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Stage 4 Renal Cell Carcinoma: Treatment and Prognosis

Medically reviewed by Steven Kim, MD on December 14, 2015Written by Mary Ellen Ellis on February 19, 2014
doctor and patient with rcc

Renal cell carcinoma (RCC) is a type of cancer that affects the cells of the kidney. RCC is the most common type of kidney cancer. There are several risk factors for developing RCC, including:

  • a family history of the disease
  • smoking
  • obesity
  • polycystic kidney disease

The earlier it’s detected, the greater your chance for effective treatment.

RCC Staging

Doctors who diagnose and treat RCC and other types of cancer use a staging system. Each RCC patient’s cancer is given a number designation ranging from 1 to 4. 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 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.

Treatment Options

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


A radical nephrectomy may be performed. This involves surgically removing most or all of the affected 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. If surgery is not possible, tumor embolization may be used. This procedure cuts off the blood supply to the tumor, which helps to reduce symptoms.

Systemic Therapy

Once surgery has been performed to remove local tumors, many patients may need systemic therapy. This type of therapy 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 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.

Targeted Therapy

Targeted therapy for RCC means using drugs that specifically target cancer cells. Targeted drugs are desirable because they don’t 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 some stage 4 patients by a year or more. The treatment has proved promising enough that researchers continue to develop new immune-therapies.


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 aren’t targeted, however, so they kill healthy cells as well and produce a lot of side effects. RCC generally doesn’t respond to chemotherapy, but some patients do benefit from this type of treatment.

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. You can discuss current clinical trials with your doctor or specialists.

Palliative Care

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


The five-year survival rate for all stage 4 RCC patients is 8 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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