Treatment Of Stage Iv And Recurrent Renal Cell Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
- Surgery .
- Surgery to reduce the size of the tumor.
- Radiation therapy as palliative therapy to relieve symptoms and improve the quality of life.
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.
Renal Cell Carcinoma Tumor Stages
- Stage 1: The tumor is only in the kidney and it is smaller than 7 centimeters in size.
- Stage 2: The tumor is only in the kidney and it is larger than 7 cm in size.
- Stage 3: The tumor has spread beyond the kidney to adjacent areas, such as the adrenal gland.
- Stage 4: the tumor has spread beyond the kidney and adjacent structures to at least one other area of the body.
What Are Causes And Risk Factors Of Renal Cell Carcinoma
The exact cause of renal cell cancer has not been determined. A number of different factors seem to contribute to renal cell cancer. These risk factors include the following:
- Cigarettesmoking doubles the risk of renal cell cancer and contributes to as many as one-third of all cases. The more someone smokes, the greater the risk is of that person developing renal cell cancer.
- Obesity is a risk factor. As body weight increases, so does the risk of developing renal cell cancer. This is especially true in women.
- Occupational exposure to petroleum products, heavy metals, solvents, coke-oven emissions, or asbestos
- Cystic kidney disease associated with chronic renal insufficiency
- Cystic changes in the kidney and renal dialysis
- Tuberous sclerosis
In its early stages, renal cell cancer usually causes no noticeable symptoms. Symptoms may occur only when cancer grows and begins to press on surrounding tissues or spread to other parts of the body. The symptoms vary considerably from person to person. Some people never develop any symptoms before the disease is discovered the cancer is found when they undergo imaging tests, such as a CT scan, for another reason. In a study in the Journal of Urology, approximately 53% of people with localized renal cell carcinoma had no symptoms.
Signs and symptoms of renal cell cancer may include the following:
- Weight loss
- Night sweats
Don’t Miss: Lobular Carcinoma Survival Rate
European Commission Approves Mercks Keytruda As Adjuvant Therapy For Certain Patients With Renal Cell Carcinoma Following Surgery
KEYTRUDA Is Now Approved as Monotherapy for Adults With RCC at Increased Risk of Recurrence Following Nephrectomy, or Following Nephrectomy and Resection of Metastatic Lesions
KEYTRUDA Is the First Immunotherapy Approved in Europe in the Adjuvant Setting for These Patients With RCC
KENILWORTH, N.J., January 27, 2022—-Merck , known as MSD outside the United States and Canada, today announced that the European Commission has approved KEYTRUDA, Mercks anti-PD-1 therapy, as monotherapy for the adjuvant treatment of adults with renal cell carcinoma at increased risk of recurrence following nephrectomy, or following nephrectomy and resection of metastatic lesions. This approval is based on results from the Phase 3 KEYNOTE-564 trial, in which KEYTRUDA demonstrated a statistically significant improvement in disease-free survival , reducing the risk of disease recurrence or death by 32% after a median follow-up of 23.9 months compared to placebo, in patients at increased risk of recurrence .
“KEYTRUDA is the first adjuvant therapy approved for certain patients with renal cell carcinoma in Europe, providing the option of immunotherapy earlier in the course of their treatment,” said Dr. Scot Ebbinghaus, vice president, clinical research, Merck Research Laboratories. “This approval demonstrates our progress in bringing KEYTRUDA to patients with earlier stages of cancer, with the goal of helping more patients around the globe prevent disease recurrence.”
About Renal Cell Carcinoma
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.
Also Check: Invasive Ductal Carcinoma Stage 2 Survival Rate
Laparoscopic Nephrectomy And Robotic
These approaches to the operation are done through several small incisions instead of one large one. If a radical nephrectomy is needed, many doctors and patients now prefer to use these approaches when they can.
Laparoscopic nephrectomy: Special long instruments are inserted through the incisions, each of which is about 1/2-inch long, to remove the kidney. One of the instruments, the laparoscope, is a long tube with a small video camera on the end. This lets the surgeon see inside the abdomen. Usually, one of the incisions has to be made longer in order to remove the kidney .
Robotic-assisted laparoscopic nephrectomy: This approach uses a robotic system to do the laparoscopic surgery remotely. The surgeon sits at a panel near the operating table and controls robotic arms to operate. For the surgeon, the robotic system may allow them to move the instruments more easily and with more precision than during standard laparoscopic surgery. But the most important factor in the success of either type of laparoscopic surgery is the surgeons experience and skill. This is a difficult approach to learn. If you are considering this type of operation, be sure to find a surgeon with a lot of experience.
Metastatic Pathway In Rcc
The development of metastatic disease is a sequential process where cancer cells depart from the primary tumor via the blood supply or lymphatic chain and deposit at proximal or distant sites. This metastatic pathway is not always predictable and certainly not for renal cancer, which is notorious for its complex lymphatic drainage. However there is a predilection for certain sites, meaning that these sites are usually the first occupied by cancer cells . Moreover, there has been evidence in support of an early dissemination model, where metastasis occurs early in the lifecycle of cancer cells.
In an experimental study, engineered untransformed mouse mammary cells were found to express inducible oncogenes transgenes that were able to bypass the primary site and show up at secondary metastatic sites . In another animal study, Kaplan et al. also showed that cancer cells in mice models might have instructed bone marrow cells to migrate to pre-selected organs in order to establish a hospitable environment. This event preceded the appearance of cancer cells by four to six days and micrometastatic colonies formed five days later . These studies might explain the unpredictable metastatic pattern of renal tumors and account for the late appearance of metastatic disease in organs and sites that are considered outside of the “usual” metastatic pathway of RCC.
Don’t Miss: Is Melanoma Bad
Renal Mass: Cysts To Renal Cell Carcinoma
Most renal masses are simple cysts, frequently found incidentally on US, CT, and MRI. They rarely occur in individuals younger than 25 years of age, but are found in more than 50% of patients older than 50 years of age. Typically, renal cysts are asymptomatic and cortical in location they may be single or multiple. Their cause is unknown, although tubular obstruction has been postulated to be a necessary element.
Renal masses produce variable findings on imaging studies, depending on their location. For years IVU was the imaging modality of choice for detection of renal masses however, the findings on IVU are frequently nonspecific, and further imaging is necessary to characterize most abnormalities found . Studies have shown that IVU has low sensitivity for detection of renal masses, especially those smaller than 3cm in diameter.237 With CT as the gold standard, IVU detected 10% of masses smaller than 1cm in diameter, 21% of masses 1 to 2cm in diameter, 52% of masses 2 to 3cm in diameter, and 85% of masses larger than 3cm in diameter.237 US fared better than IVU but detected only 26% of masses smaller than 1cm, 60% of those 1 to 2cm, 82% of those 2 to 3cm, and 85% of those larger than 3cm.237
The findings on IVU are nonspecific, and US, CT, and MRI are used to characterize the renal mass, differentiating solid from cystic.
George J. Netto, Jonathan I. Epstein, in, 2011
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.
Don’t Miss: Melanoma On Face Prognosis
What Is Renal Cell Carcinoma
It’s the most common type of kidney cancer. Although itâs a serious disease, finding and treating it early makes it more likely that youâll be cured. No matter when youâre diagnosed, you can do certain things to ease your symptoms and feel better during your treatment.
Most people who have renal cell carcinoma are older, usually between ages 50 and 70. It often starts as just one tumor in a kidney, but sometimes it begins as several tumors, or itâs found in both kidneys at once. You might also hear it called renal cell cancer.
Doctors have different ways to treat renal cell carcinoma, and scientists are testing new ones, too. Youâll want to learn as much about your disease as you can and work with your doctor so you can choose the best treatment.
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?
What Are The Types Of Kidney Cancer
The information in this document refers to renal cell carcinoma the most common form of kidney cancer. However, there are different types of kidney cancer, including:
- Renal cell carcinoma : This is the most common form of kidney cancer in adults and accounts for 85% of all kidney cancers. Renal cell carcinoma usually develops as a single tumor in one kidney, but it can affect both kidneys. Renal cell carcinoma begins in the cells that line the small tubes that are part of the nephrons within the kidneys. .
- Transitional cell carcinoma: Transitional cell carcinoma accounts for 6% to 7% of all kidney cancers. This cancer usually begins in the area where the ureter connects to the main part of the kidney. This area is called the renal pelvis. Transitional cell carcinoma also can occur in the ureters or bladder.
- Renal sarcoma: This is the least common form of kidney cancer, accounting for only 1% of kidney cancer cases. It begins in the connective tissues of the kidneys and, if not treated, can spread to nearby organs and bones.
- Wilms’ tumor: This is the most common type of kidney cancer in children. It accounts for about 5% of kidney cancers.
Renal Cell Carcinoma Support Groups And Counseling
Living with cancer presents many new challenges, both for the people with cancer and for their family and friends.
- People with cancer probably have many worries about how the cancer will affect them and their ability to “live a normal life,” to care for their family and home, to hold their job, and to continue the friendships and activities they enjoy.
- Many people feel anxious and depressed. Some people feel angry and resentful others feel helpless and defeated.
For most people with cancer, talking about their feelings and concerns helps.
- Friends and family members can be very supportive. They may be hesitant to offer support until they see how someone is coping. If people with cancer want to talk about their concerns, they should let someone know.
- Some people do not want to “burden” their loved ones, or prefer talking about their concerns with a more neutral professional. A social worker, a counselor, or a member of the clergy can be helpful if they want to discuss their feelings and concerns about having cancer. A surgeon or an oncologist should be able to recommend someone.
- Many people with cancer are helped profoundly by talking to other people who have cancer. Sharing concerns with others who have been through the same thing can be remarkably reassuring. Support groups of people with cancer may be available through the medical center where treatment was received. The American Cancer Society also has information about support groups all over the United States.
Also Check: Invasive Ductal Carcinoma Stage 3 Survival Rate
Chemotherapy Immunologic Therapy Targeted Therapy
There are several medications approved for treatment of renal cell carcinoma:
- Chemotherapy destroys actively growing cells
- Immune therapy uses a process that triggers your immune system to destroy tumor cells
- Targeted therapy is a type of therapy that specifically destroys the tumor cells
All of these medications are powerful, and they may produce serious side effects during your treatment and recovery.
Clear Cell Renal Cell Carcinoma
Clear cell renal cell carcinoma, also known as ccRCC or conventional renal cell carcinoma, is a the most common form of kidney cancer. Clear cell renal cell carcinoma is named after how the tumor looks under the microscope. The cells in the tumor look clear, like bubbles.
In adults, ccRCC makes up about 80% of all renal cell carcinoma cases. ccRCC is more common in adults than children. Renal cell carcinoma makes up 2% to 6% of childhood and young adult kidney cancer cases.”
Also Check: Large Cell Cancers
Are Childhood Kidney Tumors Serious
Although childhood kidney tumors can have serious effects, they’re generally very curable. The survival rates for Wilms tumor depend on the stage of the tumor and how far the cancer has progressed. However, even with the worst possible progression in which both kidneys and other parts of the body are affected, the survival rate is about 40% to 60%. Overall, around 60% to 95% of children who get treatment for childhood kidney tumors survive.
What Is Kidney Cancer
Kidney cancer — also called renal cancer — is a disease in which kidney cells become malignant and grow out of control, forming a tumor. Almost all kidney cancers first appear in the lining of tiny tubes in the kidney. This type of kidney cancer is called renal cell carcinoma. The good news is that most kidney cancers are found before they spread to distant organs. And cancers caught early are easier to treat successfully. However, these tumors can grow to be quite large before they are detected.
The kidneys are two bean-shaped organs, each about the size of a fist. They lie in your lower abdomen on each side of your spine. Their main job is to clean your blood, removing waste products and making urine.
Doctors don’t know the causes of kidney cancer. But certain factors appear to increase the risk of getting kidney cancer. For example, kidney cancer occurs most often in people older than age 40. These are some other risk factors for kidney cancer:
Having these risk factors does not mean you will get kidney cancer. And it’s also true that you can have none of them and still get the disease.
Don’t Miss: Invasive Ductal Carcinoma Grade 1 Survival Rate
Smoking And Misuse Of Certain Pain Medicines Can Affect The Risk Of Renal Cell Cancer
Anything that increases your risk of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesn’t mean that you will not get cancer. Talk with your doctor if you think you may be at risk.
Risk factors for renal cell cancer include the following:
- Having certain geneticconditions, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma.
How Do Physicians Determine Staging Of Renal Cell Carcinoma
Staging of renal cell cancer is based on the size of the tumor and the extent of its spread outside the kidney. Like many cancers, renal cell cancer is staged according to the tumor , nodes , and metastases classification endorsed by the American Joint Committee on Cancer . The TNM classification system assigns a T code, an N code, and an M code to each tumor. An X is used if that feature cannot be determined. The combination of these 3 codes determines the disease stage.
- Primary tumor – 0, 1, 2, 3a, 3b, 3c, 4 based on size of tumor and parts of kidney and surrounding area involved
- Regional lymph nodes – 0, 1, 2 based on number of lymph nodes involved
- Distant metastasis – 0 , 1
- Stage I – T1N0M0 cancer is 7 cm or smaller in size and confined to the kidney
- Stage II – T2N0M0 cancer is larger than 7 cm and confined to the kidney
- Stage III – T1 or 2, N1M0 or T3a-c, N0-1, M0 cancer of any size that has spread to fatty tissue, blood vessels, or a lymph node near the kidney
- Stage IV – T4 or any T, N2M0 or any T, any N, M1 cancer has spread to multiple lymph nodes to nearby organs, such as the bowel or pancreas or to other parts of the body, such as the lung, brain, or bone
Also Check: Melanoma Stage 3 Survival Rate