Renal Cell Carcinoma

Overview

Renal cell carcinoma (RCC) is the most common type of kidney cancer, accounting for nearly 90 percent of all kidney cancer diagnoses. RCC has several subtypes, which are classified mainly by what the tumor cells look like under a microscope (Table 1). The subtype can both influence treatment choices and help doctors determine whether the cause of the cancer may be an inherited genetic syndrome.

RCC begins when abnormal cells in the kidneys start to grow out of control and form one or more masses – or tumors – within the kidneys. Cases of RCC can range from one tumor in one kidney to several tumors in both kidneys, and tumors are often found on ultrasounds or CT scans that are being done for other purposes before the cancer cells have spread to other organs. As the use of imaging tests has increased, the frequency of incidental detection of RCC has also increased. If the tumor is not detected until after the cancer cells have spread, the cancer is said to have metastasized, or spread, to one or more distant sites in the body. When this happens, treatment needs to involve the primary site in the kidneys as well as the metastatic site or sites.

More than 60,000 people are diagnosed with RCC each year in the U.S. The disease is more common in men than in women, and it most commonly afflicts the older population. The rate of RCC diagnoses has risen by 2 percent each year for the last 65 years, but through research and advances in treatment, the five-year survival rate for both localized and advanced RCC has increased by about 3 percent since the early 1990s. In addition, doctors and researchers continue to investigate new treatment options to improve RCC patient outcomes even further.

Table 1. Subtypes of RCC

Clear cell Approximately 85% of RCC cases are clear cell, making this the most common subtype. Under a microscope, clear cell tumor cells look very pale or clear.
Papillary Approximately 10% of RCC cases are papillary, making this the second most common subtype. Under a microscope, the cells in these tumors look like small, finger-like projections called papillae.
Chromophobe Only a small percentage of RCC cases are chromophobe. Under a microscope, this subtype’s cells are pale as well but much larger.
Translocation Only a small percentage of RCC cases are translocation. Under a microscope, translocation tumor cells often mimic the appearance of clear cell RCC and papillary RCC.
Collecting duct Cases of collecting duct RCC are rare. Under a microscope, collecting duct tumor cells look like irregularly shaped tubes.
Unclassified On rare occasions, RCC cases are considered unclassified. This means that more than one type of cell is present and that the cells do not fit into any of the other subtype classifications.

About the kidneys

Because RCC affects the kidneys, it is important to first understand the anatomy and function of normal kidneys (Figure 1). The kidneys are a pair of bean-shaped organs located in the back of the abdomen. There is one on each side of the spine, and they are protected by the lower ribcage. Each kidney is approximately four to five inches long, which is about the size of a fist.

The kidneys are a part of the urinary tract, and their main function is to filter the blood. All of the blood in the body passes through the kidneys multiple times each day, and the kidneys filter out excess water, salt and waste products. This creates urine, which then travels to the bladder for storage until urination. The kidneys also play a role in controlling blood pressure and making red blood cells.

Risk factors

The precise cause of RCC is unknown, but several established risk factors may increase the chance of getting this disease. Men are diagnosed with kidney cancer about twice as much as women, and African Americans have a higher rate of diagnosis than their Caucasian counterparts. Other risk factors include smoking, obesity, high blood pressure, dialysis treatment and family history, including Von Hippel-Lindau (VHL) syndrome and horseshoe kidneys.

Cigarette smoking increases the risk of developing RCC, and the risk increases the more people smoke and the longer they smoke. Obesity – or being very overweight – also increases a person’s risk of developing RCC, as does high blood pressure. Dialysis treatment increases the risk of RCC as well. Dialysis removes toxins from the bodies of people whose kidneys are not working—most often in people with advanced kidney disease.

Family history also plays a role in the risk of developing RCC. People who have a close family member – especially a brother or sister – who has RCC have a slightly increased risk of the disease. Inherited conditions can also raise the risk. VHL is a rare, inherited disease caused by a mutation in the VHL gene. People who have this mutation have an increased risk of RCC. Members of families in which VHL runs can have a test to see whether they are affected.

Horseshoe kidneys are another inherited condition that can raise the risk of RCC. Horseshoe kidneys affect about one in every 500 children. During fetal development, the kidneys fuse together at the base of the pelvic area to form a “U” shape – similar to a horseshoe – instead of developing normally. Cancerous tumors are a bit more likely to occur in horseshoe kidneys than in normal kidneys.

It is important to remember that many people who are diagnosed with RCC do not have any of these risk factors, and many people who have these risk factors never develop the disease.

Take control

If you have RCC, you can help yourself feel more in control by learning as much as you can about the specific characteristics of your subtype, your treatment options and ways you can help make yourself healthier, both physically and emotionally. Numerous survivors have credited a balance of regular exercise and plenty of rest to feeling better during and after RCC treatment. Healthy eating habits also help, as they can help people achieve – and maintain – a healthy weight. Spending time with family and friends, getting involved in support groups and/or participating in religion or spirituality are also credited by survivors as helping them thrive during treatment for RCC.

 

 

 

This content

This content is primarily for people who have RCC either as a new diagnosis or as a recurrence of a previous cancer. Family and friends of people with RCC can also gain insight and knowledge that will help them provide support to their loved ones.

In the pages that follow, you will find information about the diagnosis and staging of RCC, the treatment options for the disease and ways to manage the physical and emotional side effects that come along with it. You will also find information about financial considerations and support and advocacy groups, and throughout the guide you will be directed to additional websites to help you better understand RCC.

Table 2. RCC signs and symptoms

Lingering pain in the side, abdomen or lower back
A lump or mass in the side, abdomen or lower back
Blood in the urine
Sudden weight loss
Extreme fatigue
Fever
Anemia
An enlargement of the veins in the scrotum

 

Additional Resources

 

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