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Where Does Renal Cell Carcinoma Metastasis To

How Is Ccrcc Treated

Systemic treatment options for patients with metastatic non-clear cell renal cell carcinoma

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

Treatment Of Stage Iv And Recurrent 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.

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.

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Assessing The Response Of Bone Metastases To Therapy

As mentioned above, the radiological assessment of the response to treatment of bone metastases from any malignancy is difficult. Furthermore, because the hard endpoint of SREs requires following large numbers of patients for a long period of time in order to gather meaningful results, there has been considerable interest in surrogate markers that can predict for SREs. Urinary N-telopeptide is a peptide fragment of the N-terminus of type I collagen, which is predominant in bone and is correlated with the presence of metastatic disease. Its measurement has assumed a role as such a marker .

In one study of 121 patients with bone metastases from various malignancies, patients with uNTX levels higher than 100nmol/mmol creatinine before initiation of bisphosphonate therapy had a 19-fold increase in the relative risk of a SRE during the first 3 months of therapy compared to those patients with lower uNTX . Logistic regression analyses demonstrated that 84% of the SREs that occurred in the first 3 months of treatment could be predicted by uNTX measurements.

Thus, a significant correlation exists between uNTX and subsequent risk of SREs in a number of solid tumors and because of this uNTX is used as an endpoint in many studies that are designed to assess the effectiveness of bone-specific antineoplastic therapies.

Surgery For Renal Cell Carcinoma


Removal of the diseased kidney is the standard treatment of renal cell carcinoma. People can live normally with one kidney if that kidney is healthy. The 3 main types of nephrectomy are as follows:

  • Partial nephrectomy: The tumor and part of the kidney around the tumor are removed. The partial nephrectomy is performed mainly in people who have problems with their other kidney. This treatment is being investigated by surgeons to determine if it is as effective as the standard procedures to remove the kidney, as described below.
  • Simple nephrectomy: The cancerous kidney is removed.
  • Radical nephrectomy: The cancerous kidney, adrenal gland, and surrounding tissue are removed.

Nephrectomy may be performed with a large incision or via laparoscopy. Laparoscopy is a technique that removes the kidney through a very small incision. Laparoscopy leaves a smaller scar and requires less time in the hospital. It is used for people with small kidney cancers.

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Assessment Based On Tumor Size

Response Evaluation Criteria in Solid Tumors 1.1.The RECIST 1.1 classification is currently the most widely used method of assessing the efficacy of antiangiogenic agents . RECIST 1.1 is based solely on unidimensional measurements to quantify changes in tumor size, obtained by summing the longest diameters of the target lesions in the axial plane. The widespread availability and reproducibility of CT make it the imaging modality of choice for assessing target lesions. RECIST defines four categories of tumor response.

Figure 13 summarizes the characteristics of the lesions categorized as target lesions, the four categories of response, and assessment of response to treatment. It should be noted that RECIST mandates a decrease of at least 30% in the sum of the longest diameters of the target lesions for a partial response and an increase of at least 20% in the sum of the longest diameters for progressive disease, as compared with the baseline pretreatment measurement.

Figure 13 RECIST 1.1. Diagram summarizes the RECIST 1.1 criteria for how lesions should be identified as target lesions, the imaging response categories, and assessment of response to treatment. Partial response requires a 30% decrease in size, and progressive disease requires a 20% increase in the sum of the longest diameters, as measured from the baseline study.

Figure 13

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:

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Tnm Staging And The Stages Of Kidney Cancer

Kidney cancer is described in stages that the American Joint Committee on Cancer developed. The system is better known as the TNM system.

  • T refers to the tumor. Doctors assign a T with a number thats based on the size and growth of the tumor.
  • N describes whether the cancer has spread to any nodes in the lymph system.
  • M means the cancer has metastasized.

Based on the characteristics above, doctors assign RCC a stage. The stage is based on the size of the tumor and the spread of the cancer.

There are four stages:

  • Stages 1 and 2 describe cancers in which the tumor is still in the kidney. Stage 2 means that the tumor is larger than seven centimeters across.
  • Stages 3 and 4 mean the cancer has either spread into a major vein or nearby tissue or to lymph nodes.
  • Stage 4 is the most advanced form of the disease. Stage 4 means that the cancer has spread to the adrenal gland or has spread to distant lymph nodes or other organs. Because the adrenal gland is attached to the kidney, the cancer often spreads there first.

Types Of Renal Cell Carcinoma

Risk Stratification for Metastatic 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

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Understanding The Spread: Metastatic Renal Cell Carcinoma

Metastatic renal cell carcinoma

Renal cell carcinoma, also called kidney cancer, occurs when cancer cells form in the tubules of the kidney. Tubules are tiny tubes in your kidney that help filter waste products from your blood in order to make urine.

Smoking, hypertension, obesity, and hepatitis C all increase the risk of renal cell carcinoma. Renal cell carcinoma becomes metastatic renal cell carcinoma when it spreads beyond your kidney to your lymph system, bones, or other organs.

Renal cell carcinoma can spread from a mass of cancer cells or tumor to other parts of your body. This process is called metastasis. It occurs in one of three ways:

  • Cancer cells spread into the tissue around the tumor in your kidney.
  • The cancer moves from your kidney into your lymph system, which has vessels throughout the body.
  • Kidney cancer cells enter the bloodstream and are carried and deposited to another organ or location in your body.

When renal cell carcinoma is in its early stages, its unlikely that youll experience obvious symptoms. Noticeable symptoms are often a sign that the disease has metastasized.

Symptoms typically include:

A physical exam and a review of your medical history may prompt further testing to determine the health of your kidneys.

Cancer May Spread From Where It Began To Other Parts Of The Body

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if renal cell cancer spreads to the bone, the cancer cells in the bone are actually cancerous renal cells. The disease is metastatic renal cell cancer, not bone cancer.

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What Is Clear Cell Renal Cell Carcinoma

Clear cell renal cell carcinoma, or ccRCC, is a type of kidney cancer. The kidneys are located on either side of the spine towards the lower back. The kidneys work by cleaning out waste products in the blood. Clear cell renal cell carcinoma is also called conventional renal cell carcinoma.

Clear cell renal cell carcinoma is named after how the tumor looks under the microscope. The cells in the tumor look clear, like bubbles.

Renal Cell Carcinoma And Its Metastasis:

Brain metastases (renal cell carcinoma)

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If I Have Cancer In One Kidney What Are The Chances Of It Spreading To The Other One

Like many forms of cancer, kidney cancer can potentially spread to other parts of the body, such as lymph nodes, bones and other organs. When this occurs, the condition is known as metastatic renal cell carcinoma. Patients with a personal history of kidney cancer in one kidney are at slightly higher risk of development of kidney cancer in their other kidney, but the absolute risk for this is relatively small.

Metastatic Renal Cell Carcinoma: Metastasectomy Improves Outcomes

Renal cell carcinoma represents 90% of all kidney cancers, with most patients being diagnosed with clear cell histology.1 Metastatic renal cell carcinoma is not uncommon 35% of patients eventually developing metastases and more than 25% of patients are diagnosed with metastatic disease upon initial diagnosis.2 Although treatments vary on a patient-to-patient basis, options include systemic and hormonal therapy, radiation, and surgery.3

Systemic treatments include immune checkpoint inhibitors : programmed cell death 1 inhibitors and programmed cell death ligand 1 inhibitors, and anticytotoxic T lymphocyte protein 4 antibodies.3 In addition to ICIs, there are also vascular endothelial growth factor inhibitors, tyrosine kinase inhibitors , and mammalian target of rapamycin inhibitors.3 Despite the array of medications available, these treatment options typically do not result in a complete response in patients with mRCC.3 Therefore, these patients are frequently evaluated for surgery, both of the primary tumor and metastases.

Much of the data from previous studies evaluating metastasectomy in mRCC occurred prior to the significant expansion of systemic treatment options such as TKIs and ICIs. Therefore, a group led by Dragomir et al recently aimed to update the outcomes associated with metastasectomy in the current treatment environment of mRCC, and published their findings in Urologic Oncology.1

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Patients May Want To Think About Taking Part In A Clinical Trial

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today’s standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

How Will I Feel

Risk Stratification in Metastatic Renal Cell Carcinoma

The symptoms of kidney cancer are different for each person. In most cases, youâll see blood in your pee. You may feel generally sick, tired, and like you donât want to eat much. And you may have:

  • A fever that comes and goes
  • A lump in your belly
  • Night sweats, so much that you need to change your clothes or sheets
  • Pain in your back or side that wonât go away
  • Weight loss for no reason

You might also get symptoms where the cancer spreads. If itâs in one of your bones, you might feel pain there. In your lungs, it can give you a cough or trouble breathing.

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How Fast Does Kidney Cancer Spread

As with many other types of cancer, several factors determine how fast kidney cancer can spread. Your age, overall health and the type of kidney cancer all play a role in whether the disease is fast- or slow-growing.

The spread pattern depends on how aggressive the cells are, says Saby George, MD, FACP, Department of Medicine. The most common type of kidney cancer, clear cell renal cell carcinoma, can have various subtypes within it. There are two subtypes, sarcomatoid and rhabdoid, that can spread very quickly and cause havoc throughout the body.

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