Renal cell carcinoma

Definition:

Renal cell carcinoma is a type of kidney cancer. The cancerous cells are found in the lining of very small tubes (tubules) in the kidney. It is the most common type of kidney cancer in adults.

Alternative Names:

Renal cancer; Kidney cancer; Hypernephroma; Adenocarcinoma of renal cells; Cancer - kidney

Causes, incidence, and risk factors:

Renal cell carcinoma affects about 3 in 10,000 people, resulting in about 32,000 new cases in the US per year. Every year, about 12,000 people in the US die from renal cell carcinoma. It occurs is most common in people between 50 and 70 years of age, and typically affects men.

The exact cause is unknown.

Risk factors include:

• Smoking
• Genetics
• Family history of the disease
• Dialysis treatment
• von Hippel-Lindau disease, a hereditary disease that affects the capillaries of the brain

The first symptom is usually blood in the urine. Sometimes both kidneys are involved. The cancer spreads easily, most often to the lungs and other organs. About one-third of patients have spreading ( metastasis ) at the time of diagnosis.

Kidney tumor - CT scan

Kidney metastases, CT scan

Symptoms:

• Blood in the urine
• Abnormal urine color (dark, rusty, or brown)
• Flank pain
• Back pain
• Abdominal pain
• Unintentional weight loss of more than 5% of body weight
• Emaciated, thin, malnourished appearance
• Enlargement of one testicle
• Swelling or enlargement of the abdomen

Additional symptoms that may be associated with this disease:

• Vision abnormalities
• Paleness
• Excessive hair grown in females
• Constipation
• Cold intolerance

Signs and tests:

Palpation of the abdomen may show a mass or organ enlargement, particularly of the kidney or liver. There may be a testicular varicocele in men.

• Complete blood count (CBC)
• Urine test may show red blood cells
• Serum calcium levels may be high
• SGPT and alkaline phosphatase may be high
• A urine cytology
• Liver function tests
• An ultrasound of the abdomen and kidney
• Kidney x-ray
• IVP
• Renal arteriography

The following tests may be performed to see if the cancer has spread:

• An abdominal CT scan may show a liver mass.
• Abdominal MRI can determine if the cancer has spread to any surrounding blood vessels and whether it can be surgically removed.
• A chest x-ray may show mass in the chest.
• A bone scan may show involvement of the bones.
  

Treatment:

Surgical removal of all or part of the kidney ( nephrectomy ) is recommended. This may include removal of the bladder or surrounding tissues or lymph nodes.
Radiation therapy does not usually work for renal cell carcinoma and, therefore, is not often used. Hormone treatments may reduce the growth of the tumor in some cases.
Medications such as alpha-interferon and interleukin have been successful in reducing the growth of some renal cell carcinomas, including some that have spread. In December 2005, the US Food and Drug Administration approved a new type of drug called Nexavar for adults with advanced renal cell carcinoma. The drug works by blocking a tumor's blood supply.
Chemotherapy may be used in some cases, but cure is unlikely unless all the cancer is removed with surgery.
Expectations (prognosis):
The outcome varies depending on the degree of metastasis. The 5-year survival rate is around 60 - 75% if the tumor is in the early stages and has not spread outside the kidney. If it has metastasized to the lymph nodes, the 5-year survival is around 5 - 15%. If it has spread to other organs, the 5-year survival at less than 5%.

Complications:

• Hypertension
• Metastasis of the cancer

Calling your health care provider:

Call your health care provider any time blood in the urine develops. Also call if any other symptoms of this disorder occur.

Prevention:

Stop smoking. Follow your health care provider's recommendations in the treatment of kidney disorders, especially those that may require dialysis.