Novartis has a strong heritage in advanced renal cell carcinoma treatment, the most common type of kidney cancer, and has been committed to the global kidney cancer community for more than a decade.
What is Renal Cell Carcinoma?
Renal Cell Carcinoma (RCC) is the most common type of kidney cancer and accounts for 90% of all cancerous kidney tumours.1,2 According to the World Health Organization (WHO), Renal Cell Carcinoma can be divided into three major subtypes based on their histology:3
The three main types of RCC cancer are:
Clear cell renal cell carcinoma – representing 80 to 90% of all RCC tumours
Papillary cell RCC – representing 10 to 15% of all RCC tumours
Chromophobe RCC – representing 4 to 5% of all RCC tumours
The less common subtypes are identified based on their morphologic characteristics:
Collecting duct RCC – representing 1% of all RCC tumours
Unclassified RCC – representing 3 to 5% of all RCC tumours
How is Renal Cell Carcinoma Diagnosed − Renal Cell Carcinoma Symptoms
Renal cancer is frequently undiagnosed or misdiagnosed. This is because there are few overt symptoms of this type of kidney cancer, especially in early stage disease. Delays in diagnosis could lead to significant kidney tumour growth and the spread of the disease – metastatic renal cell carcinoma.
Renal Cell Carcinoma kidney cancer symptoms include:
A lump on the side or lower back
Low back pain on one side
Weight loss for no known reason
Hematuria (blood in urine)
Anemia (low red blood cell counts)
Loss of appetite
Incidence Rates and Risk factors of Renal Cancer
Most cases occur between ages 50 and 70 years. The average age at diagnosis is 64 years, and the disease is twice as common in men as it is in women.1 In addition to these risk factors, the widespread use of non-invasive imaging modalities has contributed to the increase incidence rates of this kidney cancer.
Possible risk factors that could cause renal cell carcinoma include:
Dialysis-associated cystic kidney disease5
Exposure to the analgesic phenacetin (now widely withdrawn, but often used to adulterate cocaine)6
How to Determine The Stage of Renal Carcinoma
Kidney cancer stages are based on the size, location and spread of the tumour. Staging is based upon the degree of involvement of the following three elements:4
T: Indicates the size of the main (primary) kidney tumour and whether it has grown into nearby areas.
N: Indicates whether the regional or nearby lymph nodes are involved and the degree of involvement.
M: Indicates whether the tumour has spread or metastasised to distant organs, such as the lungs, bones, liver, brain and distant lymph nodes.
Renal Cell Carcinoma Staging is Combined Without Cancer Stage Grouping
Doctors assign the stage of the cancer by combining the T, N, and M classifications.12
Stage I: The tumour mass on kidney is 7 cm or smaller and is only located in the kidney. It has not spread to the lymph nodes or distant organs.
Stage II: The tumour mass on kidney is larger than 7 cm and is only located in the kidney. It has not spread to the lymph nodes or distant organs.
Stage III: Either of these conditions:
A tumour of any size is located only in the kidney. It has spread to the regional lymph nodes but not to other parts of the body.
The tumour has grown into major veins or perinephric tissue and may or may not have spread to regional lymph nodes. It has not spread to other parts of the body.
Stage IV: Either of these conditions:
The tumour has spread to areas beyond Gerota's fascia and extends into the adrenal gland on the same side of the body as the tumour, possibly to lymph nodes, but not to other parts of the body.
The tumour has spread to any other organ, such as the lungs, bones, or the brain.
Renal Cell Carcinoma Prognosis and Treatment Options of Renal Cell Cancer
Until recently, RCC cancer had a poor prognosis, with less than 10% of patients with metastatic renal cell carcinoma surviving beyond 5 years. Kidney cancer can be difficult to detect in its early stages, and more than 30% patients with RCC have metastatic renal cell carcinoma at the time of diagnosis, meaning the cancer cells have spread beyond the kidney to other parts of the body.12,13 This is also called stage IV kidney cancer.
Despite the difficulties in kidney cancer treatment, there are a number of options available to patients living with renal carcinoma, including: Surgery, Radiation, Cytokine therapy, Chemotherapy and Immunotherapy. In addition, the advent of targeted therapies has resulted in an improvement in disease prognosis. These treatment options may be used at different stages of the disease with the goal of temporarily stopping or slowing the growth of the tumour and/or boosting the body’s immune response against cancer cells.14
5. Brennan JF, Stilmant MM, Babayan RK, et al. Acquired renal cystic disease: implications for the urologist. Br J Urol. 1991;67(4):342–348.
6. Abbott FV, Fraser MI. Use and abuse of over-the-counter analgesic agents. J Psychiatry Neurosci. 1998;23(1):13–34.
7. Smith AH, Shearn VI, Wood R. Asbestos and kidney cancer: the evidence supports a causal association. Am J Ind Med. 1989;16(2):159–166.
8. Ljungberg B, Bensalah, K, Bex A, et al. Guidelines on Renal Cell Carcinoma, European Association of Urology, 2015.
9. Moore LE, Boffetta P, Karami S, et al. Occupational trichloroethylene exposure and renal carcinoma risk: evidence of genetic susceptibility by reductive metabolism gene variants., Cancer Res. 2010 Aug 15;70(16):6527–6536.
10. Enterline PE, Review of new evidence regarding the relationship of gasoline exposure to kidney cancer and leukemia. Environ Health Perspect. 1993 Dec;101 Suppl 6:101–103.