Renal Cell Cancer

Renal cell cancer (RCC) is cancer or a mass that grows in the meat of the kidney. It is more common than cancer of the renal pelvis, the part of the kidney that collects the urine. Affecting about 32,000 Americans each year, this cancer usually responds well to treatment when caught early.

Risk Factors

The more common risk factors associated with RCC are:
  • Smoking
  • Age, sex and race - being older than 60, male or African American puts you at higher risk
  • Obesity
  • High blood pressure
  • Exposure to substances such as asbestos or certain inks and paints
  • Family history
  • Long term hemodialysis
  • Certain genetic disorders such as Von Hippel-Lindau disease

Symptoms

Early RCC often has no symptoms and may be found by chance during a CT scan or ultrasound that is performed for other reasons. The symptoms of more advanced RCC are:
  • Blood in your urine (hematuria) - the most common sign
  • Mass or lump in your abdominal area
  • Fever
  • High blood pressure - seen in some rare kidney cancers
  • Pain in your side, flank or lower back
  • Swelling in your legs and ankles
  • Late symptoms include anemia (low blood count), persistent fatigue and rapid weight loss

Diagnosis

Following a thorough history and physical examination, your doctor may order additional imaging and lab tests, including:
  • CT Scan, MRI or ultrasound
  • Urinalysis
  • Blood tests
  • Intravenous pyelogram (IVP) - an X-ray with dye to look at the structure of the kidneys, ureters and bladder
  • X-ray or bone scan - to determine if cancer has spread to the lungs or bones
  • Needle biopsy of the mass in rare circumstances

Staging

Your cancer will be assigned to one of four stages that describe how advanced and how aggressive the cancer is. Earlier stages have a better prognosis.
  • Stage 1 - the tumor is less than or equal to 7 centimeters and confined to the kidney
  • Stage 2 - the tumor is larger than 7 centimeters but still confined to the kidney
  • Stage 3 - the tumor has spread to nearby lymph nodes or tissues
  • Stage 4 - the tumor has spread more extensively (liver, lungs, bone and/or brain)

Treatment

Treatment will depend on a number of factors, including your age and overall health, and the extent to which the cancer has spread. When appropriate, your urologist will collaborate with other specialized doctors to provide one or more of the following:
  • Surgery - the standard treatment for RCC. The following procedures often can be performed laparoscopically, where several small incisions replace one larger one to permit less pain and faster recovery.
    Simple nephrectomy - removing the whole kidney
    Radical nephrectomy - total removal of the kidney, nearby adrenal gland and lymph nodes
    Partial nephrectomy - studies have shown that this approach, removing only the cancerous part of the kidney, can be just as effective as a radical nephrectomy for many patients with early stage RCC
  • Cryosurgery - freezing cancer cells to destroy them, often done with laparoscopy
  • Radiofrequency ablation - using heat to destroy cancer cells
  • Radiation therapy - using high energy X-rays to destroy cancer cells and shrink tumors; usually used to reduce pain if cancer has spread to your bones
  • Biologic therapy - using substances to boost the immune system and fight cancer
  • Chemotherapy - using medications to treat cancer cells that have spread throughout the body

Follow-Up

Since RCC may recur, your urologist may recommend follow-up care at three to six month intervals.