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Renal Cell Carcinoma - Kidney Cancer

Name  l  Define  l  Risk  l  Detect  l  Treatment  l  Stage/Grade  l  Followup  l  Mets/Recur  l  Link

Names - Synonyms

This kidney cancer may also be referred to using the names - carcinoma of renal cells, renal carcinoma, RCC, renal adenocarcinoma, hypernephroma, Grawitz tumor, nephrocarcinoma, and kidney cancer.  This cancer is considered statistically rare, but is seen more often than several rare variants described in literature.

Additional pages for Sarcomatoid, Chromophobe,

Definition

Renal cell carcinoma is a cancer of the kidney.  It occurs when the cells lining the renal tubule undergo cancerous changes.  This kidney cancer is further classified into 5 main subtypes - clear cell, papillary, chromophobe (solid, papillary, or sarcomatoid growth patterns), collecting duct (solid or sarcomatoid growth pattern), and unclassified (appearance does not fit into other subtypes).  

Risk Factors - Causes

Known risk factors that may increase your chances of acquiring include smoking, misuse of certain pain medications, kidney dialysis treatments, and genetic conditions, a family history of kidney cancer, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma. 

Detection

The most common symptom of renal cell carcinoma is blood in the urine.  This will show as a rusty, brown, or red color in your urine. Other symptoms include, a lump in the abdomen, a pain in the side that does not diminish, loss of kidney function, unexplained fever or high blood pressure, loss of appetite or weight, anemia, enlargement of a testicle (usually the left), or swelling in the ankles and legs. Constipation, vision problems, excessive hair growth in females, and cold intolerance may be signs of hormonal changes that occur as a result of kidney cancer. 

Tests that may be used to detect renal cell carcinoma include blood tests, physical exam, urine tests, imaging using IVP dye, ultrasound, CT scan, MRI, or surgical biopsy.

Treatment

Current treatment in renal cell cancer cures well over half the patients in stage I disease.  Surgical resection is the accepted, often curative therapy for stage I.  It may be simple or radical; partial or complete.  In patients who are not candidates for surgery, external radiation therapy or arterial embolization can provide palliative results.

Radical resection is the accepted therapy for stage II renal cell cancer.  External-beam irradiation has been given before or after nephrectomy without conclusive evidence that this improves survival compared with results of surgery alone.

Stage III renal cell carcinoma is treated with radical surgical resection.  This may be followed by external-beam irradiation.

Stage IV renal cell patients are normally considered incurable; although many treatments can be tried, including surgery, radiation, chemotherapy, and biologic therapies.  Immunotherapy has shown some benefit.  Medications such as alpha-interferon and interleukin-2 (IL-2) have been successful in reducing the growth of some renal cell carcinomas, including some with metastasis.

Stem cell transplantation for this cancer are being tested in clinical trials.  Other clinical trials may also be considered.

Stage - Grade.

The following is a list of the standard characteristics of renal cell carcinoma, based on grade:

Grade 1 - Grow and spread slowly.  Have a good prognosis.  Closely resembles normal kidney tissue.

Grade 2 - Grade 4 are defined based on nuclear size, irregularity and nuclear prominence, with prognosis deterioration at each grade level.

The following is a list of the standard characteristics that may be present:

Stage 1 - Tumor is 7 cm or less.  No metastases.

Stage 2 - Tumor is larger than 7 cm.  Confined to perirenal fascia.

Stage 3 - Metastases to a single nearby lymph node, or fatty tissue near the kidney.  Metastases in the veins from the kidney to the heart, without metastases to lymph nodes or organs.

Stage 4 - Metastases to more than one nearby lymph node; or to a remote lymph node; or other body site, such as lung, liver, brain, or bones; or through the fatty tissue and fascia. 

Suggested Followups

Most recurrences appear within 4 years, although they may occur decades after treatment.  Blood and urine tests may be done during a routine followup; along with chest x-ray and/or CT scan of abdomen, pelvis or chest.  MRI, bone scan, and ultrasound may also be used in certain cases.

Metastasis - Recurrence

Metastases most commonly occurs in lung, bone, upper abdomen, brain; less often in other body sites.  Treatment options for recurring and metastatic disease may include surgery, biologic therapy, chemotherapy, and radiation therapy.  IL-2 (Proleukin) is presently being used for the treatment of metastatic renal cell carcinoma. Studies have shown that IL-2 offers the possibility of a complete and long-lasting remission in some cases of RCC.  Clinical trials may also be considered by the patient.

Links

Renal Cell Carcinoma Rare Subtype Support Forums