Renal Cancer

Renal cell carcinoma is the most prevalent form of kidney cancer, comprising various subtypes. The primary variants are clear cell—the most common—and non-clear cell forms. Included among these are distinct types such as papillary, chromophobe, medullary, oncocytoma, translocation, and collecting duct carcinoma, alongside rarer subtypes identified by specific genetic mutations. Sarcomatoid renal cell carcinoma is an aggressive form that may develop within both clear and non-clear cell categories. This condition occurs when kidney cells begin to grow uncontrollably. The kidneys are crucial organs within the urinary tract, tasked with urine production, waste removal from the body, and generating hormones that regulate blood pressure and the production of red blood cells.

Symptoms

Symptoms of renal cancer typically present as the disease progresses. These may include:

• Pain in the flank or the side of the body

• Presence of blood in the urine

• Detection of a lump or mass in the abdomen or side

• Swelling in the scrotum, known as varicocele

• Swelling in the lower legs

• Persistent fatigue or unusual tiredness

• Episodes of fever

It's crucial to note that early stages of renal cancer often show no symptoms, highlighting the importance of awareness as the disease advances.

Diagnosis

Diagnosing renal cell carcinoma generally starts with imaging studies such as a CT scan or MRI of the abdomen and pelvis. Further imaging, including chest and brain scans, might be conducted if an aggressive form of the cancer is suspected to have metastasized. Often, kidney cancer is found incidentally during imaging for other health issues, revealing an unexpected mass in the kidney. Some patients might undergo imaging due to symptoms suggestive of a potential kidney tumor.

Once a tumor is detected, patients are typically referred to a specialized cancer team for detailed staging. A biopsy might be recommended to collect tumor tissue samples for microscopic examination and testing for tumor markers, providing insights into the cancer's behavior and spread. Further imaging, like bone scans or PET scans, may be advised to identify metastasis. The cancer stage is determined based on factors such as tumor size, lymph node involvement, and potential spread beyond the kidney. Renal cell carcinoma is categorized into four stages, with Stage 1 being the least advanced and Stage 4 the most severe.

Treatments

Treatment for renal cancer, specifically renal cell carcinoma, varies according to disease stage. For early-stage cancer, surgery is commonly pursued, involving either a radical or partial nephrectomy to remove the tumor and all or part of the affected kidney. In some cases, ablation therapies are utilized for small renal tumors. Surgery may cure kidney cancer, but routine follow-ups are essential over several years to monitor for recurrence.

For those with high-risk or metastatic kidney cancer, post-surgery medications, known as adjuvant therapy, may be used to lower recurrence risks. Options include Pembrolizumab (Keytruda), an intravenous immunotherapy, and Sunitinib, an oral drug. These therapies aim to reduce relapse chances, though their effects on overall survival remain uncertain. The decision to undergo adjuvant therapy is highly personalized due to potential associated risks.

In more advanced or recurring cases, systemic therapy is used. This involves medications taken orally or intravenously, featuring targeted therapy to inhibit cancer cell growth and immunotherapy to enhance the immune system's cancer-fighting efficacy. Innovatively developed over the past 15 years, these treatments offer patients the possibility of prolonged survival when used alone or in combination.

Living

A renal cancer diagnosis can be daunting, leaving many uncertain about their next steps. The crucial first step is to assemble a care team adept at handling renal cell carcinoma, given its rarity. Starting with a consultation at a National Cancer Institute (NCI) Designated Cancer Center can provide guidance. Cultivating a support system is paramount, and joining a support group can offer connection with others who understand the experience. The Kidney Cancer Association provides support groups for both patients and caregivers and offers information resources, including patient liaisons, educational videos, and articles on kidney cancer. They also offer guidance on complementary and alternative therapies to enhance treatment.