What Is Stage 4 Renal Cell Carcinoma?

In stage 4 renal cell carcinoma, cancer cells have spread from the kidneys into other areas of the body. Treatment is possible but more difficult than for earlier stages of renal cell carcinoma. This article will provide an overview of stage 4 renal cell carcinoma and the treatment options. 

Types of Renal Cell Carcinoma

The different types of renal cell carcinoma include:

• Clear cell renal cell carcinoma: This is the most common subtype of renal cell carcinoma and makes up about 70% of all cases. Under a microscope, these cells appear pale or clear. 
• Papillary renal cell carcinoma: This is the second most common subtype and makes up about 10% of all renal cell carcinoma cases. It causes fingerlike projections to grow in the small tubes in the kidneys. 
• Chromophobe renal cell carcinoma: This type makes up about 5% of renal cell carcinoma cases, and its cells appear pale or clear under a microscope. 
• Collecting duct renal cell carcinoma 
• Multilocular cystic renal cell carcinoma 
• Medullary carcinoma
• Mucinous tubular and spindle cell carcinoma
• Neuroblastoma-associated renal cell carcinoma

Stage 4 Renal Cell Carcinoma Symptoms

Renal cell carcinoma may not have any signs or symptoms in the early stages. As the disease progresses to stage 4, more signs will be present. 

Symptoms of renal cell carcinoma include:

• Blood in the urine
• A palpable lump in the abdomen
• Side pain
• Low back pain
• Loss of appetite
• Unintended weight loss
• Anemia 

Causes

Stage 4 renal cell carcinoma may occur when cancer cells in the kidney are left untreated and continue to grow and spread throughout the body. 

Risk factors for renal cell carcinoma include:

• Smoking
• Misusing certain pain medications 
• Obesity
• High blood pressure (hypertension) 
• Family history of kidney cancer 
• Von Hippel-Lindau disease
• Hereditary papillary renal cell carcinoma 

Diagnosis

The diagnosis process for renal cell carcinoma will include a physical exam, a detailed health history, an ultrasound, lab tests, and imaging studies.

Lab tests may include:

• Blood chemistry studies: These tests use a sample of blood to measure the number of electrolytes, fats, proteins, glucose, and enzymes in the body. 
• Urinalysis: A urine sample may be obtained to test for blood.
• Biopsy: A kidney biopsy will likely be performed by placing a thin needle into the kidney and taking a tissue sample to examine under a microscope for cancer cells. 

Imaging studies may include:

• Computed tomography (CT) scan: A CT scan takes detailed pictures of the body and can show where cancerous tumors are growing, as well as how big they are. 
• Magnetic resonance imaging (MRI): An MRI may be recommended to help determine if and where cancer has spread. This is known as metastasis.
• Chest X-ray: A chest X-ray may be recommended to determine if cancer has spread to the lungs. 
• Bone scan: A bone scan may be conducted to determine if cancer has spread (metastasized) to the bones. 
• Positron-emission tomography (PET) scan: A PET scan shows cancer cells throughout the body and can help to determine the extent of metastasis. 

Treatment

Treatment for stage 4 renal cell carcinoma depends on a variety of factors, including how advanced the cancer is and to which areas of the body it has spread. In stage 4 cancer, cancer cells have usually spread to distant lymph nodes or other organs. 

Surgery 

Surgery is sometimes an option when treating stage 4 renal cell carcinoma. For example, if cancer has spread to one other organ from the kidneys, surgery may be performed to remove tumors from both organs. 

Surgery may be recommended if you are generally in good health and the medical team believes removing the tumors will improve your prognosis (outcome) or quality of life. However, if cancer cells have spread to several different areas of the body, surgery is not recommended. 

Immunotherapy

Immunotherapy is a cancer treatment that uses the body’s own immune system to fight cancer cells. Medications are given to boost the immune system’s response to better identify and kill cancer cells. 

Immunotherapy drugs approved to treat renal cell carcinoma include:

• Intron A (interferon alfa-2b)
• Interleukin-2, often called IL-2
• Opdivo (nivolumab)
• Yervoy (ipilimumab)
• Keytruda (pembrolizumab)
• Bevencio (avelumab)

Targeted Therapies

Targeted therapies are biologic treatments that work by targeting gene mutations that cause cancer. 

Targeted therapies approved to treat renal cell carcinoma include:

• Nexavar (sorafenib)
• Sutent (sunitinib)
• Torisel (temsirolimus)
• Votrient (pazopanib)
• Afinitor (everolimus)
• Avastin (bevacizumab)
• Inlyta (axitinib)
• Cabometyx (cabozantinib)
• Lenvima (lenvatinib)

Current recommended treatment for stage 4 clear cell kidney cancer includes combinations of targeted agents and immunotherapy, for example:

• Inlyta + Keytruda
• Cabometyx + Opdivo
• Lenvima + Keytruda
  

For non-clear cell carcinoma, either single targeted agents like Cabometyx or Sutent, combinations of targeted agents like Lenvima + Torisel, or single-agent immunotherapy like Opdivo or Keytruda are indicated.

Radiation

Radiation therapy is sometimes used in palliative care for stage 4 renal cell carcinoma. Radiation may be able to shrink the size of malignant (cancerous) tumors, improving pain control and quality of life. 

Pain Management

Pain management is an important part of treating stage 4 cancer. Having your pain controlled may help you to be more active and continue your activities of daily living. If your pain is not controlled, talk with your medical team about other options. 

Prognosis

Stage 4 renal cell carcinoma is the most advanced form of this type of cancer. The five-year survival rate for stage 4 renal cell carcinoma that has spread to distant areas of the body is 13%. Distant areas from the kidneys include the brain, lungs, bones, and other organs or tissues. 

Coping

Being diagnosed with stage 4 cancer is undoubtedly stressful. Finding ways to cope with the diagnosis and the uncertainty it brings will be an important aspect of your treatment plan. 

Start by talking with your medical team about your prognosis and what to expect from treatment. Ask about a palliative care team at the hospital to help with pain management and quality of life issues. 

The following organizations may be able to help as well:

• Action to Cure Kidney Cancer (ACKC): Gives education and support to those being treated for kidney cancer
• Patient Access Network (PAN) Foundation: Provides additional assistance to low-income patients who have health insurance 
• The Social Security Administration: Includes renal cell carcinoma in their Compassionate Allowances Initiative to speed up the processing of disability claims 
• The Assistance Fund: Offers education and financial aid to individuals with chronic diseases  

Summary 

Stage 4 renal cell carcinoma is an aggressive form of kidney cancer in which cancer cells have spread beyond the kidneys into other organs and tissues in the body. Treatment options may include surgery, radiation therapy, immunotherapy, and targeted therapies. Pain management and support resources will also be an important part of the treatment plan. 

A Word From Verywell 

Being diagnosed with stage 4 renal cell carcinoma is overwhelming, to say the least. It will likely take time for you to process this diagnosis and what it means for your health and well-being. It is important to remember that there are treatment options available. Work with your medical team to determine the treatment plan that provides the greatest quality of life for you and inquire about support resources.