What Is Renal Cell Carcinoma

How Is Prcc Treated

Treatment for papillary renal cell carcinoma for each patient is unique. You should go to an expert in PRCC treatment to decide the best approach for your tumor. You can contact MyPART for help fining experts near you.

Surgery: Once papillary renal cell carcinoma is diagnosed, you may have surgery to remove the tumors from the kidney. In later stages, surgery may be difficult, in which case your doctor will discuss othe options with you.

Radiation Therapy: The radiation is aimed at the tumor area to kill the tumor cells and to prevent it from growing back.

Chemotherapy: When surgery is not possible or when the cancer has spread, chemotherapy may be used to treat PRCC, but it is not used often.

What Can I Do

First, work with your doctor to figure out how to best treat it. Even if it canât be cured, you may be able to slow it down and manage your symptoms with surgery, medicine, and other treatments.

You can also do a lot on your own to feel better physically and emotionally:

Pace yourself. Cancer, and even some of its treatments, can wipe you out. Try to keep your days simple and save your energy for the important activities. And donât be shy about resting when you need to.

Speak your symptoms. Your doctor can help with all kinds of common problems from cancer and its treatments, like constipation, upset stomach, and pain. But only if you say something about them. Check in with your doctor often to get the care you need.

Stay active. Exercise lifts your energy and helps you fight off anxiety, depression, and stress. Ask your doctor whatâs safe for you to do.

Tend to your body. Along with regular exercise, try to stick to a healthy diet and get the rest you need. If you donât feel like eating much, a dietitian might be able to help.

Find ways to relax. Itâll keep your mood and energy up. Take time to read a book, go for a walk, call a friend, get a massage, or try some meditation. Or all of the above. Go with works best for you.

Work with your doctor, and try to stay positive. There are more ways to treat the condition than ever before. Your doctor can help you think about which ones are best for you.

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Summary Ofevidence And Recommendation For Epidemiology Aetiology And Pathology

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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:

• Smoking.
• Having certain geneticconditions, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma.

How Does Kidney Cancer Spread

As the tumor grows, it spreads into fat or major blood vessels around the kidney. It may also creep into the adrenal gland, which sits right on top of the organ.

From there, it can spread farther through your:

• Blood. Cancer cells that get into a blood vessel can travel to many body parts through your veins and arteries.
• Lymph system. This is a network that runs throughout your body, much like your blood vessels. It helps you fight disease. But cancer cells that get into lymph nodes can hitch a ride to other organs.

Kidney cancer most often spreads to the lungs and bones, but it can also go to the brain, liver, ovaries, and testicles.

Because it has no symptoms early on, it can spread before you even know you have it. If you do find it early, but treatment doesnât get rid of all the cancer cells, it can come back in your kidney or somewhere else.

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Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Therapeutic Approaches As Alternatives To Surgery

7.1.4.1.Surgical versus non-surgicaltreatment

Population-based studies compared the oncological outcomes of surgery and non-surgical management for tumours < 4 cm. The analyses showed asignificantly lower cancer-specific mortality in patients treated with surgery .However, the patients assigned to the surveillance arm were older and likely to be frailerand less suitable for surgery. Other-cause mortality rates in the non-surgical groupsignificantly exceeded that of the surgical group . Analyses ofolder patients failed to show the same benefit in cancer-specific mortalityfor surgical treatment .

7.1.4.2.Active surveillance and watchfulwaiting

Elderly and comorbid patients with incidental small renal masses have a lowRCC-specific mortality and significant competing-cause mortality . Active surveillance is defined asthe initial monitoring of tumour size by serial abdominal imaging withdelayed intervention reserved for tumours showing clinical progression during follow-up . The concept of AS differs from the concept of watchfulwaiting watchful waiting is reserved for patients whose comorbidities contraindicate anysubsequent active treatment and do not require follow-up imaging, unless clinicallyindicated.

In the largest reported series of AS the growth of renaltumours was low and progression to metastatic disease was reported in only a limited numberof patients .

7.1.4.3.Role of renal tumour biopsy beforeactive surveillance

7.1.4.4.Tumour ablation

7.1.4.4.2.Cryoablation

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Are Childhood Kidney Tumors Serious

Although childhood kidney tumors can have serious effects, theyre 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.

Risk Prevention And Early Detection Of Rcc

Individuals with inherited syndromes that predispose to RCC and long-term dialysis patients are at high risk but account for a minority of RCC cases. Algorithms of relative risk of RCC according to smoking status, body mass index and blood pressure have been investigated and a decrease in risk was observed for men who had stopped smoking for 30 years or more . The only evidence for the potential of chemoprevention for RCC are studies which show diets rich in fruit and vegetables as well as high vitamin D levels to be preventive . Candidates for a future chemopreventive strategy would be inherited RCC, ESRD patients and also RCC patients at high risk of recurrence.

Molecular early detection strategies must be designed with careful regard to the abundance of tumor cells in the clinical specimen as well as the frequency and timing of the alteration to be detected . LOH of 3p and point mutation of VHL are frequent and early in clear cell RCC but urine or blood contain a low ratio of DNA from renal tumor cells to DNA from normal cells that is insufficient for the robust detection of these alterations by polymorphic marker and sequencing analysis respectively. Because point mutations occur throughout the VHL gene, rather than at hotspots of particular codons like RAS, the design of more sensitive oligonucleotide molecular tests is very complicated. However, if a tumor cell-rich biopsy specimen is available, LOH and point mutation can be assessed as prognostic markers.

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How Is Ccrcc Treated

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

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

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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

AJCC Stages

• 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

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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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?

How Renal Cell Carcinoma Is Diagnosed

Since early-stage disease is usually asymptomatic, RCC is often found during computed tomography scans ordered for unrelated symptoms. This may be why RCC is more commonly diagnosed in developed countries, where imaging tests are often used.

If your healthcare providers suspects that you have RCC or any type of kidney cancer, they will do a physical examination to look for flank pain. They will also feel for an abnormal mass in your abdomen. Theyll ask about your overall health and your family history of kidney cancer.

A urinalysis will be done to check for blood in urine, another common symptom. In addition, tests will be done to make a diagnosis and check for cancer spread. They may include:

• Blood tests, including a blood chemistry test and complete blood count test
• Imaging tests such as a CT scan, magnetic resonance imaging , and ultrasound. Your CT scan or MRI may include an X-ray called an angiogram. This looks at blood flow in and around the kidneys
• Collecting a tissue sample for lab analysis of the kidneys is not always needed for diagnosis but may be helpful when imaging tests dont provide sufficient information to support surgery.

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Other Types Of Kidney Cancer

Other less-common types of kidney cancers include:

• Transitional cell carcinoma. This is also known as urothelial carcinoma. It starts where the ureter and kidney meet. This area is called the renal pelvis. This type of kidney cancer can act and look like bladder cancer.

• Wilms tumor. This cancer most always occurs in children. It’s very rare in adults.

• Renal sarcoma. This is a very rare type of kidney cancer. It begins in the blood vessels and connective tissue around the kidneys.

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.

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When Should I Call The Doctor

• Blood in your urine.
• Lump or pain in your side that doesnt go away.
• Unexplained fever or weight loss.

What should I ask my healthcare provider?

You may want to ask your healthcare provider:

• What type of kidney cancer do I have?
• What is the best treatment for me?
• What are the treatment side effects?
• Am I at risk for metastatic cancer? How can I lower this risk?
• Are other family members at risk for kidney cancer?
• Should I look out for signs of complications?

What Is The Outlook For People With Kidney Cancer

The chance of recovery depends on the type and stage of cancer . The chance of recovery also depends on the patient’s general state of health.

Like most cancers, kidney cancer is most able to be treated if it is found in its early stages. In general, if the cancer is detected early, before it breaks through the outer covering of the kidney, kidney cancer is often curable.

Last reviewed by a Cleveland Clinic medical professional on 12/08/2016.

References

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Outlook For Kidney Cancer

The outlook for kidney cancer largely depends on how big the tumour is and how far it has spread by the time it’s diagnosed.

If the cancer is still small and has not spread beyond the kidney, surgery can often cure it. Some small, slow growing cancers may not need treatment at first.

A cure is not usually possible if the cancer has spread, although treatment can sometimes help keep it under control. Some people become unwell quickly, but others may live for several years and feel well despite having kidney cancer.

Around 7 in 10 people live at least a year after diagnosis and around 5 in 10 live at least 10 years.

Cancer Research UK has more information about survival statistics for kidney cancer.

Renal Cell Cancer Is A Disease In Which Malignant Cells Form In Tubules Of The Kidney

Renal cell cancer is a disease in which malignant cells are found in the lining of tubules in the kidney. There are 2 kidneys, one on each side of the backbone, above the waist. Tiny tubules in the kidneys filter and clean the blood. They take out waste products and make urine. The urine passes from each kidney through a long tube called a ureter into the bladder. The bladder holds the urine until it passes through the urethra and leaves the body.

Cancer that starts in the ureters or the renal pelvis is different from renal cell cancer. .

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The Following Stages Are Used For Renal Cell Cancer:

Stage I

In stage I, the tumor is 7 centimeters or smaller and is found in the kidney only.

Stage II

In stage II, the tumor is larger than 7 centimeters and is found in the kidney only.

Stage III

In stage III, one of the following is found:

• the cancer in the kidney is any size and cancer has spread to nearby lymph nodes or
• cancer has spread to blood vessels in or near the kidney , to the fat around the structures in the kidney that collect urine, or to the layer of fatty tissue around the kidney. Cancer may have spread to nearby lymph nodes.

Stage IV

In stage IV, one of the following is found:

• cancer has spread beyond the layer of fatty tissue around the kidney and may have spread into the adrenal gland above the kidney with cancer or to nearby lymph nodes or
• cancer has spread to other parts of the body, such as the bones, liver, lungs, brain, adrenal glands, or distant lymph nodes.