Renal cell carcinoma is a cancer in which malignant tumours are present in the kidney. It is the most common cancer of the kidney. Although the origin of the carcinoma is still unclear, risk factors are known. If the tumour is detected at an early stage and treated by surgical removal, the chances of survival are comparatively high.

Has your urine recently become reddish in colour and do you notice blood in your urine? Do you have lateral back pain in the area below your ribcage? Can you feel a lump in your upper abdomen?

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Table of contents

1.1 What is a kidney?
1.2 What is renal cell carcinoma?
1.3 How does renal cell carcinoma develop?
1.4 What are the symptoms?
1.5 How is renal cell carcinoma diagnosed?
1.6 How is renal cell carcinoma treated?

1.1 What is a kidney?

The kidney is a bean-shaped paired organ. The kidneys help the body to detoxify and produce urine. They do this by filtering unneeded substances in the blood and water produced in the cells during energy production. Tumours can develop in all organs of the body, including the kidneys.

1.2 What is renal cell carcinoma?

Renal cell carcinoma is the most common pathological (abnormal) and malignant neoplasm of urine-producing kidney tissue. In this disease, some kidney cells lose their proper function and start dividing uncontrollably, forming a tumour (growth). If cancer cells break away from the tumour and get into the lymph (tissue water) or blood, metastases (daughter tumours) can develop. In this case, the cancer has spread.

1.3 How does renal cell carcinoma develop?

How renal cell carcinoma develops has not yet been conclusively clarified. In the meantime, however, it has been established that there are some risk factors that favour the development. In addition to smoking and obesity (being overweight), untreated high blood pressure and increasing age pose a risk.

In certain occupations, the risk of disease is increased by contact with substances made from petroleum (petrochemicals) and certain solvents used to clean metal sheets. Proximity to certain pollutants and toxins, such as arsenic, asbestos or lead, also increases the risk of developing renal cell carcinoma.

1.4 What are the symptoms?

Renal cell carcinoma is usually asymptomatic for a very long time, which is why the tumours can grow very large without the patient noticing. For this reason, this cancer is often discovered by chance during ultrasound scans or other routine examinations.

However, at a very advanced stage, some symptoms may occur, which you will find listed below.

Pain in the flank ( back pain at the side below the kidneys)
A palpable ulcer in the upper abdomen
Blood in the urine
Colicky abdominal pain (pain that is severe for a short time, subsides and then returns)
Anaemia (anaemia)
fever
Severe weight loss
If the cancer is advanced and has spread, i.e. there are metastases, these can be symptomatic; bone metastases, for example, can cause bone pain.

1.5 How is renal cell carcinoma diagnosed?

If renal cell carcinoma is suspected, a doctor can carry out various examinations to make a diagnosis. On the one hand, palpation of the abdomen can determine whether large tumours or masses are present. A urine examination can also be done, because this can detect blood in the urine.

Nowadays, ultrasound examination of the abdominal region as an imaging examination is an important tool and is also used for early detection.

If the suspicion is confirmed, a CT (computerised tomography images) of the abdomen is done to help with surgery planning. A CT of the upper body and especially the chest area is done to determine what stage of the disease the patient is in (staging).

A laboratory check, i.e. a blood test, can also be helpful in making a diagnosis; among other things, various kidney values and liver values are examined.

1.6 How is renal cell carcinoma treated?

Renal cell carcinomas are resistant to chemotherapeutic drugs, which is why they are not used in therapy. Radiotherapies also have no effect on this type of cancer cells, which is why surgical removal of the tumour is the mainstay of treatment.

If staging determines that the patient is at a stage where surgical removal is feasible, the chances of cure are quite high. Staging takes various factors into account, such as the size of the tumour or whether metastases are present. The earlier the disease is detected, the better the prospects.

Depending on the extent of the disease, either the part of the kidney affected by the cancer or the entire kidney is removed, although it is rather rare for the entire kidney to be removed. If necessary, daughter tumours can also be removed, for example if the lymph nodes are affected.

If the tumour can no longer be removed due to a very advanced stage, this is referred to as irresectability and other therapy measures with medication are considered. In these cases, a complete cure is often no longer possible, but in some patients the survival time can be extended with a high quality of life by slowing down the progression of the disease. These measures entail a lifelong intake of medication, which can lead to side effects if necessary.

Immunotherapy is a new type of treatment. Its aim is to strengthen the patient’s immune system in its fight against the carcinoma. This makes it possible to control the disease over a longer period of time and help the patient. A great advantage of this therapy is that it involves therapy-free time intervals. No medication needs to be taken during these periods.

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