Key takeaway

  • Advanced renal cell carcinoma, also known as stage 4, occurs when kidney cancer spreads to distant parts of the body. Treatments aim to slow progression and relieve symptoms.
  • Symptoms of advanced renal cell carcinoma can include a lump on the side or lower back, blood in the urine, persistent fever, fatigue, and weight loss. However, symptoms may not present in the early stages.
  • Treatments aim to slow progression and relieve symptoms. Options include surgery, immunotherapy, and targeted drugs.

Doctors classify renal cell carcinoma (RCC) into four stages according to the extent to which the cancer has progressed. They usually classify advanced RCC as stage 4.

Advanced RCC is challenging to cure. Usually, treatment aims to slow the cancer’s progression, relieve symptoms, and improve quality of life. However, research into advanced RCC is ongoing, and the Food and Drug Administration (FDA) is approving new treatments.

This article explains what advanced RCC is, including its symptoms, treatment, and survival rates according to disease stage. It also provides support information for people who have advanced RCC and their caregivers.

According to the American Cancer Society (ACS), RCC is the most common type of kidney cancer. This type of cancer develops in the lining of tubules (very small tubes) inside the kidney. These tubules help to remove waste products from the blood.

Stage 4 RCC is the most advanced stage, in which the disease has spread from the kidneys to one or more distant areas of the body.

The ACS estimated that around 81,610 people in the United States would receive a diagnosis of kidney cancer in 2024. According to a 2024 article, around 70% of people have stage 1 RCC at the time of diagnosis, and about 11% of people have stage 4.

The outlook for RCC is more favorable for people who receive an early diagnosis and appropriate treatment.

As cancer progresses, it metastasizes (spreads) from its initial site to other parts of the body. This affects a person’s outlook.

The outlook for RCC is improving due to advances in treatment, although treating advanced RCC may still be challenging.

People with RCC typically do not experience any symptoms during the disease’s early stages. Symptoms may only become apparent as the disease progresses.

The ACS advises people to see a doctor if they experience any of the following signs and symptoms:

  • a lump on the side or lower back
  • anemia
  • blood in the urine
  • fatigue
  • pain on one side of the lower back
  • persistent fever with no known cause
  • weight loss

Diagnosis for RCC

Doctors may recommend imaging tests to determine whether a person has cancer and to what extent it might have spread.

Imaging, such as CT and MRI scans, can also reveal if the cancer has spread to the following parts of the body:

  • bones
  • lymph nodes
  • liver
  • brain
  • lungs

A 2021 review notes that around 45% of people with metastatic RCC have tumors in their lungs. While they may not experience any symptoms, a CT scan may reveal atypical growths in the lung tissue.

The treatment for advanced RCC varies according to several factors, including:

  • the person’s overall health
  • the extent to which the cancer has spread
  • the tissues and organs it affects

Some possible treatment options include:

Surgery

Doctors may sometimes recommend surgery to remove the tumor, the kidney, or other affected organs.

However, in advanced RCC, surgery might not be possible, and a person may require palliative treatment to ease symptoms and reduce pain.

The ACS states that it is important that people with Stage 4 RCC understand the aim of the surgery or other treatment.

Medication

According to the ACS, medications such as immunotherapy and targeted drugs, with or without surgery, are the usual first treatments for stage 4 RCC.

A 2021 study indicates immunotherapy drugs can significantly improve outcomes in people with RCC. Such drugs include:

  • Vascular endothelial growth factor inhibitors (anti-VEGFs): These drugs are a type of tyrosine kinase inhibitor (TKI) that restrict the blood supply to the cancer.
  • Immune checkpoint inhibitors: These help the person’s immune system recognize and attack cancer cells.

The National Cancer Institute (NCI) lists the following drug combinations as treatment options for people with advanced kidney cancers:

  • ipilimubab (Yervoy) with nivolumab (Opdivo)
  • axitinib (Inlyta) with pembrolizumab (Keytruda)
  • pembrolizumab with lenvatinib (Lenvima)
  • cabozantinib (Cabometyx) with nivolumab

Is it curable?

Advanced RCC is challenging to cure. However, the Kidney Cancer Association notes that new treatments are continually emerging and gaining FDA approval.

Currently, there are over 15 first-line treatment options for advanced RCC, as well as second-line and third-line treatments.

Some people respond well to treatment. A 2023 case study in Japan documents how doctors successfully treated advanced RCC in a 49-year-old man with multiple lung metastases using a combination of therapeutic approaches.

However, for most people with advanced RCC, treatment may help only to slow the progression of the disease and relieve symptoms.

The ACS provides kidney cancer survival rates based on figures from the SEER database. Instead of referring to cancer stages, this system classifies cancers according to the following terminology:

  • Localized: The cancer is contained in the organ where it first developed.
  • Regional: The cancer has spread to nearby organs or lymph nodes.
  • Distant: The cancer has spread further into the body, and tumors may be present in the brain, bones, or lungs.

The SEER system would classify advanced RCC as distant.

Using this system, the 5-year survival rates for RCC are as follows:

SEER classification5-year survival rate
localized93%
regional75%
distant18%
combined figures78%

The relative survival rate suggests how long someone with a condition may live after their diagnosis compared to someone without the condition of the same race, sex, and age over a specific time.

This is different from an overall survival rate, which is the percentage of people still alive for a specific time after the diagnosis of a condition.

It is most important to remember that figures are estimates, and everyone is different. A person should talk with their doctor about their specific condition.

Someone with advanced RCC should talk with their doctor about treatment goals and potential side effects before deciding on a treatment plan.

For some people, the goal may be to slow down the speed at which the cancer is growing. For others, the goal may be to eliminate pain and improve their quality of life.

Some people may be eligible to participate in clinical trials. Anyone considering this can talk with their doctor for more information.

A diagnosis of advanced RCC can be overwhelming, and people may require support in various forms.

The NCI provides a database of over 100 organizations that offer emotional, practical, and financial support for people with cancer.

Through these support networks, people can:

  • meet with individuals or support groups, online or in real life
  • receive financial assistance for treatment, medical supplies, and general living expenses
  • receive practical assistance, such as transportation to and from the hospital

Life can be very stressful for people looking after loved ones with cancer.

The NCI recommends that caregivers take as much time as possible to look after themselves and continue doing things they enjoy. Keeping in touch with family and friends is also important.

Many groups and organizations offer support for people with cancer and their caregivers.

Advanced RCC is cancer that has spread from the lining of the tubules inside the kidneys to distant parts of the body. Medical professionals classify advanced RCC as stage 4 or distant.

Advanced RCC is challenging to cure. Treatments typically aim to slow the progression of the disease, relieve symptoms, and improve quality of life. Treatment success depends on factors such as the person’s overall health and the location of the tumors.

The outlook for RCC is less favorable as the cancer stage progresses from regional to distant. However, research into advanced RCC is ongoing, and new treatments continue to emerge and gain approval.