Renal Cell Carcinoma

What is renal cell carcinoma?

The kidneys are bean-shaped, fist-sized organs whose main role is to filter the blood and remove waste and excess liquid and salt from the body. The thin, long channels (tubules) of the kidneys are important to help filter out waste and to help the body reabsorb certain substances.

Cancer in the lining of these tubules is called renal cell carcinoma and is the most common type of kidney cancer. It often starts as a tumor in one kidney that can or has spread to the other kidney or other parts of the body, such as the lungs or lymph nodes.

These are the two most common types of renal cell carcinoma in adults:

• Clear cell renal cell carcinoma, which accounts for 80% of all renal cell carcinomas
• Papillary renal cell carcinoma, which accounts for 10% to 15% of all renal cell carcinomas

In children, papillary renal cell carcinomas and translocation-associated renal cell carcinomas are most common.

Several other very rare forms of renal cell carcinoma exist. The type of disease a person has is determined by how its cells look under a microscope. The type of renal cell carcinoma will help doctors decide the course of treatment.

How common is renal cell carcinoma?

Renal cell carcinoma accounts for almost all kidney cancers.

• Renal cell carcinoma accounts for about 8% of all malignant (cancerous) tumors of the kidney. It most commonly occurs in teens and young adults. In adults, there are about 64,000 new cases each year.
• Renal cell carcinoma is rare in children younger than 15. In teens ages 15 to 19, renal cell carcinomas represent two-thirds of all kidney cancers.

What are the signs and symptoms of renal cell carcinoma?

Renal cell carcinoma usually appears as blood in the urine along with these symptoms:

• Unexplained pain in the abdomen or back that does not go away
• A mass or lump in the abdomen or back
• Fatigue (feeling overly tired)
• Unexplained or rapid weight loss
• Fever

Less commonly, some people with renal cell carcinoma have these symptoms:

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

Sometimes renal cell carcinoma is not found early because there may be no noticeable symptoms at first.

How is renal cell carcinoma treated?

Like many of the tumors that can invade the kidneys, renal cell carcinoma is usually treated with surgery. This is often the best way to keep these growths from affecting kidney health and function.

A surgeon may remove just the cancerous tissue or some of the kidney or the entire kidney (nephrectomy). Fortunately, most people can live healthy lives with one kidney or even most of one kidney.

Body-wide treatments on their own do not work as well as surgery. Even so, a treatment team might prescribe them along with surgery to kill any cancer cells left behind after surgery. These treatment options include:

• Chemotherapy (“chemo”)—uses cancer-killing drugs that are given either by mouth or by vein. These drugs are toxic to all living cells (not just the cancerous ones), so they can temporarily weaken the body. Side effects can include fatigue, hair loss, appetite loss, nausea, mouth sores and infection.
• Radiation—uses high-energy light particles, such as X-rays or gamma rays, to destroy the cancer. While radiation is not the most effective treatment for renal cell carcinoma, doctors sometimes use it to ease symptoms in other areas of the body where the cancer has spread.

For people who cannot have or do not choose surgery, treatment options include the following:

• Watchful waiting. If a tumor is small, a doctor may choose to watch it and hold off on any treatment until the cancer grows or spreads (metastasizes).
• Ablation. A needle is inserted through the skin into the kidney tumor. The needle contains either a gas to freeze the cancer cells or an electrical current to burn the cancer cells. Ablation is usually used for people with renal cell carcinoma who have small tumors or who cannot tolerate other treatments.
• Immunotherapy (biologic therapy). These drugs, which include interleukin and interferon alfa, boost the immune system to help the body ward off the cancer cells. Because its side effects can be severe and even life-threatening, immunotherapy is often used as a last resort for people with advanced renal cell carcinoma.
• Targeted therapy. Various agents that target blood vessels such as axitinib, pazopanib, sorafenib and sunitinib, as well as mTOR inhibitors are available. mTOR inhibitors might be preferred over other agents in patients with non-clear cell histology.

The stage of the cancer will help doctors decide the best treatment. Other treatment factors include overall health, symptom relief and side effects.

What are the survival rates for renal cell carcinoma?

When a person is found to have renal cell carcinoma, the cancer will be staged. Staging includes how big the tumor is and how much the malignant cells have spread. The higher the stage of the tumor, the further along the cancer is.

Five-year survival rates for children with renal cell carcinoma are as follows:

• Stage I: 90%
• Stage II: 80%
• Stage III: 70%
• Stage IV: 15%

About 63% of all kidney cancers are caught in the early stages.

Why choose St. Jude for your child’s renal cell carcinoma?

• St. Jude is the only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children.
• St. Jude has created more clinical trials for cancer than any other children’s hospital in the United States.
• The nurse-to-patient ratio at St. Jude is unmatched— averaging 1:3 in hematology and oncology and 1:1 in the Intensive Care Unit.
• Your child will have access to a close-knit team of specialists that includes: surgeons; doctors and nurses who treat this cancer; doctors who specialize in radiation therapy, in hormones (endocrinologists), and in diagnosis (pathologists); experts in diagnostic imaging and nuclear medicine; dietitians; speech therapists; rehabilitation specialists (physical therapists, occupational therapists); child life specialists; psychologists; Quality of Life team members; experts who help manage and minimize the long-term or late effects of treatment; researchers; scientists; and many others.
• The medical team works closely with laboratory researchers to bring new treatments from the laboratory to the clinic.