer Committee and Council on Scientific Affairs. The College is providing this information to help you better understand your health. Ultimately any decisions you make about your health, however, should be between you and your doctor.

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