About renal cell carcinoma

Kidney cancer remains one of the most common cancers in the world, accounting for over 140,000 deaths worldwide each year,1 with renal cell carcinoma (RCC) accounting for approximately 90% of all cases.2

RCC occurs when abnormal cells develop in the tissue of the kidneys, specifically in the small tubes (also known as tubules) where our blood is filtered.3 Typically, RCC is a single tumour in one kidney but, in rare cases, there can be multiple tumours, which can occur in one or both kidneys.4

Despite recent progress in the field of kidney cancer, treatment options for people with the disease remains limited in their effectiveness.

Who is at risk of RCC?

There are a number of risk factors associated with the development of RCC. These can be broken down into two groups:5,6

Non-modifiable:

  • Incidence increases with age (until around 70 years old)
  • Sex (men are more likely to develop RCC than women)
  • Presence of other genetic diseases that affect the kidneys

Modifiable:

  • Smoking
  • Obesity
  • Presence of other medical conditions, such as increased blood pressure
  • Occupational exposure to chemicals such as TCE (trichloroethylene), which is used as a metal degreaser and chemical additive

There are 3 main stages of RCC

The degree to which a tumour has grown and spread determines the stage classified at diagnosis. Generally, RCC tumours can be categorised as localised, locally advanced or metastatic.3,7

rcc-stagescombined
Localised: Tumours that are limited to the kidney. Locally advanced: Tumours that have spread to or beyond the blood vessels or tissues surrounding the kidney. Metastatic: Tumours that have spread to other parts of the body, such as the lungs, bones or brain.

The symptoms of RCC are often silent until the advanced stages

Localised RCC presents a unique challenge as many patients do not experience symptoms at this stage of the disease.3 Nevertheless, early detection rates are acceptable,8 as the disease is often picked up when patients are having abdominal scans for other reasons.9

Whilst the majority of people do not experience any clear symptoms during the earlier stages of the disease, as the tumour grows, the most common symptoms tend to be localised near to the kidneys. The symptoms of RCC may include, but are not limited to:3

  • Blood in urine
  • Pain in side
  • Abdominal mass
  • Fatigue and loss of appetite
  • Weight loss

Early diagnosis of RCC is crucial

Like all forms of cancer, the stage at which an RCC diagnosis is made has a strong influence on the prognosis. 

“If RCC is diagnosed at the localised stage, when the cancer hasn’t yet spread from the kidneys, 93% of people will still be alive after 5 years. However, if diagnosed in the metastatic stage, where over one in ten patients will receive diagnosis, only around 12% survive beyond 5 years,7” says Dr Vladan Antic, Group International Medical Director at Roche. “This huge gap in survival rates emphasises the importance of early diagnosis and treatment.”

Various options are available for the treatment of RCC. In the early stages, where the cancer is localised to the kidney, surgery is effective. For people with advanced disease, treatment options can include chemotherapy, targeted therapies and cancer immunotherapies.10

  • Surgery: for localised disease, surgery can be curative in up to 90% of patients11
  • Chemotherapy: in patients with a particular type of the disease, sarcomatoid RCC, chemotherapy can be used12
  • Cytokine therapy: a type of immunotherapy, cytokine therapy can offer long-term responses in some patients10
  • Angiogenesis inhibitors: a targeted therapy that interferes with the formulation of blood vessels which are used by cancerous tumours to grow13
  • Tyrosine-kinase inhibitors (TKIs): a type of targeted therapy that has become the standard of care for advanced RCC

“In the metastatic stage, complete responses to treatment are sadly rare and, again and again, we see cases where patients’ tumours have become resistant to treatment. Typically patients will develop resistance in less than 12 months.” says Dr Antic.

Hence, for people with advanced forms of RCC, it is clear that a need for progress remains. Harnessing the power of the immune system to take up the fight against cancer, using cancer immunotherapies, represents a treatment option to explore further.

References

1. World Health Organization. GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide. Available at: http://globocan.iarc.fr/Pages/fact_sheets_population.aspx   Last accessed November 2016 Last accessed January 2017

2. American Cancer Society. What is kidney cancer? Available at: http://www.cancer.org/cancer/kidneycancer/detailedguide/kidney-cancer-adult-what-is-kidney-cancer Last accessed January 2017

3. Cancer.gov. Renal Cell Cancer Treatment (PDQ®)– Patient Version. Available at: https://www.cancer.gov/types/kidney/patient/kidney-treatment-pdq Last accessed January 2017

4. American Cancer Society. Kidney Cancer (Adult) - Renal Cell Carcinoma. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003107-pdf.pdf Last accessed January 2017

5. Ridge et al. Epidemiology and Staging of Renal Cell Carcinoma. Semin Intervent Radiol. 2014;31(1): 3-8. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930658/ Last accessed January 2017

6. Chow et al. Epidemiology and risk factors for kidney cancer. Nat Rev Urol. 2010; 7(5): 245–257. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3012455/ Last accessed January 2017

7. SEER. Stat Fact Sheets: Kidney and Renal Pelvis Cancer. Available at: https://seer.cancer.gov/statfacts/html/kidrp.html Last accessed January 2017

8. King et al. Continued Increase in Incidence of Renal Cell Carcinoma, Especially in Young Patients and High Grade Disease: United States 2001 to 2010. J Urol. 2014; 191(6): 1665–1670. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479175/ Last accessed January 2017

9. Chittoria and Rini. Renal Cell Carcinoma. Available at: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/renal-cell-carcinoma/ Last accessed January 2017

10. American Cancer Society. Treatment choices by stage for kidney cancer. Available at: http://www.cancer.org/cancer/kidneycancer/detailedguide/kidney-cancer-adult-treating-by-stage Last accessed January 2017

11. BMJ Best Practice. Renal Cell Carcinoma. Available at: http://bestpractice.bmj.com/best-practice/monograph/261.html Last accessed January 2017

12. NCCN. NCCN Guidelines Version 2.2017 Kidney Cancer. Available at: https://www.nccn.org/professionals/physician_gls/PDF/kidney.pdf Last accessed January 2017

13. Cancer.gov. Angiogenesis Inhibitors. Available at https://www.cancer.gov/about-cancer/treatment/types/immunotherapy/angiogenesis-inhibitors-fact-sheet Last accessed January 2017