Renal cell carcinomacancer arising from tissues that line organs (RCC) is a type of carcinoma that develops in the kidneys. More specifically, it develops in the renal cellsthe basic structural and functional unit of all living things that line the tubules in the kidneys. It is the most common form of kidneya pair of bean-shaped organs in the abdomen that are responsible for filtering excess water and waste products from the blood and converting them into urine to be removed from the body cancera disease where abnormal cells split without control and spread to other nearby body tissue and/or organs, followed by urothelial carcinoma/transitional cell carcinoma (TCC) and nephroblastoma (Wilms tumour).
The kidneys are a pair of bean-shaped organs that sit in the middle of your back on each side of your spine. It is responsible for filtering excess water and waste products from the bloodthe red bodily fluid that transports oxygen and other nutrients around the body, and converting them into urine to be removed from the body. The kidneys also produce and secrete certain hormones that regulate blood pressure and initiate the production of red blood cells.
RCC is most commonly diagnosed in men, and is usually diagnosed in people over 50 years old. However, this disease can develop in anyone.
Types of Renal Cell Carcinoma
There are several types of RCC, that are classified by their histological appearance (how the cells look under the microscope). All types generally have the same riskthe possibility that something bad will happen factors, diagnostic tests, and treatment options.
Clear Cell Renal Cell Carcinoma (ccRCC)
This is the most common form of RCC, and is named for the appearance of clear or empty-looking cells. ccRCC is most commonly diagnosed in adults, however, children can also develop this disease.
Papillary Renal Cell Carcinoma (PRCC)
PRCC is the second most common type of RCC, and is characterised by renal cells arranged in finger-like structures. There are two types of PRCC, which are classified by growth rate. Type I PRCC is more common, and tends to grow slowly, while type II tends to be more aggressive and grows quicker.
Chromophobe Renal Cell Carcinoma (ChRCC)
ChRCC is a rare form of RCC, and is characterised by large and pale renal cells. It tends to be less aggressive than other forms of RCC, and usually has a better prognosisto predict how a disease/condition may progress and what the outcome might be.
Other forms of RCC
Other types of RCC are very rare, and include:
- Renal medullary carcinoma, which stems from the innermost portion of the kidney (renal medulla).
- Collecting duct carcinoma, which stems from the end part of the kidney (collecting ducts), which connects the kidneys to the ureters and bladdera hollow, muscular sac in the pelvis that stores urine.
- MiT family translocation RCC, which is a genetic form of RCC stemming from mutations in TFE3 and TFEB genes.
- Sarcomatoid RCC, which is a more aggressive form of RCC and is usually difficult to treat.
- Other very rare forms.
Treatment
If RCC is detected, it will be staged and graded based on size, metastasiswhen the cancer has spread to other parts of the body, also known as mets, and how the cancer cells look under the microscope. Stagingthe process of determining how big the cancer is, where it started and if it has spread to other areas and grading helps your doctors determine the best treatment for you.
Cancers can be staged using the TNM staging system:
- T (tumoura tissue mass that forms from groups of unhealthy cells) indicates the size and depth of the tumour.
- N (nodea small lump or mass of tissue in your body) indicates whether the cancer has spread to nearby lymph nodessmall bean-shaped structures that filters harmful substances from lymph fluid.
- M (metastasis) indicates whether the cancer has spread to other parts of the body.
This system can also be used in combination with a numerical value, from stage 0-IV:
- Stage 0: this stage describes cancer cells in the place of origin (or ‘in situ’) that have not spread to nearby tissuea group of cells that work together to perform a function.
- Stage I: cancer cells have begun to spread to nearby tissue. It is not deeply embedded into nearby tissue and had not spread to lymph nodes. This stage is also known as early-stage cancer.
- Stage II: cancer cells have grown deeper into nearby tissue. Lymph nodes may or may not be affected. This is also known as localisedaffecting only one area of body cancer.
- Stage III: the cancer has become larger and has grown deeper into nearby tissue. Lymph nodes are generally affected at this stage. This is also known as localised cancer.
- Stage IV: the cancer has spread to other tissues and organs in the body. This is also known as advancedat a late stage, far along or metastatic cancer.
Cancers can also be graded based on the rate of growth and how likely they are to spread:
- Gradea description of how abnormal cancer cells and tissue look under a microscope when compared to healthy cells I: cancer cells present as slightly abnormal and are usually slow growing. This is also known as a low-grade tumour.
- Grade II: cancer cells present as abnormal and grow faster than grade-I tumours. This is also known as an intermediate-grade tumour.
- Grade III: cancer cells present as very abnormal and grow quickly. This is also known as a high-grade tumour.
Once your tumour has been staged and graded, your doctor may recommend genetic testinga procedure that analyses DNA to identify changes in genes, chromosomes and proteins, which can be used to analyse tumour DNA to help determine which treatment has the greatest chance of success, which analyses your tumour DNA and can help determine which treatment has the greatest chance of success. They will then discuss the most appropriate treatment option for you.
Treatment is dependent on several factors, including location, stage of disease and overall health.
Treatment options for patients with renal cell carcinoma may include:
- Surgerytreatment involving removal of cancerous tissue and/or tumours and a margin of healthy tissue around it to reduce recurrence, potentially including:
- Nephrectomycomplete or partial removal of affected kidney(s).
- Lymphadenectomysurgical removal of lymph node(s).
- Radiation therapya treatment that uses controlled doses of radiation to damage or kill cancer cells, potentially including stereotactic ablative body radiation (SABR)a precise radiation therapy technique that delivers high doses of radiation to tumors while minimising damage to surrounding healthy tissues, may be given to patients who can't undergo surgery .
- Cryotherapythe process of freezing off cancerous tumours and/or lesions using liquid nitrogen.
- Targeted therapymedication that targets specific molecular features of cancer cells.
- Immunotherapya treatment that uses a person's immune system to fight cancer.
- Ablation therapya minimally invasive procedure that uses extremely high or low temperatures to destroy (ablate) abnormal tissue and/or cancer cells.
- Watch and waitthe close monitoring of a cancer without giving treatment until symptoms appear or worsen.
- Clinical trialsresearch studies performed to test new treatments, tests or procedures and evaluate their effectiveness on various diseases.
- Palliative carea variety of practices and exercises used to provide pain relief and improve quality of life without curing the disease.
Risk factors
While the exact cause of RCC is unknown, the following factors have been linked to the potential development of this disease:
- Smoking (past or present usage).
- Use (or misues) of pain medications over a long period of time.
- Obesity/being overweight.
- High blood pressure.
- Having a family history of RCC or other kidney cancers.
- Having genetic conditions such as:
- Von Hippel-Lindau disease.
- Lynch syndrome.
- Herditary Papillary RCC.
- Birt-Hogg-Dubè syndrome.
- Hereditary leiomyomatosis RCC.
- Tuberous sclerosis.
- Being regularly exposed to certain chemicals, such as:
- Asbestos.
- Lead.
- Cadmium.
- Dry-cleaning solvents.
- Herbicides.
- Benzene or organic solvents.
- Petroleum products.
- Being infected with Hepatitis C.
- Long-term dialysisa procedure that removes excess fluid and/or waste from the blood in people whose kidneys aren't functioning properly treatment.
Not everyone with these risk factors will develop the disease, and some people who have the disease may have none of these risk factors. See your general practitioner (GP) if you are concerned.
Symptoms
The symptoms of an RCC include:
- Haematuriathe presence of blood in urine.
- Pain/dull ache in the side or lower back.
- Unexplained weight loss.
- Fatiguea state of extreme tiredness or exhaustion, can be physical or mental.
- Fever.
- A lump in the kidney region.
Not everyone with the symptoms above will have cancer but see your general practitioner (GP) if you are concerned.
Diagnosis
If your doctor suspects you have a RCC, they may order the following tests to confirm the diagnosisthe process of identifying a disease based on signs and symptoms, patient history and medical test results and refer you to a specialist for treatment:
- Physical examinationan examination of your current symptoms, affected area(s) and overall medical history.
- Urine teststesting done to measure the levels of certain substances in the urine.
- Blood teststesting done to measure the levels of certain substances in the blood.
- Imagingtests that create detailed images of areas inside the body tests, potentially including:
- MRI (magnetic resonance imaging)a type of medical imaging that uses radiowaves, a strong magnet and computer technology to create detailed images of the body.
- CT (computed tomography) scana type of medical imaging that uses x-rays and computer technology to create detailed images of the body.
- Ultrasounda type of medical imaging that uses soundwaves to create detailed images of the body .
- Exploratory surgeryan exploratory surgical procedure used for conditions that cannot be confirmed by scans and tests alone, potentially including:
- Cystoscopyan examination of the bladder and urethra with a small, flexible instrument known as a cystoscope.
- Ureteroscopyexamination of the bladder and ureters using a small, flexible instrument called a ureteroscope .
- Biopsyremoval of a section of tissue to analyse for cancer cells.
