Metastatic Renal Cell Carcinoma

Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults. It starts as one or more tumors in the kidneys. People with RCC may not have symptoms until the tumor grows or starts to spread. Renal cell carcinoma that metastasizes (spreads) to other areas of the body is known as metastatic renal cell carcinoma.

This type of cancer is also referred to as stage 4 kidney cancer. Around one-third of people with RCC have some level of metastasis when they first seek medical attention. Metastasized kidney cancer can be challenging to treat. However, there are treatment options available.

This article will explore the causes and risks of metastatic renal cell carcinoma. It will also discuss treatment options and hands-on coping strategies that can help you through this time.

Looking at diagnostic scans

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Metastatic Renal Cell Carcinoma: An Overview

Approximately 9 out of 10 people with kidney cancer have renal cell carcinoma. This condition is also referred to as renal cell cancer.

Renal cell carcinoma is typically asymptomatic in its early stages. Sometimes this disease is caught early through routine imaging exams. Fatigue, flank pain (pain on your side, between the ribs and hips), and hematuria (blood in the urine) may be the first symptoms you notice if you have this condition.

RCC usually begins as one tumor in one kidney. However, it’s possible to have multiple tumors in one kidney or tumors in both kidneys. Renal cell carcinoma has several subtypes, which are determined by how the cancer cells look under a microscope. The type you have may impact your treatment options.

Clear cell renal cell carcinoma is the most common form of this disease. Around 7 out of 10 people with RCC have this subtype.

Non-clear cell renal cell carcinomas are less common. This subtype is divided into additional categories. The most common forms of non-clear cell renal cell carcinomas are papillary RCC and chromophobe RCC.

What Is Renal Cell Cancer?

Your kidneys contain millions of tiny tubes, called renal (kidney) tubules. Renal cell carcinoma originates in the lining of one or more of these tubes.

The renal tubules transport necessary nutrients and fluids that have been filtered out of blood back into the bloodstream. The waste products that remain in the tubules turn into urine.

When cancer cells start to multiply and grow in these tubes, renal cell carcinoma results. This can clog or damage tubes, reducing or eliminating their ability to function over time.

If you have RCC that has metastasized (spread to distant areas of the body), the amount of spread, as well as your age and overall health, will impact your treatment and overall outlook.

In addition to RCC, there are other types of kidney cancer. Each type originates in a different location. They include:

  • Transitional cell carcinoma: This type of cancer begins in transitional cells, located in the lining of the renal pelvis. This is the part of the body where the ureter (which transports urine to the bladder) connects with the kidneys. It can also start in the ureter itself.
  • Renal sarcoma: This rare type of kidney cancer starts in the connective tissues or blood vessels of the kidneys.
  • Wilms' tumor: This childhood cancer starts in immature kidney cells that grow out of control.

Causes and Risks

RCC is more common in males than it is in females. It is most likely to be diagnosed in people aged 55–74. The most common risk factors for RCC are:

  • Use of tobacco products such as cigarettes:Higher risk in current smokers than in former smokers
  • Hypertension (high blood pressure) 
  • Obesity
  • Long-term or overuse of certain pain medications
  • Diagnosis of acquired cystic kidney disease (kidneys develop fluid-filled sacs)
  • Genetic conditions, such as von Hippel-Lindau disease (which results in abnormal blood vessel growth and tumors)
  • Family history of this disease

Having one or more risk factors does not mean you will get RCC. Why some people get it and others don’t is not completely understood.

How Renal Cell Carcinoma Is Diagnosed

Since early-stage disease is usually asymptomatic, RCC is often found during computed tomography (CT) scans ordered for unrelated symptoms. This may be why RCC is more commonly diagnosed in developed countries, where imaging tests are often used.

If your healthcare providers suspects that you have RCC or any type of kidney cancer, they will do a physical examination to look for flank pain. They will also feel for an abnormal mass in your abdomen. They’ll ask about your overall health and your family history of kidney cancer.

A urinalysis will be done to check for blood in urine, another common symptom. In addition, tests will be done to make a diagnosis and check for cancer spread. They may include:

  • Blood tests, including a blood chemistry test and complete blood count test (CBC)
  • Imaging tests such as a CT scan, magnetic resonance imaging (MRI), and ultrasound. Your CT scan or MRI may include an X-ray called an angiogram. This looks at blood flow in and around the kidneys
  • Collecting a tissue sample for lab analysis (biopsy) of the kidneys is not always needed for diagnosis but may be helpful when imaging tests don’t provide sufficient information to support surgery.

Renal Cell Carcinoma and Metastatic Disease

Like other types of cancer, renal cell carcinoma is categorized by stage. Metastatic renal cell carcinoma is stage 4. The stage of your disease will determine your prognosis and the type of treatments that may be most effective.

How Renal Cancer Stages Are Determined

After getting a diagnosis of renal cell cancer, additional Imaging tests will be done to determine the stage and level of metastasis. Your doctor will be looking to see if the cancer has spread to other parts of the kidney and other parts of the body. No matter where the cancer has spread, it will still be classified as RCC.

Tests may include:

  • Tissue biopsy (removing a sample of tissue to be tested in a lab) in area where spread is suspected
  • Bone scan to see if the cancer has spread to the bones
  • Chest X-ray or chest CT to check for spread to the lungs
  • MRI

How Cancer Spreads

Cancer can spread throughout the body via the lymphatic system, the blood, or grow into other tissues.

Lymphatic system: The lymphatic system contains a network of lymph vessels that carry fluid from the tissues back to the blood circulation, plus white blood cells such as lymphocytes that are active in the immune system and cells that clean up debris.

When cancer cells break off from a tumor, they can travel through the lymph system and settle into lymph nodes. The lymph nodes closest to the primary location are usually the first sites where the cancer cells form new tumors.

Blood: When cancer cells break off from a tumor, they can get into small blood vessels near the primary source. The cancer cells can then enter the bloodstream and circulate throughout the body.

Cancer cells that travel this way are called circulating tumor cells. When circulating tumor cells break through the wall of a blood vessel, they can penetrate the tissues of other organs.

Tissues: Cancer cells can spread from the primary tumor site into other tissues of the same organ or the tissues of other organs. There they can continue to grow and form a new tumor.

The Stages of Renal Cancer

Cancer stages provide information about how much cancer is in the body. The higher the stage, the more serious your cancer is.

Kidney cancer staging uses the American Joint Committee on Cancer’s TNM system, meaning:

  • T: Size and localized spread (near primary tumor) of the primary tumor
  • N: Spread to nearby lymph nodes
  • M: Metastasis to other areas of the body

Stage 1: This is the earliest stage. It has the highest five-year relative survival rate. The tumor is localized within the kidney and is smaller than 7 centimeters (cm). There is no spread to nearby lymph nodes (NO) or metastasis (MO).

Stage 2: The tumor is localized within the kidney but is larger than 7 cm in size. There is no spread to nearby lymph nodes or metastasis.

Stage 3: This stage of renal cancer is more aggressive. It meets one of two criteria: It has spread into a large vein such as the vena cava and nearby tissue, but not into nearby lymph nodes, or it is a tumor of any size that has spread outside of the kidney and into nearby lymph nodes.

Stage 4: This stage is the most aggressive and with the least optimistic prognosis. It meets one of two criteria: The main tumor is growing beyond Gerota’s facia and may have infiltrated the adrenal gland situated on top of the kidney, or it is a tumor of any size that has spread outside of the kidney to distant lymph nodes and/or other organs.

The relative five-year survival rate for kidney cancer is impacted upon by the stage and spread of cancer:

  • Localized (no spread outside of the kidney): 93%
  • Regional (cancer has spread to nearby lymph nodes or structures): 70%
  • Distant (cancer has metastasized to distant lymph nodes or other organs): 13%

It’s important to remember that these numbers are estimates and not written in stone. Many factors will impact your prognosis, including your overall health, age, and response to treatment.

What to Expect From Metastatic Renal Cell Carcinoma

If you have metastatic renal cell carcinoma, you can expect to have symptoms from your disease, and side effects from treatments. You may also deal with a rollercoaster ride of emotions.

How Will I Feel?

Physical symptoms include:

  • Blood in the urine (hematuria)
  • Anemia (low red blood cell count)
  • Flank pain
  • Low back pain
  • Nagging fever that won’t go away
  • Unexplained weight loss
  • Poor appetite

You may also experience emotional symptoms after receiving your diagnosis, such as:

  • Anger
  • Depression
  • Anxiety
  • Worry
  • Difficulty sleeping

Treatments for Metastatic Renal Cell Carcinoma

Treatment for metastatic renal cell carcinoma is determined by the extent and location of spread. You may require one or more types of treatment.

Surgery: Surgery is usually done during earlier stages, when cancer is still localized. However, a radical nephrectomy (removal of the entire kidney) may still be done during stage 4. Your surgeon may also remove lymph nodes near the kidney. Tumors that have spread may be surgically removed from other organs, such as the lungs.

Radiation: Radiation therapy may kill or slow down the growth of cancer in other organs. It is sometimes used instead of surgery for this purpose. It is also used as part of palliative care—to reduce pain in areas of the body where cancer has metastasized. Side effects from radiation include nausea, fatigue, and diarrhea.  

Immunotherapy: Immunotherapy may be tried on its own or combined with a targeted therapy drug as a primary treatment instead of surgery. Immunotherapy may also be used after surgery as an adjuvant treatment (done after another treatment to clear more cancer cells). Immunotherapy is also called biologic therapy.

It uses drugs such as immune checkpoint inhibitors to bolster your immune system so you can fight cancer more effectively. Immune checkpoint inhibitors enable immune cells to find and respond to cancer cells more aggressively.

Immunotherapy side effects vary based on the drugs used. Some side effects include rash, chills, pain, trouble breathing, and fatigue. Kidney damage and fluid in the lungs can also occur.

Targeted therapy: Targeted therapy is a form of precision medicine. Targeted therapy drugs block the proteins in cancer cells that control how they grow, divide, and spread.

Targeted therapy drugs can cause side effects that range from mild to serious, including diarrhea, weight loss, fainting, and fluid buildup in the legs or face. Liver problems, elevated blood sugar, and elevated cholesterol levels can also occur.

Chemotherapy: Kidney cancer cells don’t usually respond well to chemotherapy. Currently, no chemotherapy is endorsed by the National Comprehensive Cancer Network guidelines for the treatment of kidney cancer.

Coping With Metastatic RCC

Living with stage 4 cancer can be challenging at best. Taking care of yourself is of primary importance and may look differently for each individual.

Keep yourself informed about treatments and symptoms you can expect by scheduling time with your oncologist or other members of your cancer team. Ask as many questions as you need to. If necessary, bring someone with you to appointments to act as a second pair of ears.   

Getting enough rest can help you feel stronger and better able to face the challenges of each day. Relaxation techniques may help you sleep better, plus feel calmer during waking hours. Things to consider include yoga, meditation, and deep breathing exercises.

Exercise and physical activity can also support health, physical relaxation, and feelings of well-being. No need to turn into a gym rat if you’re not one already. Instead, find activities you enjoy, such as hiking, walking, and swimming.

Eating healthy food is an important aspect of self-care. Your doctor may recommend you eat or avoid certain foods. Foods that may not be recommended include those that cause fluid retention.  

You may have good days and bad days. When you’re able, stay social and active. Seeing people you care about can lift your spirits, plus be fun. Try not to isolate, even on the bad days. Take a moment to call a friend.

If you feel that therapeutic support will be beneficial, seek out a psychologist or therapist who specializes in working with people who have cancer. This may give you a much-needed pace to vent, as well as advice. Cancer Care has a staff of oncology social workers you may wish to contact.

Joining a patient support group may also provide input from others going through the same situation. You can find support groups through CanCare, the American Cancer Society, and other sources.

You may also feel empowered by joining an advocacy group, such as KidneyCan. If your head is spinning and you don’t know where to start, the Kidney Cancer Association has a patient navigation service that can help you identify local support services and answer questions.

Summary

Metastatic renal cell carcinoma is a form of kidney cancer that has spread to other sites and organs of the body. It is diagnosed by imaging tests. A biopsy can also determine the type of cancer. Treatment will vary based on the extent of spread and other factors but may include surgery, radiation therapy, immunotherapy, or targeted therapy.

A Word From Verywell

Metastatic renal cell carcinoma can be a challenging diagnosis, and a hard one to get. Even so, you are more than just your cancer. Survival rates have improved for this diagnosis, and new treatments support a better quality of life than in decades past. No, it won’t be easy. But, a good life with metastatic RCC is possible.

 

Frequently Asked Questions

  • How long can you live with metastatic kidney cancer?

    Your level of metastasis and your response to treatment both play a role in how long you can expect to live after diagnosis. Other factors that have an impact include your age and overall health.

  • What is the prognosis for stage 4 renal cell carcinoma?

    The five-year relative survival rate for metastatic kidney cancer is around 13%. This means that people with metastatic RCC are around 13% as likely as people without it to live for at least five years.


  • Where does renal cell carcinoma typically metastasize to?

    Common sites include the lungs, lymph nodes, bones, liver, adrenal glands, and brain.

  • Can metastatic renal cell carcinoma be cured?

    Currently there is no cure for this condition.

 

 

 

 

 

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