Are you having problems with your kidneys? Let's learn about Renal Cell Carcinoma (RCC)!

Have you ever thought deeply about your kidneys? Kidneys are two small but very important organs in our body. They are like filters in our body. However, sometimes these kidneys can also have problems. Today we are going to talk about one of the most common types of cancer that can occur in the kidneys, "Renal Cell Carcinoma" or RCC . Don't worry, we will talk about this simply, in a way that you can understand.

What is renal cell carcinoma (RCC)?

Simply put, renal cell carcinoma (RCC) is the most common type of kidney cancer. Our kidneys have a very fine network of tubes called tubules . These tubes are what transport the body's water and nutrients into the bloodstream and remove waste products in the urine. It is within these tubules that RCC begins to form. About 85% of kidney cancers are of this type.

Most often, RCC starts as a small lump of cancer cells in one kidney. This is also called a tumor . However, sometimes multiple lumps can form in one kidney, or in both kidneys.

What are the main types of RCC?

There are different types of RCC. Think of it like having different people in the same family. This classification is based on how the cancer cells look under a microscope, their DNA , or genetic material. There are a few main types:

• Clear cell renal cell carcinoma (ccRCC): This type accounts for about 85% of RCC. It gets its name because the cancer cells appear clear under a microscope.
• Papillary renal cell carcinoma: This type accounts for between 10% and 15% of all renal cell carcinomas. It is named for the finger-like protrusions ( papillae ) that are found on these tumors.
• Chromophobe renal cell carcinoma: This type accounts for between 5% and 10%. These cells are also usually light in color, similar to clear cells, but are slightly larger.
• Unclassified RCC: About 6% of RCC cannot be classified into any major type. However, scientists are continuously trying to classify this unclassified group in new ways, based on things like the microscopic characteristics of the cells and their DNA .

You may have heard doctors use the terms "localized" or "advanced" or "metastatic" when talking about RCC. Localized RCC means the cancer is only in the kidney, and may have spread to nearby tissues. Metastatic RCCThis means that the cancer has spread to other parts of the body. The type you have determines your treatment options and chances of recovery.

How common is RCC?

Worldwide, about 400,000 new cases of RCC are reported each year. In the United States, the number is about 80,000. Although anyone can develop RCC, it is most common in men between the ages of 60 and 80 .

What are the symptoms of renal cell carcinoma?

Many people do not experience any symptoms in the early stages. Symptoms begin to appear when the cancer grows and begins to affect surrounding tissues or organs.

Symptoms of RCC may include:

• Blood in the urine (hematuria). This is the most common symptom.
• Flank pain: This refers to pain that occurs on either side of the body, above the waist and below the ribs.
• A feeling of a lump in the stomach, lower back, or groin.
• Fever that comes without a reason.
• Night sweats.
• Unexplained weight loss.

In addition, symptoms of anemia , such as shortness of breath and fatigue, may also occur. Or symptoms of a condition called paraneoplastic syndromes may also appear. In this case, substances such as hormones are released from cancerous tumors, which cause various changes in the body.

What are the causes of RCC?

RCC occurs when abnormal cells in the kidney tubules start to grow uncontrollably. The exact cause is not yet known. However, scientists have identified certain risk factors that increase the risk of developing RCC.

What are the risk factors?

The risk of developing RCC is higher if you have these things:

• Smoking: The more you smoke, the higher the risk.
• Obesity: The higher your body mass index (BMI), the higher your risk.
• High blood pressure (Hypertension).
• Chronic kidney disease: This includes those who receive long-term dialysis treatment.
• Chronic Hepatitis C infection.
• Long-term use of certain painkillers (e.g. NSAIDs, acetaminophen).
• Having previously received radiation therapy to the abdominal area.
• Exposure to carcinogens, such as cadmium and asbestos .
• Sickle cell disease: This is associated with a rare type of RCC.
• Family history of kidney cancer.
• Genetic mutations: These are changes in the DNA of cells.
• Tuberous sclerosis complex.
• Von Hippel-Lindau disease (VHL).

If you have one of these risk factors, your doctor may recommend that you have regular kidney exams, which can help detect cancer at an early stage.

How to identify RCC?

About 25% of people with RCC are diagnosed with the disease after the cancer has spread a little, meaning when symptoms start to appear.

However, the good news is that imaging tests done for other reasons are now increasingly detecting RCC tumors incidentally, before symptoms appear. As a result, more people are receiving treatment for the cancer at its most treatable stage.

Tests to diagnose RCC

Doctors use imaging tests to diagnose cancer and plan treatment. The most common tests are:

• Ultrasound scan: This involves sending high-frequency sound waves through body tissue and creating images that can be viewed on a monitor. An ultrasound can help determine whether the lump is filled with fluid (which is often a cyst ) or solid (which is more common in cancerous lumps).
• Computed tomography (CT) scan: This creates a series of pictures that give a detailed picture of the inside of the body. You will likely have to inject a dye called contrast into a vein and have a scan before and after. This dye travels to the cancer and shows it up clearly.
• Magnetic resonance imaging (MRI) scan: This uses a large magnet, radio waves, and a computer to create detailed images of the inside of the body. Your doctor may recommend an MRI if you can't have a CT scan (for example, if you're allergic to the dye mentioned earlier), or if the results of an ultrasound and CT scan are inconclusive.

Although a biopsy is usually performed to diagnose cancer, this is rarely done in RCC. A biopsy involves taking a small sample of tissue from the tumor and examining it under a microscope to see if there are cancer cells.

But biopsying RCC is often risky because it can damage the kidney. So, doctors often test for cancer cells after removing the entire tumor as a treatment. If imaging shows that the cancer has spread, they can take cancer cells from somewhere other than the kidney and test them.

Testing these cells is the only way to know for sure what type of RCC you have (if it's not clear from imaging). It also helps identify which treatments work best for that type of cancer.

Staging of renal cell carcinoma

Knowing the stage of your cancer helps your doctor understand how far your cancer has spread. It also tells you whether the cancer is localized or metastatic . This information can help you plan your treatment and give you an idea of ​​the prognosis.

Doctors use a system called TNM (tumor, lymph node, metastasis) to determine the stage of RCC. They classify the cancer into stages I through IV. Stages I, II, and III cancers are classified as localized, while stage IV is metastatic RCC.

• Stage I RCC: The cancer is smaller than 7 centimeters and has not spread outside the kidney.
• Stage II RCC: The cancer is larger than 7 centimeters, but has not spread outside the kidney.
• Stage III RCC: The tumor can be any size and has spread to nearby tissues around the kidney.
• Stage IV RCC: The cancer has spread beyond the kidney to the lymph nodes and other organs.

Important: Knowing the stage of the cancer is essential for determining treatment, so discuss this carefully with your doctor.

Where does RCC spread first?

Metastatic RCC often spreads to your lymph nodes, lungs, bones, liver, and brain. It can sometimes spread to your ovaries or testicles.

What are the treatments for renal cell carcinoma?

Treatment depends on many factors, including the stage of the cancer and your overall health. Treatment for localized RCC is different from treatment for metastatic RCC .

Localized renal cell carcinoma treatment

The treatment for this is to remove the cancer, or to destroy the cancer using ablation techniques (killing cells with extreme heat or cold).

Surgery is the most common treatment for localized RCC.

• Radical nephrectomy: This involves removing the kidney with the cancer and some of the surrounding tissue (such as the lymph nodes and adrenal glands, where cancer cells may be present). For most people, one healthy kidney is sufficient.
• Partial nephrectomy:This involves removing only the part of the kidney that has cancer. This surgery can be done if your cancer is small. This can save some of your kidney function. This is very important if you don't have two healthy kidneys.

If you are not a good candidate for surgery, your doctor may recommend ablation procedures. These include:

• Cryotherapy: Cancer cells are killed by exposing them to extreme cold.
• Radiofrequency ablation: Cancer cells are burned away by exposing them to high heat.

Metastatic renal cell carcinoma treatment

Treatment for metastatic RCC involves fighting cancer cells throughout the body. Surgery can be done to remove the tumor, but it is not enough to completely eliminate metastatic cancer. However, removing the tumor can help reduce symptoms and delay the start of other treatments.

The most common treatments are immunotherapy and targeted therapy . Depending on various factors, these drugs are given alone or in combination.

Immunotherapy treatments

Immunotherapy works by strengthening your immune system, helping it find and fight cancer cells. Some of these drugs include:

• Avelumab (Avelumab - Bavencio®)
• Ipilimumab (Ipilimumab - Yervoy®)
• Nivolumab (Nivolumab - Opdivo®)
• Pembrolizumab (Pembrolizumab - Keytruda®)

Targeted therapy treatments

Targeted therapies work by interfering with the process of cancer cell multiplication. This treatment limits the blood supply to cancer cells, slowing their growth. Some of these drugs include:

• Axitinib (Axitinib - Inlyta®)
• Bevacizumab (Bevacizumab - Avastin®)
• Cabozantinib (Cabozantinib - Cabometyx®)
• Everolimus (Everolimus - Afinitor®)
• Lenvatinib (Lenvatinib - Lenvima®)
• Pazopanib (Pazopanib - Votrient®)
• Sorafenib (Sorafenib - Nexavar®)
• Sunitinib (Sunitinib - Sutent®)
• Temsirolimus (Temsirolimus - Torisel®)
• Tivozanib (Tivozanib - Fotivda®)

Depending on the stage of the cancer, where it has spread, its severity, and your response to other treatments, your doctor may recommend other cancer treatments, such as radiation therapy .

Can RCC be completely cured?

It depends on your specific diagnosis. Localized RCCPeople with high-risk localized RCC who have their cancer removed surgically usually have a good long-term outcome. People with high-risk localized RCC may also be given immunotherapy after the cancer is removed to improve long-term outcomes.

There is currently no cure for advanced RCC that has spread beyond the kidney. However, as scientists find better treatments that target specific cancer cells, people with metastatic RCC are now living longer.

What is the outlook for RCCs?

Doctors are now better able to detect RCC in its early stages, when the cancer is most treatable. Early detection and improved treatments have improved survival rates. 90% of people with stage I RCC survive for five years. Similarly, while the life expectancy for people with stage IV RCC used to be limited to months, many now live for several years.

Can RCC be prevented?

RCC can't always be prevented. But you can reduce your risk. For example, not smoking (or quitting if you do) is one of the best things you can do to reduce your risk of cancer. It's also important to maintain a healthy weight, eat a balanced diet, and control high blood pressure.

How can I take care of myself?

Talk to your doctor about a care plan to help you manage your cancer symptoms and the side effects of your treatment. For example, some people may need to start dialysis after surgery if one or both kidneys are not working properly. It's important to know how these treatments will affect you.

You may need help managing the side effects of targeted therapy or immunotherapy . Ask your doctor what to expect before starting treatment.

What questions should I ask my doctor?

• What type of RCC do I have?
• How far has my cancer spread (what is the stage)?
• What are the advantages and disadvantages of the available treatments?
• What are the side effects or complications I should be aware of before undergoing treatment?
• How often should I come for check-ups after treatment?
• What changes should I expect in my lifestyle during treatment?
• What is the prognosis of my condition?

Your renal cell carcinoma (RCC) cancer treatment experience will depend on many factors, including your overall health, the type and stage of RCC, and your response to treatment. But anyone diagnosed with kidney cancer will benefit from building a close relationship with their medical team. Don’t hesitate to ask questions about your diagnosis, the pros and cons of treatment options, and the expected outcomes. Your doctor is the best person to explain what it means to you to have RCC.

Finally, things to remember

Although renal cell carcinoma (RCC) is a serious condition, its cure rate has improved greatly with early detection and proper treatment. If you have any symptoms, especially blood in your urine, pain in your pelvis, a lump in your arm, or a family history of kidney cancer, seek medical advice immediately. You can reduce your risk of developing this disease by avoiding smoking and adopting a healthy lifestyle. Don't be afraid to talk to your doctor if you have any concerns. You are not alone.

` Kidney cancer, renal cell carcinoma, RCC, kidney tumors, cancer symptoms, cancer treatment, kidney health