Renal Cell Carcinoma

By Peter Galvin, MD

Renal cell carcinoma (RCC) is a common cancer that forms in the kidneys. In 2023, an estimated 81,800 people were diagnosed with RCC in the U.S., making it the sixth most common cancer among men and the ninth among women. It is most often diagnosed in people aged 60 to 70 years. Although the diagnosis has increased slightly in the U.S. in recent years, deaths from RCC have declined thanks to new forms of therapy. Risk factors for RCC include high blood pressure, smoking, kidney disease (especially among those undergoing dialysis), environmental exposures to heavy metals or industrial solvents, obesity, and certain hereditary cancer disorders.

Symptoms of RCC may include pain on one side of the body between the ribs and the waist (flank pain), an abdominal mass, and blood in the urine. However, only 10% of patients with RCC will have all three symptoms. Other signs may include fever, elevated blood calcium levels, anemia, increased platelet counts, and a high concentration of red blood cells. For many patients (37% – 61%), RCC is detected during an imaging study (ultrasound or CT scan) that was performed for another reason. This is called an incidental finding. In other words, very often RCC is discovered by accident. Those with symptoms of RCC should undergo an abdominal CT or MRI scan and should be referred to a urologist.

RCC is categorized into stages I through IV. Stage I is defined as tumor confined to the kidney, and stage IV is tumor that has spread to distant organs. Currently, about 70% of patients with RCC are diagnosed as stage I, and about 11% as stage IV. First-line treatment of stage I is surgical removal of part or all of the kidney, followed by treatment with pembrolizumab, an immune checkpoint inhibitor. This is a relatively new form of cancer therapy. Most cancer cells, including RCC cells, have proteins on the cell surface called tumor antigens. These tumor antigens can be recognized and attacked by the body’s own immune system. Immune checkpoint inhibitors block the natural restraints to the immune system, allowing it to aggressively attack tumor cells.

A treatment option for small RCC tumors (< 4 cm) is active surveillance, which involves monitoring the tumor with ultrasound or CT scan at intervals of 3 months, then every six months for up to three years. If the tumor grows during surveillance, patients may opt for surgery to remove it, ablation therapy (which uses high heat or extreme cold to destroy cancer cells), or radiation therapy. Ablation therapy is a good choice for those with small tumors (< 3 cm) and high surgical risk. Patients with RCC that has spread outside of the kidney can be treated with anticancer regimens like immune checkpoint inhibitors or tyrosine kinase inhibitors.

The five-year survival rate for those with stage I disease who undergo surgery is 94%. The average five-year survival rate for stage II is 63% and stage III is 78%. The five-year survival rate for stage IV disease varies among individuals but is approximately 28%. For more information go to the website of the National Cancer Institute at www.cancer.gov

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