Renal cell carcinoma

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

Definition
Renal cell carcinoma, a form of kidney cancer that involves cancerous changes in the cells of the renal tubule, is the most common type of kidney cancer in adults

Causes, incidence, and risk factors

Renal cell carcinoma affects about 3 in 10,000 people, resulting in about 31,000 new cases in the US per year. Every year, about 12,000 people in the US die from renal cell carcinoma. It is more common in men than women, usually affecting men older than 55.

What causes the cells to become cancerous is not known. A history of smoking greatly increases the risk for developing renal cell carcinoma. Some people may also have inherited an increased risk to develop renal cell carcinoma, and a family history of kidney cancer increases the risk.

People with von Hippel-Lindau disease, a hereditary disease that affects the capillaries of the brain, commonly also develop renal cell carcinoma. Kidney disorders that require dialysis for treatment also increase the risk for developing renal cell carcinoma.

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

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.

• A CBC may show increased red blood cells (RBC) caused by stimulation of RBC production by the tumor. More commonly, though, it shows a decrease in RBC count.
  
• The RBC in urine is increased.
  
• Serum calcium levels may increase because of hormonal changes resulting from the tumor.
  
• The SGPT and alkaline phosphatase may be elevated.
  
• A urine cytology examination may show carcinoma cells.
  
• Liver function tests may show involvement of the liver from metastasis, or may be abnormal without metastasis.
  
• An ultrasound of the abdomen and kidney may show the tumor.
  
• Kidney x-ray may indicate a tumor or calcification.
  
• IVP may indicate obstruction by the tumor.
  
• Renal arteriography may show the tumor if it is highly vascular.

Because metastasis is common, the following tests to look for metastasis may be performed:

• An abdominal CT scan shows the kidney tumor and may show a liver mass.
  
• Sometimes an abdominal MRI has to be done to determine if the tumor involves any surrounding blood vessels and to determine 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 is not commonly used for treatment of renal cell carcinoma because it is usually not successful. 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 with metastasis. Chemotherapy may be used in some cases, but cure is unlikely unless all the cancer is removed with surgery.

Support Groups
The stress of illness may be eased by joining a support group whose members share common experiences and problems. See cancer - support group and kidney disease - support group.

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.

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