Advanced renal cell carcinoma (RCC) is a form of kidney cancer that has progressed beyond its original site.
Understanding Advanced Renal Cell Carcinoma
Renal cell carcinoma is the most common type of kidney cancer, originating in the lining of the small tubes within the kidneys that filter waste from the blood. When RCC is classified as “advanced,” it means the cancer has spread from the kidney to distant areas of the body, a process known as metastasis.
Common sites where advanced RCC can spread include the lungs, bones, liver, brain, and lymph nodes. Approximately 11% of individuals are diagnosed with stage 4 RCC at the time of diagnosis.
Recognizing Symptoms and Diagnosis
Symptoms of advanced renal cell carcinoma can vary widely depending on where the cancer has spread. General symptoms may include persistent fatigue, unexplained weight loss, and night sweats. If the cancer has spread to the lungs, individuals might experience shortness of breath, while bone metastases can lead to bone pain. A lump or swelling around the lower back or side, or blood in the urine, can also be present, particularly if the primary kidney tumor is large.
The diagnostic process begins with a physical examination and a review of symptoms by a healthcare provider. Imaging tests identify tumors and assess the extent of spread. These tests include computed tomography (CT) scans, magnetic resonance imaging (MRI), and positron emission tomography (PET) scans. A biopsy, which involves taking a tissue sample, confirms the presence of cancer cells.
Treatment Approaches
Treatment for advanced renal cell carcinoma involves a personalized approach, combining various modalities to control the disease and manage symptoms. Systemic therapies, which treat the entire body, are employed. These include targeted therapies and immunotherapies, used alone or in combination.
Targeted therapies work by blocking specific proteins or pathways that cancer cells need to grow and spread. Tyrosine kinase inhibitors (TKIs) block signals involved in tumor growth and blood vessel formation. Examples include sunitinib, pazopanib, axitinib, cabozantinib, and lenvatinib. These medications aim to restrict the blood supply to the cancer, thereby limiting its growth.
Immunotherapies harness the body’s own immune system to fight cancer cells. Immune checkpoint inhibitors, such as nivolumab, pembrolizumab, ipilimumab, and avelumab, work by releasing “brakes” on the immune system, allowing it to recognize and attack cancer cells more effectively. Combination therapies, such as nivolumab with ipilimumab, or pembrolizumab with axitinib, are increasingly used as first-line treatments for advanced RCC, showing enhanced efficacy by targeting different mechanisms.
While systemic therapies are primary, local treatments for metastases may also be used. Radiation therapy, which uses high-energy X-rays to kill cancer cells, can help control localized tumors and relieve symptoms, especially in cases of bone or brain metastases. Ablative techniques, such as radiofrequency ablation or cryoablation, can destroy tumors using heat or cold.
Cytoreductive nephrectomy, the surgical removal of the primary kidney tumor, is considered in select cases of advanced RCC. This procedure aims to reduce the overall tumor burden and may improve symptoms like pain or bleeding. It is reserved for patients with good overall health and manageable metastatic disease, sometimes after an initial response to systemic therapy. The decision to perform surgery is made carefully, often in consultation with a multidisciplinary team.
Living with Advanced RCC and Outlook
Living with advanced renal cell carcinoma involves managing symptoms and maintaining quality of life. Supportive care plays a significant role, focusing on alleviating discomfort and addressing the physical and emotional challenges of the disease. This may include pain management, nutritional support, and fatigue management strategies.
The prognosis for advanced RCC varies considerably among individuals. Factors influencing outlook include the extent of the cancer’s spread, a person’s overall health, and how well they respond to treatment. While advanced RCC is challenging to cure, ongoing research and the approval of new treatments are improving outcomes.
Many individuals with advanced RCC are now living longer than in previous decades due to advancements in systemic therapies. A multidisciplinary care team, involving oncologists, surgeons, radiation therapists, and supportive care specialists, is important for management. Patient support groups and resources provide assistance for patients and their caregivers, offering practical advice and emotional support.