What to know about advanced renal cell carcinoma

Share on Pinterest

According to the Centers for Disease Control and Prevention (CDC), RCC is the most common type of kidney cancer. This type of cancer develops in the lining of very small tubes, or tubules, inside the kidney. These tubules help to remove waste products from the blood.

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

The American Cancer Society (ACS) estimates that around 79,000 people in the United States will receive a diagnosis of kidney cancer in 2022. A 2019 study notes that around 65% of people will have early-stage RCC at the time of diagnosis, while up to 30% of people will have stage 4. Among those with early-stage RCC, 20–40% will progress to stage 4.

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

As cancer progresses, it spreads, or metastasizes, from its initial site to other parts of the body.

According to a 2016 study, the outlook for advanced RCC depends largely on where the new tumors are growing in the body. For example, people with RCC that has spread to the pancreas have a higher overall survival rate than those where cancer has spread to the brain, bones, or liver.

People with RCC typically do not experience any symptoms during the early stages of the disease. 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:

• blood in the urine
• persistent pain on one side of the lower back
• a lump on the side or abdomen
• general fatigue
• unexplained weight loss
• anemia

Doctors may recommend imaging tests to confirm the cancer and determine whether and to what extent it has spread.

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

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

It is very difficult to cure advanced kidney cancers. However, treatments can help to extend life expectancy in some cases:

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 affected

Some possible treatment options include.

Surgery

Doctors may sometimes recommend surgery to remove the tumor, kidney, or other affected organs. However, surgery may not extend life expectancy in cases where the cancer has spread extensively.

Medication

According to the ACS, systemic therapy with or without surgery is the mainstay treatment for stage 4 RCC. Systemic therapy may consist of two immunotherapy drugs, a targeted therapy drug with an immunotherapy drug, or a targeted therapy drug alone.

According to a 2021 study, immunotherapy drugs can significantly improve outcomes in people with RCC. Such drugs include:

• Vascular endothelial growth factor inhibitors (anti-VEGFs): These restrict the blood supply to the cancer.
• Immune checkpoint inhibitors: These help the person’s own immune system recognize and attack cancer cells.

Another class of drugs that may successfully treat RCC is tyrosine kinase inhibitors (TKIs). These medications inhibit the production of enzymes that cancer cells require for growth.

The following drug combinations appear to offer the most favorable outcomes for people with advanced kidney cancers:

• ipilimubab with nivolumab
• axitinib with pembrolizumab
• cabozantinib with nivolumab

Is it curable?

Advanced RCC is very difficult to cure. However, the Kidney Cancer Association (KCA) notes that new treatments are continually emerging and gaining FDA approval. In 2021 alone, the FDA approved the following drug treatments for advanced RCC:

• Lenvatinib plus pembrolizumab: Gained approval as a first-line treatment for advanced RCC.
• Nivolumab plus cabozantinib: Gained approval as a first-line treatment in advanced RCC.
• Tivozanib (Fotivda): Gained approval for adults with relapsed or treatment-resistant RCC.

Some people respond well to treatment. A 2019 case study documents how doctors successfully treated advanced RCC in a 63-year-old man with brain metastases using a combination of radiation therapy and TKI medications.

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

The ACS provides RSS 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 remains 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 classification system, the 5-year survival rates for RCC are as follows:

Before deciding on a treatment plan, a person with advanced RCC should talk with their doctor about treatment goals and any potential side effects.

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

Some people may be eligible to participate in clinical trials. A person should talk with their doctor about this possibility if it is something they wish to consider.

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

The National Cancer Institute (NCI) provides a database of over 100 organizations that offer emotional, practical, and financial support for people living with cancer.

Through these support networks, people can:

• meet with individuals or support groups either 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 time to look after themselves and do things they enjoy. Keeping in touch with family and friends is also important.

Many groups offer support for people living 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 very difficult to cure. Treatments typically aim to slow the progression of the disease, alleviate symptoms, and improve quality of life. Treatment success depends on several factors, including the person’s overall health and the location of the tumors within the body.

5-year survival rates for RCC decrease substantially as the cancer stage progresses from regional to distal. However, research into advanced RCC is ongoing, and new treatments continue to emerge and gain approval.

A person can also talk with their doctor about the possibility of participating in clinical trials for advanced RCC.