Renal Cell Carcinoma (Kidney Cancer)

Clinical Description

Renal cell carcinoma is the most common form of kidney cancer in adults. The kidneys are bean-shaped, approximately fist-size organs that are located on each side in the mid-back, just below the ribs. The kidneys filter the blood and get rid of excess water and waste in the urine.

Symptoms of Renal Cell Carcinoma

Renal cell carcinoma does not always cause obvious symptoms, especially in the early stages. As a result, the cancer may not be discovered until it is advanced. Symptoms of renal cell carcinoma include:

·         Blood in the urine

·         Pain in the sides of the low back (the flank)

·         A lump in the abdomen or side of the back

·         Weight loss

·         Pain in the back, side or abdomen

·         Scrotal swelling (in men)

If you experience any of these symptoms, contact your healthcare provider for evaluation.

Risk Factors of Renal Cell Carcinoma

A number of environmental and clinical factors have been implicated in the etiology of renal cell carcinoma (RCC). These include smoking, occupational exposure to toxic compounds, obesity, acquired cystic disease of the kidney (typically associated with dialysis), analgesic-induced kidney disease, and genetic predisposition.

Occupational exposure to toxic compounds, such as cadmium, asbestos, and petroleum by-products, has been implicated in the risk of RCC. Increased exposure to such carcinogens may be associated with mutations in genes associated with the development of RCC.

Acquired cystic disease of the kidney is a condition that is acquired in some patients receiving dialysis. The risk of RCC has been estimated to be 30 times greater in such patients.

How Renal Cell Carcinoma is Diagnosed

If you have symptoms of renal cell carcinoma, your doctor may order an imaging test such as a CT scan, MRI or ultrasound to evaluate the kidneys. In some cases, the cancer is found if one of these tests is done for another reason. If an ultrasound suggests kidney cancer, a CT scan or MRI will be performed to further evaluate the abnormality. Unlike other cancers, RCC is usually diagnosed based on the appearance of the CT scan, and biopsy is seldom necessary. The diagnosis is confirmed when the tumor or kidney is removed during surgery as part of the treatment for this disease.

Treatment Options for Renal Cell Carcinoma at Tufts Medical Center

Localized renal cell carcinoma can sometimes be treated with surgery to remove part or the entire affected kidney. The term “radical nephrectomy” refers to complete removal of the kidney and surrounding tissues. Most people can live with only one kidney.

If your kidneys do not work well, “nephron-sparing surgery” may be recommended, where only the cancerous part of the tumor is removed. If the tumor is large or if there are multiple tumors, this may not be possible.

For patients with localized RCC, further treatment after surgery is not usually needed. For those with advanced or metastatic renal cell carcinoma, treatment with medicine may be recommended instead of or along with surgery. Advanced RCC is difficult to cure, and such patients may be presented with the option to enroll in a clinical trial.

Currently available medical treatment for advanced RCC includes targeted therapy, anti-angiogenic therapy, and immune therapy.

• Targeted therapy is designed to slow the growth of the tumor by “targeting” one or more steps in the cancer’s growth process. Depending on you particular situation, targeted therapy may be recommended. These medicines include temsirolimus (Torisel) and everolimus (Afinitor).
  
• Anti-angiogenic treatments reduce the blood supply to the tumor, thus slowing or stopping it’s growth. Immune therapy aims to trigger your own immunes system to attack and “reject”, or kill, the cancer cells. The most commonly used treatment for advance renal cell carcinoma is anti-angiogenic therapy. The most commonly used drugs are sunitinib (Sutent) or sorafenib (Nexavar). Other medicines include pazopanib (Votrient) and bevacizumab (Avastin).
  
• Immune therapy is reserved only for rare patients, as the drug which is used (interleukin-2) is highly toxic and requires a healthy patient and multiple admissions to the hospital for treatment.

Advanced or metastatic RCC is rarely cured, and therefore ongoing research continues in this disease to develop new and improved treatments. When available, patients are encouraged to enroll in a clinic trial.

Clinical Trials Available for Patients

Our patients have access to novel therapies through participation in both Tufts Medical Center clinical trials and national clinical trials.

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