Stage 4 Renal Cell Carcinoma: Treatment and Prognosis

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  • What Is Renal Cell Carcinoma?

    What Is Renal Cell Carcinoma?

    Renal cell carcinoma (RCC) is a type of cancer that affects the cells of the kidney. Among all types of kidney cancer, RCC is the most common. There are several risk factors for developing RCC, including: a family history, smoking, and having polycystic kidney disease. As with all types of cancer, the earlier it’s detected, the greater your chance for effective treatment.

    Click through the slideshow to learn about this type of cancer.

  • RCC Staging

    RCC Staging

    Doctors who diagnose and treat RCC and other types of cancer use a staging system.  Each patient’s cancer is given a number designation ranging from one to four. Stage 1 is the earliest stage of the disease, and 4 is the latest and most advanced.

    Staging for RCC is based on:

    • the size of the primary tumor in the kidney
    • the spread of cancerous cells from the primary tumor to nearby tissues
    • the degree of metastasis
    • the spread of the cancer to other organs in the body
  • Stage 4 RCC

    Stage 4 RCC

    Stage 4 RCC can include two different combinations of staging criteria. The first is when the primary tumor is large and has spread throughout the kidney and into nearby tissues. In this instance, the cancer cells may or may not have spread into other organs in the body.

    The other possibility for classifying RCC as stage 4 is when the cancer has metastasized and is present in distant organs. In this case, the primary tumor may be of any size and there may or may not be any cancer in the tissues immediately surrounding the kidney.

  • Surgery


    Although stage 4 RCC is classified as an advanced stage of cancer, there are still treatment options available, including surgery.

    A radical nephrectomy may be performed. This involves moving most or all of a kidney. Surgical removal of other tumors may be needed for patients with metastatic cancer.

    A team of specialists will decide whether the metastasized tumors can be removed without too much risk to the patient.

  • Systemic Therapy

    Systemic Therapy

    Surgery to remove tumors is considered local therapy. It targets cancer in specific locations only. Once surgery has been performed to remove local tumors, many patients may need systemic therapy, which treats cancer throughout the body. This can help to reduce cancer recurrences. Systemic therapy for stage 4 RCC includes immunotherapy, targeted therapy, and chemotherapy.

  • Immunotherapy


    Immunotherapy is a treatment technique that aims to stimulate the immune system to attack cancer cells. Not everyone with RCC responds well to immunotherapy and side effects can be serious. Only about 15 percent of patients see anti-cancer effects from immune-boosting drug treatment.

    Despite the low numbers, the treatment does help some people, and it proves promising enough that researchers continue to develop new immune-therapies.

  • Targeted Therapy

    Targeted Therapy

    Targeted therapy for RCC means using drugs that specifically target cancer cells. Targeted drugs are desirable because they do not harm or kill healthy cells in the body. There are several targeted medications for stage 4 RCC.

    They work by targeting a protein called vascular endothelial growth factor, which stimulates the growth of cancer cells. The development of these targeted drugs has helped extend the lives of stage 4 patients by a year or more.

  • Chemotherapy


    Chemotherapy is a traditional treatment method for several different types of cancers. It involves using a drug or combination of drugs to kill cancer cells. Chemotherapy drugs are not targeted, however, so they kill healthy cells as well and produce a lot of side effects. RCC generally resists chemotherapy, but some patients do benefit from this type of treatment.

  • Clinical Trials

    Clinical Trials

    Another option for patients with stage 4 RCC is to become involved in clinical trials. Clinical trials are research trials for testing new drugs and treatments, which may be risky.

    The survival rate for patients with stage 4 cancer is low, so entry into these trials is usually possible. Patients can discuss current clinical trials with their doctors or specialists.

  • Palliative Care

    Palliative Care

    If all treatment options have been exhausted and have been ineffective, or if the patient is ineligible for treatment, palliative care may be initiated. This involves making sure the patient is as comfortable and as pain-free as possible.

    If surgery is not possible for a stage 4 RCC, tumor embolization may be used. This procedure cuts off the blood supply to the kidney tumor, which helps to reduce symptoms.

  • Outlook for Stage 4 Patients

    Outlook for Stage 4 Patients

    The five-year survival rate for all stage 4 RCC patients is eight percent. However, different scenarios may result in higher survival rates. Patients who are able to have surgery to remove metastatic tumors have better survival rates, and many who are treated with targeted drugs survive longer.


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●     Renal cell carcinoma. (2013, August). Cleveland Clinic. Retrieved January 28, 2014, from

●     Stage IV renal cancer. (2013). University of New Mexico Cancer Center. Retrieved January 28, 2014, from

●     Survival rates for kidney cancer by TNM stage (2013, January 23). American Cancer Society. Retrieved January 28, 2014, from

●     Treatment choices by stage for kidney cancer (2013, January 18). American Cancer Society. Retrieved January 28, 2014, from