Renal Cell Carcinoma (Kindey Cancer): causes, symptoms, diagnosis and treatment

Medically reviewed: 19, February 2024

Renal cell carcinoma: what do we know about kidney cancer

Adenocarcinoma of a kidney is a renal cell carcinoma that originates from the epithelium of the tubule of the kidney. Manifestations of adenocarcinoma of the kidney are pain in the lower back, hematuria, an increase in the size of the kidney, anemia, cachexia.

Possible metastasis of the tumor into the lungs, paracaval and para-aortic lymph nodes, bones, liver, adrenals, opposite kidney. Adenocarcinoma is diagnosed during renal ultrasound, cystoscopy, excretory urography, ureteropyelography, renal CT.

Morphological verification of the diagnosis is performed by puncture biopsy of the kidney and histological examination of the biopsy specimen. The detection of renal adenocarcinoma is an indication for nephrectomy followed by radiation therapy.

Adenocarcinoma of the kidney is about 2.5% of the number of neoplasias of various localizations. Adenocarcinoma is the prevailing histotype of kidney cancer among adults in the field of urology. This particular type of cancer accounts for a staggering 90% of all kidney tumors. Typically, kidney adenocarcinoma tends to manifest between the ages of 40 and 70, affecting both the left and right kidneys with equal frequency. However, it is worth noting that men are diagnosed with this condition approximately twice as often as women.

Macroscopically, the adenocarcinoma of the kidney looks like a node of a soft-elastic consistency. In the section, intermittent areas of hemorrhage and necrosis are seen, giving the tumor a mottled appearance. Tumor growth can be multidirectional:

• towards the renal capsule or the bowl-pelvis complex;
• rather quickly adenocarcinoma sprouts the renal veins, the lower hollow vein, adjacent tissues;
• metastasizes to lymph nodes, lungs, bones, liver, brain.

The microscopic structure of the kidney adenocarcinoma is represented by strands and clusters of polygonal cells having a light protoplasm containing glycogen and lipids; The stroma of the tumor is weakly expressed.

Causes of renal cell carcinoma (kidney cancer)

The kidney adnocarcinoma has a polyethological and completely unclear nature. A certain role in tumor development is played by kidney diseases (glomerulonephritis, pyelonephritis), trauma; the effect on the renal tissue of chemical agents (nitrosoamines, hydrocarbons, aromatic amines), radiation exposure, intoxication (smoking).

Adnocarcinoma often develops from a benign adenoma of the kidney, therefore, all revealed kidney neoplasms are subject to removal and histological examination. Correlation of kidney adenocarcinoma with obesity and hypertension was noted. Less common causes of adenocarcinoma are dysontogenetic disorders, hereditary forms of kidney cancer.

Stages of renal cell carcinoma (kidney adenocarcinoma)

Kidney adenocarcinoma is a type of renal cell carcinoma (hypernaroid cancer) and can have a different degree of differentiation.

The international classification of the TNM system identifies the following stages of renal adenocarcinoma:

• T1 – The tumor is contained within the outer layer of the kidney known as the renal capsule.
• T2 – The tumor has extended beyond the renal capsule and has started to infiltrate the fibrous tissue surrounding the kidney
• T3 – the vascular pedicle of the kidney or the paranephric fatty tissue is involved in the tumor process
• T4 – the tumor sprouts into the nearest organs
• Nx – It is not feasible to conduct a preoperative evaluation of regional lymph nodes in the case of Nx
• N1 – regional metastasis is determined using radiological or radioisotope techniques
• M0 – absence of distant metastases
• M1 – single metastasis in distant organs is defined
• M2 – multiple distant metastasis is defined.

In adenocarcinoma of the kidney, distant metastases are detected in 50% of patients, and renal vein tumor growth in 15%. More often distant metastases are located in the lungs (54%), regional paracaval and para-aortic lymph nodes (46%), bone skeleton (32%), liver (36%), opposite kidney (20%), adrenal (16%). Kidney adenocarcinoma metastases can manifest clinically even before the primary focus is detected or occur after a time after nephrectomy for kidney cancer.

In the clinical course, adenocarcinomas of the kidney distinguish a latent (latent) period, as well as periods of local and general manifestations.

Symptoms of renal cell carcinoma

In the latent period, clinical manifestations are absent. The development of local symptoms is accompanied by the appearance of macromuturia and pain, an increase in the kidney. Hematuria is noted in 70-80% of patients with kidney adenocarcinoma. The discharge of blood in the urine occurs unexpectedly, more often in the form of filamentous clots 6-7 cm in length.

Hematuria usually has an episodic character, stopping and resuming again. In the case of intensive renal bleeding (profuse hematuria), thrombosis of the renal veins, blockade (tamponade) of the bladder and acute urinary retention may occur.

Pain syndrome in kidney adenocarcinoma occurs in 60-70% of observations. The pain is dull, aching, localized in the lower back, irradiates in the groin and thigh; at hematuria heights can be amplified to renal colic. The increase in the kidney is noted in 75% of cases. In later stages, a tumor that is palpable through the abdominal wall is determined.

With the germination of adenocarcinoma of the kidney of venous vessels, varicose veins of the labia are observed in women, varicocele in men.

In the period of common manifestations, weight loss, weakness, hypertension progresses; there is a causeless persistent increase in body temperature, anemia, cachexia. In far-reaching stages, paraneoplastic amyloidosis and nephrotic syndrome develop (generalized edema, massive proteinuria, hypoproteinemia, hypoalbuminemia, etc.).

Diagnosis of renal cell carcinoma

In the detection of kidney adenocarcinoma, a variety of laboratory and instrumental methods are utilized. Hematuria and proteinuria are commonly observed in the routine analysis of urine.

in the blood – normochromic anemia, an increase in ESR.

The leading role in identifying adenocarcinoma of the kidney is given to ultrasound, endoscopic and X-ray diagnostics. An informative method for confirming adenocarcinoma is ultrasound of the kidneys, which, in addition to visualizing the tumor, makes it possible to accurately perform a puncture biopsy of the kidney with the collection of tumor tissue for the morphological study of the biopsy.

To perform cystoscopy resorted at the time of hematuria, which allows you to determine the ureter from which blood is excreted.

Carrying out of excretory urography allows to consider uneven contours and enlarged sizes of a kidney, to reveal deformation, amputation of calyces, deviation of ureters, defects of filling of pelvis. Sometimes, medical professionals may carry out procedures such as retrograde ureteropyelography, renal angiography, and nephroscintigraphy in certain situations.

The fact of distant metastasis of renal adenocarcinoma is established with the route of lung radiography, scintigraphy of the skeleton, ultrasound of the liver, adrenal and retroperitoneal space. Adenocarcinoma of the kidney is differentiated from nephrolithiasis, adenoma of the kidney, chronic glomerulonephritis, pionephrosis, kidney tuberculosis, polycystosis.

Treatment of renal cell carcinoma

With adenocarcinoma of the kidney, it is optimal to carry out combined treatment, including radical surgery on the kidney and radiation therapy. During the initial phases of kidney adenocarcinoma, a surgical procedure known as a partial nephrectomy may be recommended as a treatment option.

With the widespread process, total nephrectomy is performed, removal of paranephric and retroperitoneal tissue with regional lymph nodes.

The growth of the tumor of the inferior vena cava and even the presence of single distant metastases do not prevent the performance of a nephrectomy. With a single metastasis in the lungs, the second stage removes the metastatic focus. The combination of surgical treatment with radiation increases the survival rate for kidney adenocarcinoma.

Total cancerous damage of both kidneys can require a binarectomy with transfer of the patient to hemodialysis. The widespread form of renal adenocarcinoma, characterized by extensive metastasis and tumor germination, involves symptomatic and palliative treatment with radiation and chemotherapy.

Prognosis and prevention of kidney adenocarcinoma

Following a nephrectomy, patients undergo regular monitoring by a urologist and may also undergo dynamic lung radiography to detect any potential metastases at an early stage. The long-term prognosis for adenocarcinoma of the kidney is unfavorable: there is a high percentage of late metastasis of the tumor in the bones and lungs. After total nephrectomy, a 5-year survival margin is overcome by 40-70% of patients.

To avoid the possibility of developing adenocarcinoma of the kidney, it is recommended to observe a healthy lifestyle, exclude bad habits, timely treatment of kidney diseases. It is necessary to carry out prophylactic ultrasound of the kidneys and immediately address a nephrologist (urologist) in case of pain in the lower back or blood in the urine.

Questions and Answers about Renal Cell Carcinoma

What is the life expectancy of a person with renal cell carcinoma?

Life expectancy for individuals diagnosed with renal cell carcinoma greatly depends on several factors, such as the cancer stage at diagnosis, overall health, and the effectiveness of the chosen treatment options. According to statistics published by the American Cancer Society, the five-year relative survival rate for localized renal cell carcinoma is 93%, while regional cases have a 70% five-year survival rate. Unfortunately, distant metastatic renal cell carcinomas have a significantly lower survival rate of just 12%. It’s crucial to remember that each patient’s case is different, and discussing individual prognoses with healthcare professionals provides the most accurate information.

Sources:

• American Cancer Society. Key Statistics About Kidney Cancer.

How serious is renal cell carcinoma?

Renal cell carcinoma, also known as kidney cancer, is considered a serious condition due to its potential to invade surrounding tissues and organs, spreading to other parts of the body when left untreated. While some patients may present no symptoms in early stages, allowing the disease to progress unnoticed, others might experience discomfort or complications affecting quality of life. However, advancements in medical technology continue offering improved diagnostic tools and treatments, helping many patients fight against renal cell carcinoma successfully.

Source:

• National Institute of Diabetes and Digestive and Kidney Diseases. What Is Kidney Cancer?

What is the first stage of renal cell carcinoma?

In the TNM staging system widely used for renal cell carcinoma, Stage I signifies that the tumor is confined within the kidney and has not surpassed 7 centimeters in diameter. At this point, the malignancy remains localized and curable through surgical removal or ablation therapy. Patients detected at earlier stages often encounter better prognoses than those found in later stages.

Source:

• Mayo Clinic. Stages of kidney cancer.

What is the most common treatment for renal cell carcinoma?

Surgical intervention represents one of the most frequent forms of treating renal cell carcinoma. This approach generally involves removing either the entire affected kidney (radical nephrectomy) or only the tumorous portion (partial nephrectomy). Surgeons usually perform minimally invasive laparoscopic procedures, though open surgery may still occur depending on specific circumstances. Additional therapies, like targeted drug treatment, immunotherapy, radiation, or cryoablation, could supplement primary surgical interventions based on a patient’s needs.

Source:

• Cleveland Clinic. Kidney Cancer Treatment.

Can you be cured from renal cell carcinoma?

Yes, cure is possible for certain renal cell carcinoma patients, especially if detected early. With successful initial treatment, routine surveillance helps ensure lasting remission. Nevertheless, recurrence rates remain relatively high compared to other cancers, necessitating continued vigilance following recovery. Late-stage diagnoses pose greater challenges, making timely detection imperative to boosting cure chances.

Source:

• Cancer Research UK. Survival for kidney cancer.

Can you survive stage 4 renal cell carcinoma?

Although challenging, surviving stage 4 renal cell carcinoma is indeed feasible thanks to advances in modern medicine. Five-year survival rates approximate 12%, contingent on effective multidisciplinary therapeutic approaches integrating surgical intervention, radiotherapy, chemotherapy, immunotherapy, or targeted drugs. Palliative measures alleviate distressing symptoms, enhancing quality of life even amid aggressive malignancies. Still, prognosis varies between individuals, demanding tailored assessment from healthcare providers.

Source:

• American Cancer Society. Survival Rates for Kidney Cancer By Stage.

How long can you live with stage 4 renal cell carcinoma?

Median survivals range between 10 to 20 months post-diagnosis for stage 4 renal cell carcinoma. Yet, longevity largely hinges on personalized therapies addressing comorbidities and particular genetic mutations driving cancer growth. Some patients endure years beyond average estimates owing to innovative clinical trials, specialized regimens, and robust support systems. Regular evaluations enable adjustments to evolving conditions, ensuring optimal strategies throughout illness trajectories.

Source:

• Journal of Global Oncology. Management Of Metastatic Renal Cell Carcinoma: Recent Advances And Ongoing Challenges.

How bad is stage 4 renal cell carcinoma?

Stage 4 renal cell carcinoma denotes advanced metastasis, engulfing both kidneys or extending external organ involvements. Overall, severe implications accompany such encroachments, provoking complex syndromes warranting multi-pronged interventions. Despite grim connotations, revolutionary breakthroughs continue expanding horizons, presenting hopeful alternatives where few existed previously.

Source:

• Memorial Sloan Kettering Cancer Center. Stage IV Renal Cell Carcinoma.

Can renal cell carcinoma cause death?

Regrettably, yes, renal cell carcinoma can lead to fatal outcomes without appropriate management. Progression correlates directly with declining prospects; hence, swift recognition and action are paramount. Mortality risks lessen considerably once identified promptly and treated appropriately, reinforcing rigorous screening protocols for susceptible populations.

Source:

• Centers for Disease Control and Prevention. What Are the Signs and Symptoms of Kidney Cancer?

How painful is renal cell carcinoma?

Pain levels vary among renal cell carcinoma sufferers, ranging from mild irritations to debilitating agonies. Initial manifestations typically entail flank pain, blood traces in urine, fever, weight loss, or fatigue. Advanced diseases potentially elicit additional unpleasant sensations attributable to expansions impinging nearby structures or invasions encompassing remote locations. Comfort-enhancing palliation complements frontline treatment arsenals, delivering symptom relief alongside active malignant countermeasures.

Source:

• Urology Care Foundation. Kidney Cancer Signs & Symptoms.

How fast does renal cell carcinoma spread?

Renal cell carcinoma dissemination velocity differs across instances, contingent on biological distinctions influencing aggressiveness. Certain variants grow gradually over decades, permitting prolonged asymptomatic phases before discovery. Conversely, other types exhibit brisker evolutionary tendencies, leading to accelerated propagations transiting successive stages inside brief periods. Early identification captures emergent threats prior to widespread ramifications, improving therapeutic responses and bolstering favorable results.

Source:

• National Center for Biotechnology Information. Genomic landscape and biomarkers of clear cell renal cell carcinoma: current insights.

What age do people get renal cell carcinoma?

Renal cell carcinoma prevalence increases exponentially after middle age, peaking around ages 60-70. Though conceivable anytime thereafter, incidence diminishes noticeably past this span due to reduced life spans combined with attenuated vulnerability trends. Nonetheless, rare juvenile phenotypes materialize occasionally, underscoring age diversity inherent within reniform carcinogenesis.

Source:

• Canadian Cancer Society. Kidney cancer: Who’s at risk?