Renal Cell Carcinoma Prognosis

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When someone receives a kidney cancer diagnosis, their first question is often about prognosis and survival rates. Of course, this is understandable. Renal cell carcinoma (RCC) is a common type of kidney cancer that occurs mostly in older adults. There also are other types of kidney cancer in adults and children.

If you’ve gotten a renal cell carcinoma diagnosis, your prognosis will largely be determined by its stage and level of spread.

Images help doctor stage kidney cancer

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No matter what stage of kidney cancer you have, it’s important to remember that published survival rates are only estimates. They’re based on the experiences of people who have gone through the same type and stage of cancer you have.

Survival rates typically list the percentage of people who are alive five years after diagnosis. Since survival rates are based on the cases of people diagnosed at least five years ago, they don’t take current research and treatments into account. Nor do they account for individual differences in overall health and response to treatment.

For those reasons, it’s important to remember that your experience may differ, either positively or negatively, from published survival rates.     

This article will describe each type of kidney cancer. It will also discuss the diagnosis of renal cell carcinoma, and five-year survival rates you can use as a ballpark estimate. RCC can be challenging, so this article will provide tips and ideas that may help you cope.

Kidney Cancer Diagnosis

Kidney cancer doesn’t usually cause symptoms in its early stages. Very often, people find out they have this condition during routine imaging tests or treatments for some other condition. 

Certain risk factors may increase your chances of getting this diagnosis. Having risk factors or being part of specific demographic groups may make your doctor more likely to suspect kidney cancer, such as:

  • Age: Kidney cancer is most common in people aged 55–74.  
  • Ethnicity: Black American, Native Alaskan, and Native American men have the highest statistical risk for this disease.
  • Sex: Males are more likely to get kidney cancer than females. According to the Centers for Disease Control and Prevention (CDC), 41,000 men and 24,000 women get kidney cancer each year.

Other risk factors include:

  • Having high blood pressure
  • Being overweight or obese
  • Smoking cigarettes
  • Long-term use of analgesic pain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), including Advil or Motrin (ibuprofen) and aspirin, which reduce blood flow to the kidneys, increasing risk
  • Exposure to trichloroethylene (a chemical solvent used to clean metal) 

Symptoms of Kidney Cancer

As kidney cancer progresses, it may cause certain symptoms. You may or may not have one or more of these common symptoms:  

  • Blood in the urine (hematuria
  • Flank pain (pain along the side of your abdomen)
  • Lower back pain
  • A lump or swelling you can feel in your abdomen or kidneys
  • Recurrent or nagging fever
  • Reduced appetite
  • Unexplained weight loss 
  • Anemia (low numbers of red blood cells)
  • Fatigue
  • Feeling like something is blocking your bowels

How Kidney Cancer Is Diagnosed

There are several diagnostic tests used when kidney cancer is suspected. Testing helps identify each cancer stage and the extent of spread you have, if any.

As a start, your doctor will discuss your health history with you. If you have a family history of kidney cancer, let your doctor know. Also, tell them how you’ve been feeling. Many kidney cancer symptoms could be caused by other conditions. Even so, they will provide relevant information about a potential diagnosis.  

A physical exam will check for body pain and lumps in or around the kidneys. Your healthcare provider will also check for swollen lymph nodes and lumps or swelling in other areas of your body.

You’ll give a urine sample. A urinalysis will check for blood in your urine. In some instances, you may see blood when you urinate. However, it’s possible to have trace amounts of blood in the urine that are not visible.

You’ll give a blood sample. A blood chemistry test provides information about how well your kidneys, liver, and other organs are functioning. This test measures electrolytes (salts in the blood), glucose, fats, proteins, and enzymes (proteins that promote chemical reactions).

A complete blood count test will be done to measure and count red blood cells (that carry oxygen), white blood cells (that fight disease), and platelets (cells that promote clotting). This gives information about your overall health and helps confirm a diagnosis of a disorder or underlying condition.   

If the physical exam, urinalysis, or blood test indicates kidney cancer, imaging tests will be done. Imaging tests help identify tumors and areas of spread.  

A computed tomography (CT) scan is a detailed X-ray study that can provide specific information about the location, shape, and size of a tumor. It can also identify cancer metastasis (spread) to lymph nodes and other organs.

A magnetic resonance imaging (MRI) scan can show cancer spread into major blood vessels near the kidneys. These include the inferior vena cava. An MRI can also help identify cancer that has spread into the brain or spinal cord.

Angiography (X-ray imaging of blood flow) may be added to your CT scan or MRI. This test looks for signs of cancer in blood vessels that might nourish a kidney tumor, such as the renal artery.

An ultrasound (a type of imaging using sound waves) can help locate a kidney tumor and determine if it is solid or cystic (filled with fluid). Most kidney tumors are solid. An ultrasound may also help your doctor determine if a tumor is malignant (cancerous) or benign (noncancerous).  

Renal cancer that has spread often affects the lungs. A chest X-ray or chest CT can show if kidney cancer has spread to this area of the body.

The bones are another place where late-stage kidney cancer often spreads. A bone scan looks for evidence of kidney cancer in bones. It uses a small amount of radioactive tracer and an imaging camera to look for rapidly growing cells in the bones.

Kidney cancer is often diagnosed without a biopsy (taking a tissue sample and analyzing it in the lab). However, a biopsy may be done when imaging tests don’t provide enough information about your condition.

This test uses a needle to extract a small tissue sample in an area of the kidney where cancer is suspected. A biopsy may also be done on another organ or lymph nodes where spread is suspected.

Types of Kidney Cancer

There are several types and subtypes of kidney cancer. The location and kind of tumor determine which kind you have.

The main types of kidney cancer are renal cell carcinoma (RCC), transitional cell carcinoma (TCC), and Wilms' tumor. RCC and TCC affect older adults. Wilms' tumor occurs in children. RCC also has several subtypes that can impact treatment and prognosis.

Renal Cell Carcinoma

Renal cell carcinoma is the most common type of kidney cancer. Around 85% of all kidney cancer is this type. RCC occurs when cancer cells form and grow out of control in the lining of a renal tubule.

Your kidneys contain millions of renal tubules. These tubules are located in filtering units called nephrons. When blood enters the kidney, the nutrients it contains are separated from waste products by a filtering structure called the glomerulus.

After the blood has been filtered, the renal tubules transport much-needed nutrients and fluids back into the bloodstream. The tubules capture and remove waste products in the form of urine. Renal cell cancer can start out as one or more tumors in the renal tubules.

There are several subtypes of RCC. The type you have will be determined by how cancer cells look under a microscope. The three most common kinds are:

Clear cell renal cell carcinoma: Clear cell renal cell carcinoma accounts for around 70% of all cases of renal cell cancer. Clear cell carcinoma cells are pale or transparent when viewed under a microscope.

Papillary renal cell carcinoma: A form of non-clear cell renal cell carcinoma, it’s the second most common type. Up to 15% of all kidney cancers are papillary renal cell carcinomas. These tumors usually contain fingerlike formations called papillae. The cells sometimes look pink under a microscope.

When there is no metastasis, papillary renal cell carcinoma presents with a better prognosis than clear cell renal cell carcinoma.

Chromophobe renal cell carcinoma: This subtype is also a form of non-clear cell renal cell carcinoma. It accounts for around 5% of all kidney cancers. The cancer cells that cause this subtype are clear in color, but much larger in size than clear cell renal cell carcinomas.

Transitional Cell Carcinoma of the Kidney

Transitional cell carcinoma of the kidney is rare. It starts in the transitional cells located in the lining of the renal pelvis. Transitional cells stretch or change shape to accommodate the flow and storage of urine.

When the tumor is superficial and there is no spread, this type of cancer is curable in around 90% of patients. Deeply invasive tumors that remain confined to the renal pelvis have a cure rate of 10%–15%. Once metastasis has occurred, a cure is no longer possible. However, treatments may help reduce spread and prolong life.

Wilms' Tumor

Wilms' tumor is a common type of childhood cancer that starts in immature kidney cells. Children are often diagnosed with Wilms' tumor when a kidney mass becomes large and causes pain in the abdomen. Blood in urine and high blood pressure are other telltale symptoms.

There are different forms of this disease. The stage of the cancer and form of the disease will affect the prognosis. Long-term survival rates are excellent in most instances.

Wilms' tumor with anaplastic histology (cells dividing rapidly and looking different from healthy cells) is an aggressive form with a less-favorable prognosis.

Renal Sarcoma

Renal sarcoma is a rare form of kidney cancer in adults. It occurs in the blood vessels, fat, or connective tissue that surrounds the kidneys. Less than 1% of all kidney cancers are this type.

Renal sarcoma can be aggressive, and metastasis is common at the time of diagnosis. Once metastasis has occurred, the prognosis is generally poor. However, early diagnosis and aggressive treatment can provide better outcomes.

Kidney Cancer Stages

Kidney cancer has five stages. These stages indicate the amount of cancer you have throughout your body. The higher the stage, the more serious your condition is. Each stage has a different potential survival rate and prognosis.

How Kidney Cancer Stages Are Determined

Kidney cancer stage is determined through diagnostic testing. Usually, imaging tests will be done to analyze the tumor or tumors within the kidney.

Imaging tests will also be done to identify metastasis in other areas of the body, including the lungs, brain, and bones. These tests may include CT scans, MRIs, a bone scan, and a chest CT or X-ray. 

How Cancer Spreads

Cancer spreads through the body via these three paths:

  • Lymphatic system: This system returns excess fluid into circulation and includes lymph nodes where immune system cells cluster. Cancer cells that break off from the original tumor may travel through the thin-walled lymph vessels to other parts of the body. Renal cancer cells typically settle first in the lymph nodes closest to the kidney.
  • Bloodstream: Cancer cells can also break off from the primary tumor and infiltrate the bloodstream. These cells are referred to as circulating tumor cells. Circulating tumor cells can break through a blood vessel wall and enter the tissues of other organs.
  • Tissue: Cancer cells can spread into tissues surrounding the tumor and into the tissues of other organs.

The Stages of Kidney Cancer

Kidney cancer staging relies on the TNM system. This system was created by the American Joint Committee on Cancer:

  • T: Size and localized spread of the original tumor
  • N: How much spread has occurred in lymph nodes located near the original tumor
  • M: Metastasis outside of the kidney into other organs and distant lymph nodes

Stage 1: Stage 1 is the first stage of kidney cancer. When kidney cancer is found during stage 1, you’ll have the most optimistic five-year relative survival rate. A stage 1 tumor is smaller than 7 centimeters and has not spread outside of the kidney. There is no cancer in the lymph nodes and no metastasis.

Stage 2: In this stage, the tumor is larger than 7 centimeters, but still hasn’t spread outside of the kidney.

Stage 3: Stage 3 is a more aggressive cancer. In this stage, the tumor has either spread into a large vein and nearby tissue, or it is a tumor of any size that has spread outside of the kidney into lymph nodes located nearby.

Stage 4: Stage 4 renal cancer has the least favorable prognosis. Kidney cancer is stage 4 if the primary tumor has entered the adrenal gland, located on top of the kidney. Kidney cancer may also be considered stage 4 if it is a tumor of any size and has metastasized to other parts of the body, including distant lymph nodes or other organs.

Spread by Stage

Stages 1 and 2 tumors are considered localized. Stage 3 and some stage 4 cancers are considered regional. Most stage 4 cancers are considered metastatic/distant.

5-Year Survival Rates for Kidney Cancer

The relative five-year survival rates for renal cell carcinoma are determined by the amount of metastasis that has occurred:

  • Localized spread: Cancer hasn’t spread outside of the kidney, and five-year survival is 93%. 
  • Regional spread: Cancer has already spread to nearby lymph nodes or organs, and five-year survival is 70%.
  • Distant spread: Cancer has spread to distant areas of the body, such as the bones, lungs, or brain, and five-year survival is 13%.

Several factors can affect survival rates, and your prognosis can differ from these estimates. Starting treatment early can slow down or halt metastasis, significantly improving your chances for longer-term survival or cure.

Many people with kidney cancer survive for longer than five years. Ever-improving treatments, including targeted therapy and immunotherapy, have impacted favorably upon survival rates.

 Other factors also play a role. These include:

  • Your overall health and age
  • How well you respond to treatments
  • The type or subtype of kidney cancer you have
  • Whether or not your cancer recurs
  • Lifestyle factors, such as eliminating smoking

Coping With Kidney Cancer

Coping with kidney cancer isn’t easy. It’s important to remember that not every person with renal cell carcinoma has the same esponse to treatment.

Living with a diagnosis of kidney cancer can be highly stressful. Taking care of yourself can help you feel better physically and mentally. There’s even some evidence that proactive behaviors can support longevity, such as exercising and eating healthy foods.

Quitting smoking also can help. Smoking cigarettes is a leading risk factor for kidney cancer. Of course, it can be stressful trying to quit, especially if you feel that the damage has been done.

However, data indicates that stopping smoking improves survival rates in people with clear cell renal cell carcinoma. It also lowers your risk of getting and dying from another disease.  

Try to get enough sleep. Adequate rest can help you maintain your strength. You may need more sleep during cancer treatment while your body works to repair itself.

In your quest to support health, you may find yourself drawn to the supplements aisle of your drugstore. Talk to your doctor before taking supplements, even if they seem to be a health booster. Many supplements, just like analgesic pain medications, may harm your kidneys and shouldn’t be used.

Some people are more private than others, and it’s up to you how much you disclose to others about your condition. Talking to close friends and family can provide support and strength. It can also help to find other people who are going through the same thing.

Support groups, both online and in-person, may be a beneficial way to find new friends who know what you’re dealing with first-hand. You can find support groups through CanCare, the American Cancer Society, and other sources, such as your hospital or treatment care facility.

Summary

Most adult kidney cancers are renal cell carcinoma. They are often found at an advanced stage since the early stages have few symptoms. The prognosis for renal cell carcinoma depends on the subtype and whether it is localized or has spread regionally or distantly. Individual factors can make a difference in the longevity of any one person with this cancer.

A Word From Verywell

Renal cell carcinoma can be a scary diagnosis to get, especially if it’s progressed to later stages. Your symptoms and treatments may be best dealt with one day at a time. On some days, you may feel like you’ve got this beat. Other days may be harder to get through.

No matter what each day brings, remind yourself that the survival rates given for this disease are ballpark figures. Many people live and thrive well past average rates. Taking care of your physical and emotional health every day is proactive behavior that may help you feel better and live longer.

Frequently Asked Questions

  • Is kidney cancer aggressive?

    It can be, depending on stage. Kidney cancer becomes more aggressive as it progresses through each stage. Certain types, such as renal sarcoma, may also be more aggressive than other types.

  • Is kidney cancer a death sentence?

    No. When kidney cancer is caught early, it has a high survival rate.

  • Is kidney cancer curable?

    Some types of kidney cancer, such as early-stage Wilms' tumor, can be cured. However, cancer of any kind may recur. After getting a kidney cancer diagnosis you will need medical follow-up to look for signs of recurrence.

  • How fast does kidney cancer grow?

    This may depend upon the type of tumor or tumors you have. The growth rate of tumors can be hard to study, since most people start treatment upon diagnosis or shortly thereafter.

    Surveillance studies of small renal cancer tumors in elderly people showed that tumors grew around 0.3 centimeters (less than 1 inch) in one year.

 

 

 

 

 

 

 

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