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Renal Cell Carcinoma

Most common kidney cancer in adults treated with surgery, ablation, immunotherapy, and targeted agents.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Onkoloji department. Book Appointment →

What is Renal Cell Carcinoma?

Renal cell carcinoma (RCC) accounts for 90% of kidney malignancies in adults. Histologic subtypes include clear cell (75%, often VHL-related), papillary (10-15%, type 1 and type 2), chromophobe (5%), and rarer collecting duct, medullary, translocation, MiT family, and unclassified RCC. Hereditary syndromes include von Hippel-Lindau, hereditary papillary, Birt-Hogg-Dube, hereditary leiomyomatosis and RCC (HLRCC), and tuberous sclerosis.

Most cases are diagnosed incidentally on cross-sectional imaging. The classic triad of flank pain, hematuria, and palpable mass is uncommon. Paraneoplastic syndromes include hypercalcemia, polycythemia, hypertension, and Stauffer syndrome (hepatic dysfunction without metastases). Staging uses AJCC TNM with IMDC risk stratification (favorable, intermediate, poor) for metastatic disease guiding therapy.

Localized RCC is managed with partial nephrectomy when feasible (preserves kidney function), radical nephrectomy for larger or central tumors, or ablation (radiofrequency, cryoablation) for small tumors in surgically unfit patients. Surveillance for very small lesions is appropriate. Metastatic RCC treatment has evolved: combination immune checkpoint inhibitors plus tyrosine kinase inhibitors are first-line (pembrolizumab + axitinib, nivolumab + cabozantinib, pembrolizumab + lenvatinib, ipilimumab + nivolumab) with subsequent lines including cabozantinib, lenvatinib + everolimus, tivozanib, and clinical trials.

Symptoms

Hematuria (gross or microscopic)
Flank pain
Palpable abdominal mass
Weight loss, anorexia, fatigue
Fever of unknown origin
Anemia or polycythemia
Hypercalcemia (paraneoplastic)
Hypertension (renin-secreting tumors)
Varicocele (left-sided, sudden new onset)
Lower extremity edema (IVC tumor thrombus)
Cough, dyspnea (lung metastases)
Bone pain (metastatic)
Hepatic dysfunction without metastases (Stauffer syndrome)
Incidental imaging finding

Risk Factors

Smoking
Obesity
Hypertension
Acquired cystic kidney disease (dialysis)
Family history
VHL, Birt-Hogg-Dube, HLRCC, hereditary papillary syndromes
Tuberous sclerosis
Trichloroethylene and asbestos exposure
Long-term analgesic use
End-stage kidney disease
Sickle cell trait (medullary RCC)
Male sex

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Visible blood in urine
  • Persistent flank or abdominal pain
  • Unexplained weight loss
  • Sudden left-sided varicocele
  • Persistent fatigue with anemia
  • New-onset polycythemia or hypercalcemia
  • Lower extremity swelling
  • Family history with screening recommendation

Treatment Methods

01
Diagnosis: contrast-enhanced CT or MRI characterizing renal mass
02
Bosniak classification for cystic lesions
03
Renal mass biopsy for selected cases (small mass, suspected metastasis, hereditary syndrome)
04
Staging: chest CT, bone scan if symptomatic, brain MRI in metastatic or symptomatic, IVC imaging for venous thrombus
05
Genetic counseling for young, multifocal, bilateral, syndrome-suggestive cases
06
Stage I: partial nephrectomy preferred; ablation for small tumor in poor surgical candidate; active surveillance for small (less than 2 cm) low-risk masses
07
Stage II-III: radical or partial nephrectomy with regional lymph node assessment
08
IVC tumor thrombus: cardiothoracic-urology team for venous thrombectomy
09
Adjuvant pembrolizumab for high-risk clear cell RCC after nephrectomy (PD-L1 positive)
10
Cytoreductive nephrectomy in selected metastatic patients with low burden, good performance
11
Metastatic first-line by IMDC risk: combination immune checkpoint inhibitor + tyrosine kinase inhibitor (pembrolizumab + axitinib, nivolumab + cabozantinib, pembrolizumab + lenvatinib) or ipilimumab + nivolumab for intermediate/poor risk
12
Subsequent lines: cabozantinib, lenvatinib + everolimus, tivozanib, axitinib, sorafenib, clinical trials
13
Stereotactic body radiation for selected metastases (oligometastatic, brain, painful bone)
14
Bone-modifying agents (denosumab or zoledronic acid) for bone metastases
15
Bevacizumab plus interferon historical option
16
Manage adverse effects: hypertension, proteinuria, hand-foot syndrome, hypothyroidism, immune-related events
17
Treat hypercalcemia (paraneoplastic) with hydration, bisphosphonates, denosumab
18
Surveillance: stage-adapted imaging and labs over 5+ years
19
Multidisciplinary care: urology, medical oncology, radiation oncology, interventional radiology, genetics, palliative care
20
Family screening for hereditary syndromes

Which Department to Visit?

You can visit our Onkoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.