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Kidney cancer (Renal Cell Carcinoma (RCC))

Renal cell carcinoma (RCC) is a type of carcinoma (cancer arising from the tissues that line organs) that develops in the kidneys. More specifically, it develops in the renal cells that line the tubules in the kidneys. It is the most common form of kidney cancer, followed by urothelial carcinoma/transitional cell carcinoma (TCC) and nephroblastoma (Wilms tumour). 

The kidneys are a pair of bean-shaped organs that sit in the middle of your back on each side of your spine. It is responsible for filtering excess water and waste products from the blood, and converting them into urine to be removed from the body. The kidneys also produce and secrete certain hormones that regulate blood pressure and initiate the production of red blood cells. 

RCC is most commonly diagnosed in men, and is usually diagnosed in people over 50 years old. However, this disease can develop in anyone.

Types of Renal Cell Carcinoma

There are several types of RCC, that are classified by their histological appearance (how the cells look under the microscope). All types generally have the same risk factors, diagnostic tests, and treatment options.

Clear Cell Renal Cell Carcinoma (ccRCC)

This is the most common form of RCC, and is named for the appearance of clear or empty-looking cells. ccRCC is most commonly diagnosed in adults, however, children can also develop this disease.

Papillary Renal Cell Carcinoma (PRCC)

PRCC is the second most common type of RCC, and is characterised by renal cells arranged in finger-like structures. There are two types of PRCC, which are classified by growth rate. Type I PRCC is more common, and tends to grow slowly, while type II tends to be more aggressive and grows quicker.

Chromophobe Renal Cell Carcinoma (ChRCC)

ChRCC is a rare form of RCC, and is characterised by large and pale renal cells. It tends to be less aggressive than other forms of RCC, and usually has a better prognosis.

Other forms of RCC

Other types of RCC are very rare, and include:

  • Renal medullary carcinoma, which stems from the innermost portion of the kidney (renal medulla).
  • Collecting duct carcinoma, which stems from the end part of the kidney (collecting ducts), which connects the kidneys to the ureters and bladder. 
  • MiT family translocation RCC, which is a genetic form of RCC stemming from mutations in TFE3 and TFEB genes.
  • Sarcomatoid RCC, which is a more aggressive form of RCC and is usually difficult to treat.
  • Other very rare forms.

Treatment

If RCC is detected, it will be staged and graded based on size, metastasis (whether the cancer has spread to other parts of the body) and how the cancer cells look under the microscope. Staging and grading helps your doctors determine the best treatment for you.

Cancers can be staged using the TNM staging system:

  • T (tumour) indicates the size and depth of the tumour.
  • N (nodes) indicates whether the cancer has spread to nearby lymph nodes.
  • M (metastasis) indicates whether the cancer has spread to other parts of the body.

This system can also be used in combination with a numerical value, from stage 0-IV:

  • Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissue.
  • Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
  • Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localised cancer.
  • Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
  • Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advanced or metastatic cancer.

Cancers can also be graded based on the rate of growth and how likely they are to spread:

  • Grade I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
  • Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour. 
  • Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour. 

Once your tumour has been staged and graded, your doctor may recommend genetic testing, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you. 

Treatment is dependent on several factors, including location, stage of disease and overall health. 

Treatment options for patients with renal cell carcinoma may include:

  • Surgery, potentially including:
    • Partial nephrectomy (removing the tumour and some surrounding tissue).
    • Simple nephrectomy (removal of the whole kidney).
    • Radical nephrectomy (removal of the kidney, the adrenal gland that sits on top of the kidney, and nearby tissues and lymph nodes). 
    • Lymph node dissection (removal of lymph nodes).
  • Radiation therapy, potentially including stereotactic body radiation therapy (SBRT).
  • Cryotherapy.
  • Watch and wait.
  • Clinical trials.
  • Palliative care.

For more information on the treatment options, please refer to the Rare Cancers Australia Treatment Options page.

Risk factors

While the exact cause of RCC is unknown, the following factors have been linked to the potential development of this disease:

  • Smoking (past or present usage).
  • Misuse of pain medications over a long period of time.
  • Obesity/being overweight.
  • Having high blood pressure.
  • Having a family history of RCC or other kidney cancers.
  • Having genetic conditions such as von Hippel-Lindau disease or PRCC.

Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.

Early symptoms

The symptoms of an RCC include:

  • Blood in the urine.
  • Pain/dull ache in the side or lower back.
  • Unexplained weight loss.
  • Fatigue.
  • Fever.
  • A lump in the kidney region.

Not everyone with the symptoms above will have cancer but see your general practitioner (GP) if you are concerned.

Diagnosis/diagnosing

If your doctor suspects you have a RCC, they will order a range of diagnostic tests to confirm the diagnosis, and refer you to a specialist for treatment,

Physical examination

Your doctor will collect your overall medical history, as well as your current symptoms. Following this, they may examine your body to check for any abnormalities.

Urine & blood tests

Urine and blood tests are used to assess overall health and detect any abnormalities. Some of these tests may include:

  • General blood test to assess overall health.
  • Full blood count, which measure the levels of red blood cells, white blood cells and platelets.
  • Blood chemistry and/or blood hormone studies, which analyse the levels of certain hormones and other substances in the blood.
  • Urinalysis, which analyses the colour of your urine and its contents (e.g., sugar, protein, red and/or white blood cells etc.). 

Imaging tests

The doctor will take images of your body using magnetic resonance imaging (MRI), a computed tomography scan (CT scan), ultrasound, radioisotope bone scan and/or positron emission tomography (PET scan), depending on where it is suspected the cancer is. The doctor may also look at other parts of the body and look for signs of metastasis. 

Exploratory procedures & biopsy 

You may require an exploratory procedure if you have blood in your urine, or if the imaging scans were inconclusive. Some of these procedures include a cystoscopy (an examination of the bladder), ureteroscopy (examination of the ureters) and ureterorenoscopy (examination of the kidneys). In all procedures, thin tube with a light and a camera is inserted through the genital tract to examine these areas and detect any abnormalities.

Once the location(s) of the cancer has been identified, the doctor will perform a biopsy to remove a section of tissue using a needle. The tissue sample will then be analysed for cancer cells. This can be done by a fine needle aspiration (FNA) or a core needle biopsy (CNB). 

Prognosis (Certain factors affect the prognosis and treatment options)

While it is not possible to predict the exact course of the disease, your doctor may be able to give you a general idea based on the rate and depth of tumour growth, susceptibility to treatment, age, overall fitness, and medical history. Generally, early-stage RCCs have a better prognosis and survival rates. However, if the cancer is advanced and has spread, the prognosis may not be as good and there may be a higher risk of cancer recurrence. It is very important to discuss your individual circumstances with your doctor to better understand your prognosis. 

References

Some references are to overseas websites. There may be references to drugs and clinical trials that are not available here in Australia.