Renal cell carcinoma

Definition

Renal cell carcinoma is a type of kidney cancer that starts in the lining of very small tubes (tubules) in the kidney.

Alternative Names

Renal cancer; Kidney cancer; Hypernephroma; Adenocarcinoma of renal cells; Cancer - kidney

Causes, incidence, and risk factors

Renal cell carcinoma is the most common type of kidney cancer in adults. It occurs most often in men ages 50 - 70.

The exact cause is unknown.

The following may increase your risk of kidney cancer:

• Dialysis treatment
• Family history of the disease
• High blood pressure
• Horseshoe kidney
• Polycystic kidney disease
• Smoking
• Von Hippel-Lindau disease (a hereditary disease that affects blood vessels in the brain, eyes, and other body parts)

Symptoms

• Abdominal pain and swelling
• Back pain
• Blood in the urine
• Swelling of the veins around a testicle (varicocele)
• Flank pain
• Weight loss

Other symptoms that can occur with this disease:

• Excessive hair growth in females
• Pale skin
• Vision problems

Signs and tests

The health care provider will perform a physical exam. This may reveal:

• Mass or swelling of the abdomen
• A varicocele in the male scrotum

Tests include:

• Abdominal CT scan
• Blood chemistry
• Complete blood count (CBC)
• Intravenous pyelogram (IVP)
• Liver function tests
• Renal arteriography
• Ultrasound of the abdomen and kidney
• Urine tests

The following tests may be done to see if the cancer has spread:

• Abdominal CT scan
• Abdominal MRI
• Bone scan
• Chest x-ray 
• Chest CT scan
• PET scan

Treatment

Surgery to remove of all or part of the kidney (nephrectomy) is 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.

Hormone treatments may may the tumor smaller in some cases.

Chemotherapy is generally not effective for treating kidney cancer. However, the drug interleukin-2 (IL-2) may help some patients. It is a very powerful drug that can have severe side effects.

Newer medicines to treat kidney cancer include:

• Sorafenib (Nexavar)
• Sunitinib (Sutent)
• Temsirolimus (Torisel)
• Bevacizumab (Avastin)

Radiation therapy usually does not work for kidney cancer. 

Support Groups

You can ease the stress of illness by joining a support group whose members share common experiences and problems.

See also:

• Cancer - support group
• Kidney disease - support group

Expectations (prognosis)

Sometimes both kidneys are involved. The cancer spreads easily, most often to the lungs and other organs. In about one-third of patients, the cancer has already spread (metastasized) at the time of diagnosis.

How well a patient does depends on how much the cancer has spread and how well treatment works. 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.

Complications

• High blood pressure (hypertension)
• Too much calcium in the blood
• High red blood cell count
• Liver problems
• Spread of the cancer

Calling your health care provider

Call your health care provider any time you see blood in the urine. Also call if you have any other symptoms of this disorder.

Prevention

Stop smoking. Follow your health care provider's recommendations in the treatment of kidney disorders, especially those that may require dialysis.

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References

Barjorin D. Tumors of the kidney, bladder, ureters, and renal pelvis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 2003.

National Comprehensive Cancer Network. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Kidney Cancer. 2012. Version 1.2012.