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Renal Cell Carcinoma: Causes, Symptoms & Treatment

Renal cell carcinoma is the most common malignant kidney disease in adults. Early diagnosis significantly improves the chances of successful treatment.

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Things worth knowing about "Renal cell carcinoma"

Renal cell carcinoma is the most common malignant kidney disease in adults. Early diagnosis significantly improves the chances of successful treatment.

What is Renal Cell Carcinoma?

Renal cell carcinoma (RCC) is a malignant tumor that originates in the cells of the renal cortex. It is the most common form of kidney cancer in adults, accounting for approximately 85 percent of all kidney tumors. Men are more frequently affected than women, and the risk of developing the disease increases significantly after the age of 60.

Causes and Risk Factors

The exact causes of renal cell carcinoma are not fully understood. However, several risk factors are known to increase the likelihood of developing the disease:

Smoking: Tobacco use is one of the most important preventable risk factors.
Obesity: Being significantly overweight increases the risk of developing RCC.
High blood pressure: Chronic arterial hypertension is associated with a higher risk.
Genetic factors: Hereditary syndromes such as Von Hippel-Lindau syndrome substantially increase the risk.
Chronic kidney disease and dialysis: Patients with long-term kidney failure requiring dialysis have an elevated risk.
Occupational exposure: Contact with substances such as asbestos or cadmium may increase the risk.

Symptoms

In early stages, renal cell carcinoma often causes no symptoms. Many tumors are discovered incidentally during ultrasound examinations. In advanced stages, the following symptoms may occur:

Blood in the urine (hematuria) – often painless
Pain in the flank or back region
A palpable mass in the abdomen or flank area
Unexplained weight loss and loss of appetite
Persistent fatigue and general malaise
Fever without an identifiable infection
Anemia or elevated erythrocyte sedimentation rate

Diagnosis

The diagnosis of renal cell carcinoma is established using a variety of examination methods:

Imaging Procedures

Ultrasound (sonography): Often the first examination performed when a kidney tumor is suspected.
Computed tomography (CT): The standard method for accurately assessing the size, location, and extent of the tumor.
Magnetic resonance imaging (MRI): Used as a supplement, particularly when CT contrast agents are contraindicated.

Additional Examinations

Blood and urine tests: To assess kidney function and detect blood in the urine.
Biopsy: Tissue sampling for histological confirmation of the diagnosis, especially when therapeutic decisions are uncertain.
Bone scan or PET-CT: Used when metastases to other organs or bones are suspected.

Treatment

Treatment of renal cell carcinoma depends on the stage of the disease, the general health of the patient, and the presence of metastases.

Surgical Treatment

For locally confined tumors, surgical removal is the treatment of choice. Depending on the size and location of the tumor, either a kidney-sparing procedure (partial nephrectomy) or complete removal of the kidney (radical nephrectomy) is performed. Both procedures can be performed as open surgery or minimally invasively (laparoscopic or robot-assisted).

Ablative Procedures

For small tumors or patients who are not suitable candidates for surgery, ablative procedures such as radiofrequency ablation (RFA) or cryoablation (freezing) may be considered.

Systemic Therapy for Metastatic Renal Cell Carcinoma

In advanced or metastatic stages, the following treatment approaches are available:

Targeted therapies: Drugs such as sunitinib, pazopanib, or cabozantinib inhibit specific tumor growth signaling pathways.
Immunotherapy (checkpoint inhibitors): Agents such as nivolumab or pembrolizumab activate the immune system to fight the tumor and are frequently used in combination therapies.
mTOR inhibitors: Substances such as everolimus inhibit a central metabolic pathway involved in tumor growth.

Radiation Therapy

Renal cell carcinoma has a limited response to conventional radiation therapy. However, stereotactic radiosurgery is used for individual metastases, particularly brain metastases.

Prognosis

The prognosis depends strongly on the stage of the disease at the time of diagnosis. For locally confined tumors, the chances of cure are good, with 5-year survival rates exceeding 90 percent in early stages. In metastatic renal cell carcinoma, the prognosis is considerably worse; however, it has improved significantly in recent years due to modern immunotherapies and targeted therapies.

References

Ljungberg B. et al. - EAU Guidelines on Renal Cell Carcinoma. European Association of Urology (2023). Available at: https://uroweb.org/guidelines/renal-cell-carcinoma
Motzer RJ. et al. - Kidney Cancer, Version 3.2022. NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network (2022).
Hsieh JJ. et al. - Renal cell carcinoma. Nature Reviews Disease Primers, 3: 17009 (2017). DOI: 10.1038/nrdp.2017.9

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