9 out of 10 cases of adult renal cancers are attributed to Renal Cell Carcinoma (RCC), making it the most common type of kidney cancer. RCC is also known as Grawitz tumor or hypernephroma. RCC is commonly seen in the older age group, people aged between 50 and 70 years. The male-to-female ratio of RCC incidence is 2:1.
The tumorous growth originates in the lining of the small tubes inside the kidney. In most cases, it has been observed that the development of Renal Cell Carcinoma is silent and generally gets identified when imaging tests are conducted for other health conditions.
In current times, the use of advanced imaging, surgical procedures, and targeted therapies makes the prognosis of kidney cancer significantly better. This write-up has been prepared to help readers understand the symptoms, diagnosis, and different options of RCC treatment
What Is Renal Cell Carcinoma?
RCC is the malignancy of the renal cortex or the outer region of the kidney. Renal cell carcinoma usually originates in the proximal convoluted tubule or the part of the nephron that helps filter blood to form urine. The risks of developing RCC include smoking, obesity, high blood pressure, renal failure, and at times, exposure to certain chemicals.
There are different subtypes of RCC:
Subtypes of RCC
- Clear Cell RCC: This is the most common subtype in adults. Almost 80% of all RCC cases are of this subtype. It is common in adults vis-à-vis kids. It often grows rapidly but responds well to targeted therapy and immunotherapy.
- Papillary Renal Cell Carcinoma (PRCC): It accounts for about 15% of all renal cell carcinoma cases. It is not as aggressive as clear cell RCC. There are two types of PRCC: Type 1 and Type 2, the latter of which is more aggressive.
- Chromophobe RCC: ChRCC accounts for about 5% to 7% of all Renal Cell carcinoma cases. It is the third-most common subtype of RCC. This originates in the intercalated cell of the distal tubules.
- Collecting Duct RCC and Medullary RCC: These are the rarest forms of RCC - extremely rare but very aggressive, which require specialized care.
Symptoms of RCC
The biggest challenge in the diagnosis of RCC is that there are very few symptoms during the initial stage. In most patients, during imaging tests, the disease is usually discovered. But as the kidney tumor grows, the symptoms start to show up.
Common Symptoms of RCC
- Hematuria or blood in the urine is indicative of kidney tumors. It is one of the first noticeable symptoms.
- Persistent pain in the back just below the ribs. This can be dull or sharp pain.
- Unexplained weight loss
- Fatigue and loss of appetite
- Fever not associated with infection
- An abdominal mass on the side of the abdomen.
- High blood pressure or anemia caused by kidney dysfunction
Diagnosis of Renal Cell Carcinoma
A comprehensive check-up of the patient's medical history is carried out along with physical examination. In case renal cell carcinoma is suspected, the doctor may advise a series of test for the proper diagnosis of the kidney tumor.
Common Diagnostic Tools for RCC
- Ultrasound: It is usually the first-line tool to identify abnormalities in kidney structure.
- CT Scan/MRI: The imaging results are used to get details of the size, location, and potential spread of the tumor.
- Urinalysis and Blood Tests: These tests help detect anomalies in the physiological functions of the kidneys and other biochemical changes. The tests also help detect hematuria.
- Biopsy: If the doctor will advise In select cases, a sample of tissue is extracted for microscopic analysis to confirm the subtype of RCC.
After the detection of renal cell carcinoma, the stage of cancer is determined to understand the spread of the cancerous growth and also the further course of action.
RCC Treatment: Leading Options
Treatment options depend largely on the stage of the cancer. In the case of RCC, there are four stages as follows -
- Stage I - In this stage, the kidney tumor is 7 cm or smaller and is inside the kidney only
- Stage II - in this stage, the tumor is more than 7 cm and is inside the kidney only
- Stage III - in this stage, the tumor can be of any size but it has spread to the surrounding lymph nodes, blood vessels, fatty tissues around the kidney, or the structure that collects urine.
- Stage IV - In this stage, the cancer has spread around the kidney or to other body parts.
If the kidney tumor is in its early stages, it can be removed via surgical methods. In case of advanced cases, systematic treatment procedures are usually employed.
Here’s a brief about the different RCC treatment options:
1. Cases where surgery is a possibility
For localized RCC, surgical removal of the tumor is the best route. One of the following options is advised as per the location of the tumors:
- Partial Nephrectomy - In this surgical procedure, the tumor and surrounding tissues are removed only. The function of the kidney is preserved.
- Radical Nephrectomy - The procedure involves the removal of the entire kidney along with nearby tissues and lymph nodes.
- Simple Nephrectomy - In this case, only the affected kidney is removed.
2. Cases where surgery is not a possibility
- Arterial Embolization: In this process, the tumor size is shrunk where a catheter is inserted into the kidney’s main blood vessel through a small cut. Tiny pieces made from gelatin sponge are injected into the blood vessel to prevent blood flow and oxygen to the cancerous area.
- Cryosurgery: In this process, a medical-grade instrument is used to freeze and annihilate the cancerous cells.
- Thermal Ablation or Hyperthermia: This is a process where heat is used to demolish abnormal cell growth.
- Radiation Therapy: High-energy x-ray beams are used to destroy cancer cells using a machine.
- Targeted Therapy: In this process, medications are used to work on the cancer cell pathways like a growth in blood vessels or genetic mutations. Patients with Clear Cell RCC respond particularly well to targeted therapy.
- Immunotherapy: This is a RCC treatment method that helps make the body’s immune system stronger to fight cancer. Benefits include lesser side effects vis-a-vis traditonal chemotherapy, and better response in advanced cases. This therapy is particularly effective in the case of clear cell RCC and papillary renal cell carcinoma.
Renal cell carcinoma is a serious condition. However, with modern technology and advancement in surgical techniques, the condition can be managed, provided the kidney tumor is diagnosed early.
