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How Do You Get Renal Cell Carcinoma

Summary Ofevidence And Recommendation For Epidemiology Aetiology And Pathology

Determining Progression in Metastatic Renal Cell Carcinoma

Summary of evidence

Several verified risk factors have been identifiedincluding smoking, obesity and hypertension. These are considered definite riskfactors for RCC.

Recommendation

Strength rating

Increase physical activity, eliminate cigarettesmoking and in obese patients reduce weight are the primary preventativemeasures to decrease risk of RCC.

Strong

Treatment Of Stage Ii Renal Cell Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Adjuvant And Neoadjuvant Therapy

Adjuvant therapy, which refers to therapy given after a primary surgery, has not been found to be beneficial in renal cell cancer. Conversely, neoadjuvant therapy is administered before the intended primary or main treatment. In some cases neoadjuvant therapy has been shown to decrease the size and stage of the RCC to then allow it to be surgically removed. This is a new form of treatment and the effectiveness of this approach is still being assessed in clinical trials.

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Collecting Duct And Other Rare Forms Of Rcc

Collecting duct RCC is a rare but highly aggressive tumor of the distal nephron that shows LOH of chromosome 1q, 6p, 8p, 13q and 21q . Mapping of chromosome 1q , 8p and 13q have narrowed down the region but not yet identified the target suppressor genes. Renal medullary carcinoma described in African-Americans and associated with sickle cell trait, mucinous tubulocystic RCC and other rare forms of RCC have been reviewed in Srigley and Delahunt 2009 .

Managementof Locally Advanced Unresectable Rcc

Getting A Clear Perception Of Kidney Cancer

In case of locally advanced unresectable RCC, a multidisciplinaryevaluation, including urologists, medical oncologists and radiation therapists is suggestedto maximise cancer control, pain control and the best supportive care. In patients withnon-resectable disease, embolisation can control symptoms, including visible haematuria orflank pain . The use of systemic therapy to downsize tumours isexperimental and cannot be recommended outside clinical trials.

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Radicaland Partial Nephrectomy Techniques

7.1.3.1.Radical nephrectomy techniques

No RCTs have assessed the oncological outcomes of laparoscopic vs. open RN.A cohort study and retrospective database reviews areavailable, mostly of low methodological quality, showing similar oncological outcomes evenfor higher stage disease and locally more advanced tumours . Based on a systematic review, less morbidity wasfound for laparoscopic vs. open RN .

Data from one RCT and twonon-randomised studies showed asignificantly shorter hospital stay and lower analgesic requirement for the laparoscopic RNgroup as compared with the open group. Convalescence time was also significantly shorter . No difference in the number of patients receiving bloodtransfusions was observed, but peri-operative blood loss was significantly less in thelaparoscopic arm in all 3 studies . Surgical complication rates werelow with very wide confidence intervals. There was no difference in complications, butoperation time was significantly shorter in the open nephrectomy arm. Post-operative QoLscores were similar .

7.1.3.2.Partial nephrectomy techniques

7.1.3.2.1.Open versus laparoscopicapproach
7.1.3.2.2.Open versus robotic approach
7.1.3.2.3.Open versus hand-assistedapproach
7.1.3.2.4.Open versus laparoscopic versusrobotic approaches
7.1.3.2.5.Laparoscopic versus roboticapproach
7.1.3.2.6.Surgical volume

7.1.3.3.Positive surgical margins onhistopathological specimens

Summary of evidence

When To Get Medical Advice

See a GP if you have symptoms of kidney cancer.

Although it’s unlikely you have cancer, it’s important to get your symptoms checked out.

The GP will ask about your symptoms and may test a sample of your urine to see if it contains blood or an infection.

If necessary, they may refer you to a hospital specialist for further tests to find out what the problem is.

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Rare Types Of Kidney Cancer

Rare kidney cancers occur most frequently in children, teenagers, and young adults.

Papillary renal cell carcinoma

  • 15% of all renal cell carcinomas
  • Tumor located in the kidney tubes
  • Type 1 PRCC is more common and grows slowly
  • Type 2 PRCC is more aggressive and grows more quickly

Translocation renal cell carcinoma

  • Accounts for 1% to 5% of all renal cell carcinomas and 20% of childhood caces
  • Tumor located in the kidney
  • In children, TRCC usually grows slowly often without any symptoms
  • In adults, TRCC tends to be agressive and fast-growing

There Are Different Types Of Treatment For Patients With Renal Cell Cancer

Introduction and Frontline Treatment of Renal Cell Carcinoma

Different types of treatments are available for patients with renal cell cancer. Some treatments are standard , and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

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Symptoms Of Kidney Cancer

In many cases, there are no obvious symptoms at first and kidney cancer may only be found during tests for another condition or reason.

If there are symptoms, they can include:

  • blood in your pee you may notice your pee is darker than usual or reddish in colour
  • a persistent pain in your lower back or side, just below your ribs
  • a lump or swelling in your side

Molecular Basis Of Clear Cell Rcc

Recent advances in the understanding of cancer as a genetic disease have allowed the identification of clonal genetic and epigenetic alterations, which accumulate during cancer progression, often in a general temporal order. However, relatively little is known about the secondary and later genetic alterations which drive progression after the initiating event of inactivation of VHL in clear cell RCC. Even less is known about the alterations that underlie the initiation and progression of sporadic papillary or chromophobe RCC, or the importance of different tumor suppressor and signaling pathways in renal cancer. It remains that much of what we know of the molecular basis of sporadic RCC arose from identification of the genes predisposing to inherited RCC .

With the exception of VHL, all these tumor suppressor genes appear to be inactivated in a minority of RCC, Indeed the number with clear evidence of inactivation of the retained allele by point mutation, homozygous deletion or hypermethylation is substantially less than the number with LOH. This may simply be due to not looking hard enough. The case of germline mutation of VHL is instructive because as investigators searched deeper for the second mutation, more were found . The target suppressor gene on several of the more frequently deleted chromosomal arms e.g. 6q, 8p or 14q in RCC have not yet been identified. Subtyping of RCC by tumor suppressor inactivation may prove important for prognostic stratification.

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Genetic Conditions And Kidney Cancer

Although kidney cancer can run in families, inherited kidney cancers linked to a single, inherited gene are uncommon, accounting for 5% or less of kidney cancers. Over a dozen unique genes that increase the risk of developing kidney cancer have been found, and many are linked to specific genetic syndromes. Most of these conditions are associated with a specific type of kidney cancer .

Finding a specific genetic syndrome in a family can help a person and their doctor develop an appropriate cancer screening plan and, in some cases, help determine the best treatment options. Only genetic testing can determine whether a person has a genetic mutation. Most experts strongly recommend that people considering genetic testing first talk with someone with expertise in cancer genetics, such as a genetic counselor, who can explain the risks and benefits of genetic testing.

Genetic conditions that increase a person’s risk of developing kidney cancer include:

Other genetic conditions may be associated with an increased risk of kidney cancer. Research to find other genetic causes of kidney cancer is ongoing.

Does Renal Cell Carcinoma Spread To The Liver

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RCC patients develop metastases at various sites, including the lungs, lymph nodes, bone, brain and liver and their prognosis depends on the metastatic site. The frequency of liver metastasis in RCC patients is lower compared to that of metastasis to other sites, such as the lungs, lymph nodes and bone.

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After Renal Cell Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Kidney Or To Other Parts Of The Body

The process used to find out if cancer has spread within the kidney or to otherparts of the body is called staging. The information gathered from thestaging process determines the stage of the disease. It is important to knowthe stage in order to plan treatment. The following tests andprocedures may be used in the staging process:

  • CT scan : A procedure that makes a series of detailed pictures of areas inside the body, such as the chest or brain, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • MRI : A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the brain. This procedure is also called nuclear magnetic resonance imaging .
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones with cancer and is detected by a scanner.

What Is The Most Common Treatment For Renal Cell Carcinoma

Radical nephrectomy, which remains the most commonly performed standard surgical procedure today for treatment of localized renal cell carcinoma involves complete removal of the Gerota fascia and its contents, including a resection of kidney, perirenal fat, and ipsilateral adrenal gland, with or without ipsilateral

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Outlook After An Rcc Diagnosis

The outlook after being diagnosed with RCC depends largely on whether the cancer has spread and how soon treatment is started. The sooner its caught, the more likely you are to have a full recovery.

If the cancer has spread to other organs, the survival rate is much lower than if its caught before spreading.

According to the National Cancer Institute, the five-year survival rate for RCC is over

How Common Is Kidney Cancer

Recent Advances in Renal Cell Carcinoma

Each year an estimated 75,000 patients are found with a kidney tumor. Approximately 65,000 of these are ultimately found to be renal cell carcinoma .

The most common type is clear cell carcinoma. Renal cell cancer is not one disease but rather a collection of 15-20 types of renal tumors that can arise from the kidney. Kidney cancer is among the 10 most common cancers in both men and women, and the risk for developing kidney cancer is higher in men than in women. More information about kidney cancer risk factors >

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Other Types Of Kidney Cancers

Other types of kidney cancers include transitional cell carcinomas, Wilms tumors, and renal sarcomas.

Transitional cell carcinoma: Of every 100 cancers in the kidney, about 5 to 10 are transitional cell carcinomas , also known as urothelial carcinomas.

Transitional cell carcinomas dont start in the kidney itself, but in the lining of the renal pelvis . This lining is made up of cells called transitional cellsthat look like the cells that line the ureters and bladder. Cancers that develop from these cells look like other urothelial carcinomas, such as bladder cancer, when looked at closely in the lab. Like bladder cancer, these cancers are often linked to cigarette smoking and being exposed to certain cancer-causing chemicals in the workplace.

People with TCC often have the same signs and symptoms as people with renal cell cancer blood in the urine and, sometimes, back pain.

For more information about transitional cell carcinoma, see Bladder Cancer.

Wilms tumor : Wilms tumors almost always occur in children. This type of cancer is very rare among adults. To learn more about this type of cancer, see Wilms Tumor.

Renal sarcoma: Renal sarcomas are a rare type of kidney cancer that begin in the blood vessels or connective tissue of the kidney. They make up less than 1% of all kidney cancers.

Sarcomas are discussed in more detail in Sarcoma- Adult Soft Tissue Cancer.

Questions To Ask Your Doctor

  • What stage is my cancer? What does that mean for me?
  • Do I need any more tests?
  • Do I need to see any other doctors?
  • Have you ever treated this kind of cancer before?
  • What kinds of treatments are there? Which would you recommend?
  • How will those treatments make me feel?
  • When should I start treatment?
  • How will we know if it works?
  • What will my recovery be like?
  • What would you expect for me?
  • Are there any clinical trials I can sign up for?

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Prognostic Systems For Metastatic Renal Cell Carcinoma

Two similar prognostic systems are commonly used to calculate risk in patients with metastatic renal cell carcinoma . The Memorial Sloan-Kettering Cancer Center /Motzer score includes the following criteria :

  • Time from diagnosis to systemic treatment less than 1 year
  • Hemoglobin concentration below the lower limit of normal
  • Serum calcium concentration > 10 mg/dL
  • Lactate dehydrogenase level more than 1.5 times the upper limit of normal
  • Performance status less than 80%

The International Metastatic RCC Database Consortium risk model, validated and further developed by Heng et al, includes the following prognostic criteria :

  • Time from diagnosis to systemic treatment less than 1 year
  • Karnofsky performance status less than 80%
  • Hemoglobin concentration below LLN
  • Serum calcium above ULN
  • Platelet count above the ULN
  • Neutrophil count above the ULN

Both systems categorize patients into the following 3 risk groups:

  • Favorable risk – Median survival 20 months 2-year overall survival 75%
  • Intermediate risk – Median survival 10 months 2y OS 53%
  • Poor/high risk group – Median survival 4 months 2y OS 7%

Review of an external validation cohort of 4657 patients treated for kidney cancer in clinical trials from 2003 to 2013 also demonstrated longer overall survival in obese patients, with median overall survivals of 23.4 months versus 14.5 months for those with low BMI.

How Is Ccrcc Treated

Find Dying From Kidney Cancer Information

Treatments for people with ccRCC include surgery and immunotherapy. Treatment will depend on how much the cancer has grown.

Surgery: Once ccRCC is diagnosed, you may have surgery to remove the cancer and part of the kidney surrounding it. In early stage ccRCC, part of the kidney with the cancer is taken out. If ccRCC is in the middle of the kidney, or if the tumor is large, sometimes the entire kidney must be removed. In later stage ccRCC, removal of the kidney is controversial but may be appropriate in some patients.

Immunotherapy: Immunotherapy helps the bodys immune system fight the cancer cells.

Targeted therapy: Targeted therapy targets the changes in cancer cells that help them grow, divide, and spread. Some targeted therapies that are used to treat clear cell renal carcinoma include cabozantinib, axitinib, sunitinib, sorafenib, and pazopanib.

Other treatments can be used that do not involve removing the kidney, such as:

  • Radiation therapy, which uses radiation to kill the tumor cells
  • Thermal ablation, which uses heat to kill the tumor cells
  • Crysosurgery, which uses liquid nitrogen to freeze and kill the tumor cells

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Approach And Management Of Rcc

Management of renal cancers is evolving, because an increasing proportion of RCC is SRMs, which are found incidentally with favorable survival outcomes. Patients with SRMs are no longer dying primarily of kidney cancer, but rather, the RCC and CKD populations both have common risk factors, which predispose them to cardiovascular events and cardiovascular diseaserelated death. Therefore, a greater focus of SRM treatment should center on maximizing kidney function preservation, cardiovascular risk reduction, and longterm CKD care . A multidisciplinary team approach is necessary, involving the nephrologist, oncologist, pathologist, and urologist.

Renal outcomes after PN versus RN

Nonsurgical therapies, including radiofrequency ablation and cryoablation, have favorable oncologic and overall survival outcomes. Although associated with slightly higher disease progression than observed for surgical treatment , ablative therapies resulted in fewer procedural complications, shorter duration of hospitalization, and greater GFR preservation.,, When excluding those with high risk for recurrence, oncologic outcomes were equivalent with PN. These alternative therapies also enable treatment for those with high operative risk. Furthermore, the use of active surveillance when tumor size was monitored closely and regularly, with surgical treatment as required, has also been shown to be effective and comparable with surgical resection, particularly for the elderly and in select populations.

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