An Overview of Renal Cell Carcinoma

Renal cell carcinoma is a type of kidney cancer. This type of cancer can produce a variety of symptoms, including pain, fatigue, and blood in the urine. Risk factors include smoking, toxin exposure, and a family history of renal cell cancer. 

The noticeable effects of renal cell carcinoma typically begin as the cancer reaches an advanced stage. You may need to have a number of diagnostic tests to identify the cause of your symptoms because renal cell carcinoma has such vague effects.

There are several approaches to treatment of renal cell carcinoma, including surgery, radiation, and chemotherapy.

Symptoms of Renal Cell Cancer

There are many different effects that can occur as the result of renal cell carcinoma. This cancer starts in the kidney, and it can also metastasize (spread) to other areas in the body. 

The first symptoms of renal cell carcinoma can vary. You may experience some of the effects, but you are unlikely to experience all of them.

Symptoms of renal cell carcinoma can include:

• Fatigue 
• Low energy
• Abdominal pain
• Flank pain (pain at your side, below your belly)
• Blood in the urine
• Abdominal swelling 
• Dizziness 
• Weight loss 
• Fevers 

Any of these symptoms can occur if your cancer is only in your kidney, and you can also expect to experience these effects if the cancer spreads.

Impaired Kidney Function

With renal cell carcinoma, your kidney function can be impaired. This may cause specific physical signs, including:

• Hypertension (high blood pressure) due to changes in renin level (a hormone produced by the kidneys)
• Erythrocytosis (high level of red blood cells) due to excessive production of erythropoietin (a hormone that is produced by the kidneys—it stimulates red blood cell production)
• Anemia (low red blood cells) due to low levels of erythropoietin 

Symptoms of Cancer Spread

Your renal cell cancer might not produce symptoms until it spreads outside your kidney—what's called metastatic renal cell cancer.

Your first symptoms may be caused by the effects of metastatic cancer in a different part of your body besides your kidney:

• Back pain can occur due to renal cell carcinoma metastasis to the spine 
• Breathing problems or feeling faint can occur due to the spread of renal cell carcinoma to the lungs or heart
• Headaches or weakness on one side of the body
• Behavioral changes, confusion, or seizures can occur if renal cell carcinoma spreads to the brain

Paraneoplastic Effects

Sometimes renal cell carcinoma can cause an effect described as paraneoplastic syndrome. This may occur if the tumor produces hormones or other substances that affect distant parts of the body.

For example, renal cell carcinoma can cause ataxia (a severe problem with balance) if the tumor produces immune cells that attack the cerebellum (the part of the brain that controls balance).

What Causes Renal Cell Cancer?

Renal cells are a type of cell in the kidneys. Renal cell carcinoma usually involves only one kidney, but it can affect both kidneys. The kidneys are organs that balance fluids and chemicals in the body. Your kidneys filter your blood to remove waste material. They produce urine, which contains the wastes that your body doesn’t need.

There are a number of risk factors associated with renal cell carcinoma. Smoking and exposure to toxic chemicals are considered the leading causes of this type of cancer. 

Obesity, hypertension, and diabetes are considered risk factors, although it isn’t completely clear why or how these conditions may lead to renal cell carcinoma.

Medications that are metabolized and detoxified in the kidneys, such as non-steroidal anti-inflammatory medications (NSAIDS) are also associated with renal carcinoma.

Toxin Exposure 

Experts suggest that certain chemicals are nephrotoxic—meaning they damage the kidneys. Chemicals such as industrial materials and pesticides can harm the kidneys.

When the kidneys become damaged, the renal cells may heal, but they can also undergo a cancerous transformation. It may take months of toxin exposure before renal cell carcinoma develops.

Genetics 

You may also have a genetic predisposition to developing renal cell carcinoma if you have a family history of kidney cancer. Another familial risk factor, von Hippel-Lindau disease, is a condition characterized by the development of tumors in organs throughout the body.

How Renal Cell Carcinoma Spreads 

Renal cell carcinoma can spread from the kidney to other areas of the body. It can enlarge within the kidney and grow into the adrenal glands, which are adjacent to the kidneys. Adrenal glands are small organs that make and release hormones. Each kidney has one adrenal gland located right above it.

Cancer cells can also enter into the bloodstream or the lymphatic vessels, spreading to other areas of the body. The cancer can then grow in other organs, such as the lungs, bones, or brain, causing serious harm to these areas. 

Diagnosis 

Often, renal cell carcinoma is identified on an imaging test. It can be seen before any symptoms occur (when a test is done for another medical reason). Additional testing, such as blood tests, a biopsy, or a search for metastatic lesions is usually needed.

If you have any of the symptoms of renal cell carcinoma, your medical team will evaluate them with a medical history, physical examination, and diagnostic tests. 

Your medical history will include questions about your symptoms, your smoking history, and environmental chemical exposures, as well as your medications and any other illnesses or conditions that you have.

Your physical examination will include an abdominal examination, which can identify tenderness or enlargement of your kidneys. Your medical team will check your blood pressure.

Blood Tests

The symptoms associated with renal cell cancer are vague, and they can also be signs of many different medical conditions. Your healthcare providers may order a complete blood count (CBC) or electrolyte levels. These tests often give your medical team an idea about your overall health. 

If you have anemia or erythrocytosis, your CBC will show an altered red blood cell count. If your kidneys are starting to fail, your electrolyte levels (such as calcium, phosphorus, or magnesium) may be altered.

Urine Test

A urinalysis (UA) test is a simple test that involves analysis of your urine. The fluid sample can be analyzed with a microscopic evaluation. Your medical team can assess your urine to see if there is blood, protein, or cancer cells—all of which are signs of renal cell cancer. 

Kidney failure may cause a change in the concentration of electrolytes in your urine. 

Additionally, other illnesses can be diagnosed with a UA. Diabetes often results in excess glucose in the urine. Kidney or bladder infections often cause an increase in white blood cells. The infectious organisms that cause these infections can often be identified in the urine as well.

Imaging

Imaging tests, such as X-ray, computerized tomography (CT), ultrasound, or magnetic resonance imaging (MRI) can be used to obtain a picture of your kidney. 

If there is a concern about metastatic cancer, your medical team may also obtain imaging tests to look at other areas of your body. A bone scan can be used to identify lesions in the bones. 

Often, imaging tests can differentiate between cancer and other conditions, such as infections, traumatic injuries, cysts, and inflammation. When there is uncertainty about the lesion, or whenever more detailed information is needed, a biopsy may be the next step. 

Biopsy 

You may need to have a biopsy of your kidney. This is an interventional surgical procedure in which your healthcare providers would take a sample of kidney tissue (usually with a very thin needle) so that it can be examined under a microscope.

With a biopsy, your healthcare providers can evaluate whether a growth in your kidneys is an infection, an inflammatory lesion, or cancer. A biopsy can also determine the type of cancer and the aggressiveness of the cancer (often described as cancer grade). Identifying your disease and type of cancer under a microscope is very important in planning the right medical treatment.

If there is a concern that your cancer may have spread, you may also need to have a biopsy of nearby lymph nodes or other areas in the body, such as your lungs. 

Staging and Grading 

Your tumor will be given a stage and a grade. These designations are used to help your medical team with planning your treatment. Tumor grading is a description of how aggressive the tumor is and how quickly it is expected to grow and spread.

Grading is based on a combination of factors, including the microscopic appearance of the tumor, and its size and location. The tumor stage describes how far the tumor has grown or spread in the body. 

Treatment 

There are a number of treatments used for renal cell carcinoma. These include having the tumor surgically removed, radiation therapy to shrink the tumor, and therapies such as chemotherapy, immunologic therapy, and/or targeted therapy to kill tumor cells.

Additionally, you receive symptomatic treatment that helps relieve the effects of your tumor. 

Surgery 

You may need to have your tumor removed from your kidney or have your whole kidney removed. Surgery may also be used to remove metastatic lesions from elsewhere in your body.

There are several types of kidney surgery used for removal of renal cell carcinoma:

• Partial nephrectomy: With this procedure, the part of your kidney that contains the tumor must be removed.
• Simple nephrectomy: This is removing your whole kidney.
• Radical nephrectomy: You may need to have your whole kidney removed, along with surrounding structures, such as lymph nodes, blood vessels, and/or and the adrenal gland.

Dialysis is a procedure that involves filtration of your blood so that waste material can be removed from your body. If your kidneys are absent or are not functional, you would need to have dialysis several times per week.

Radiation 

Radiation therapy is a treatment that uses powerful rays to destroy tumor cells. You can have radiation directed towards the cancer in your kidneys and/or towards metastatic lesions in other areas of your body.

Depending on your situation, you might have radiation therapy before or after surgical resection of your tumor.

Chemotherapy, Immunologic Therapy, Targeted Therapy 

Medications approved for treatment of renal cell carcinoma include:

• Chemotherapy: Destroys actively growing cells
• Immune therapy: Uses a process that triggers your immune system to destroy tumor cells
• Targeted therapy: A type of therapy that specifically destroys the tumor cells.

Keytruda (pembrolizumab) is a monoclonal antibody that is given along with other targeted therapies such as Inlyta (axitinib) or Lenvima (lenvatinib) to treat renal cell carcinoma.

Keytruda is approved for the adjuvant treatment of adults with renal cell carcinoma at risk of recurrence after nephrectomy or following nephrectomy and resection of metastatic lesions. Adjuvant therapies help keep cancer from returning.

All of these medications are powerful, and they may produce serious side effects during your treatment and recovery.

Symptomatic Treatment 

In addition to treatments that are aimed at shrinking or removing your tumor, you may also require medical care to alleviate the effects of the tumor. For example, you may receive a blood transfusion if your red blood cells are extremely low.

You may be given anti-hypertensive medication to manage your blood pressure. And, if you have lost weight due to your cancer, you may need treatment to help increase your appetite. Your healthcare provider may also prescribe vitamins, minerals, proteins, or other supplements to help maintain your body’s nutritional needs. 

A Word From Verywell

Renal cell carcinoma can be asymptomatic (without symptoms) until a late stage. If you are diagnosed with this type of cancer at a late stage, you may need extensive treatment, but you can still have a good outcome. 

If you are diagnosed with renal cell carcinoma at an early stage, you may require long term monitoring after your cancer treatment to identify any tumor recurrence. Because there are several known risk factors of renal cell carcinoma that are related to lifestyle habits—such as smoking, obesity, and toxin exposure—it is especially important that you avoid these risks if you have a family history of renal cell carcinoma.