Renal cell carcinoma

Definition

Renal cell carcinoma is a type of kidney cancer in which the cancerous cells are found 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.

Risk factors include:

• Dialysis treatment
• Family history of the disease
• Genetics
• Smoking
• Von Hippel-Lindau disease (a hereditary disease that affects the capillaries of the brain, eyes, and other body parts)

Symptoms

• Abdominal pain
• Abnormal urine color (dark, rusty, or brown)
• Back pain
• Blood in the urine
• Emaciated, thin, malnourished appearance
• Enlargement of the veins around a testicle (varicocele)
• Flank pain
• Swelling or enlargement of the abdomen
• Unintentional weight loss of more than 5% of body weight

Other symptoms that can occur with this disease:

• Constipation
• Cold intolerance
• Excessive hair growth in females
• Paleness
• Vision abnormalities

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.

Signs and tests

Pressing with the fingers (palpation) on the abdomen may show a mass or organ enlargement, particularly of the kidney or liver. Men may have a varicocele in the scrotum (a varicocele that is only on the right side is especially suspicious).

Tests include:

• Abdominal CT scan
• Complete blood count (CBC)
• Intravenous pyelogram (IVP)
• Liver function tests
• Renal arteriography
• Serum calcium
• Ultrasound of the abdomen and kidney
• Urine cytology
• Urine test (urinalysis)

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

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

Treatment

Surgical removal of all or part of the kidney (nephrectomy) is recommended. This may include removing the bladder or surrounding tissues or lymph nodes.

Radiation therapy does not usually work for renal cell carcinoma so it is not often used. Hormone treatments may reduce the growth of the tumor in some cases.

Chemotherapy is generally not effective for treating renal cell carcinoma. The drug interleukin-2 (IL-2) is effective in a small percentage of patients, but it is very toxic. Other chemotherapy drugs have been used, but patients generally do not live long once the disease has spead outside the kidney.

Newer therapies include sorafenib (Nexavar), sunitinib (Sutent), and temsirolimus (Torisel). The biologic drug bevacizumab (Avastin) has also been used.

A cure is unlikely unless all of the cancer is removed with surgery.

Support Groups

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

Expectations (prognosis)

The outcome depends on how much the cancer has spread and how well it responds to treatment. 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)
• High calcium level
• High red blood cell count
• Liver function abnormalities
• 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.

References

Barjorin D. Tumors of the kidney, bladder, ureters, and renal pelvis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 2007.

National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Kidney Cancer. V.1.2009. National Comprehensive Cancer Network; 2009.