Disease Description (Causes and Symptoms)
- Definition: Renal cell carcinoma (RCC) is a malignant solid tumor that develops in the kidneys and accounts for most kidney cancers.
- Causes/Risk factors: No single definite cause is known. Smoking, hypertension (and some antihypertensive drugs), obesity, excessive use of painkillers, occupational exposure to carcinogens, and family history/genetic factors (such as the VHL gene) are associated with it.
- Pathophysiology: A tumor originating from renal cells (proximal tubule cells). It begins as a localized tumor and may spread hematogenously or through the lymphatic system (especially to the lungs, bones, liver, and brain). Paraneoplastic syndromes caused by substances secreted by the tumor (such as polycythemia, hypercalcemia, and nonmetastatic liver dysfunction) may occur.
- Main symptoms: It is often asymptomatic in the early stages. As it progresses, hematuria, flank pain, and a palpable abdominal mass may occur. With metastasis, symptoms may include shortness of breath and cough (lung metastasis), bone pain (bone metastasis), and neurological symptoms (brain metastasis).
Treatment Methods
- Surgery
- Radical nephrectomy: Standard treatment for extensive tumors or large lesions.
- Partial nephrectomy (nephron-sparing surgery): Preferentially considered to preserve renal function when the tumor is small and localized.
- Surgical resection of metastatic lesions (e.g., resection of lung or bone metastases) may improve survival in some selected patients.
- Local treatment
- Thermal ablation (radiofrequency or microwave) and percutaneous ablation: Considered for patients who cannot undergo surgery or for small tumors.
- Renal artery embolization: Used to reduce tumor size before major surgery or for palliative purposes.
- Systemic treatment (advanced/metastatic RCC)
- Immune checkpoint inhibitor (ICI) monotherapy or combination therapy: For example, nivolumab + ipilimumab (for certain risk groups), and ICI + TKI combination regimens such as pembrolizumab + axitinib are widely used as first-line standard treatments.
- Targeted therapy (TKIs): Angiogenesis and signal-transduction pathway inhibitors such as sunitinib, pazopanib, axitinib, and cabozantinib.
- mTOR inhibitors such as everolimus are used in certain situations.
- Cytokine therapy (interferon-α and high-dose IL-2) was a major treatment in the past but is now limited to selective use.
- Conservative and symptomatic treatment
- Radiation therapy: Used mainly to relieve pain and for local control of symptoms from brain or bone metastases.
- Supportive care such as transfusions, pain management, and electrolyte correction.
- Lifestyle management and precautions
- Regular monitoring of renal function (creatinine), blood pressure, and hematologic and liver-function tests is necessary after surgery and during systemic treatment.
- Immune therapy-related adverse reactions (such as hepatitis, colitis, and endocrine adverse effects) and characteristic TKI adverse effects (such as hypertension, diarrhea, and skin reactions) should be reported promptly.
- Risk-factor modification, including smoking cessation, weight management, and blood pressure control, is recommended.
Checklist Before an Outpatient Visit (Including Example Questions)
- Items to prepare
- A list of currently used medications (including prescription drugs, OTC drugs, and supplements) and a history of allergies
- Previous surgeries and medical history, and family history (including kidney cancer and VHL)
- Copies or images of previous test results: abdominal CT/MRI, ultrasound, chest imaging, blood tests, and biopsy results (if available)
- A record of changes in symptoms (hematuria, pain, weight changes, fever, etc.) and when they began
- Recent weight and blood pressure readings (if possible)
- Information to tell the healthcare provider during the outpatient visit
- Whether you are taking anticoagulants or antiplatelet drugs
- Possibility of pregnancy (women) or reproductive plans (of childbearing age)
- Previous experience with immunotherapy or targeted therapy and a history of adverse effects
- Example questions (prepare in advance)
- When did the symptoms begin, and what were they like?
- When did the symptoms worsen? Do specific activities or medications relieve or worsen them?
Examples of General Questions to Ask the Doctor
- Can this disease be cured in my case? What is the prognosis?
- What first-line treatment is recommended for my stage of disease (based on imaging/biopsy results)? Is partial nephrectomy possible?
- What are the main benefits and common adverse effects of the systemic treatment you recommend for me? How are adverse effects managed if they occur?
- To what extent will surgery or medication affect my remaining renal function? How can my renal function be protected?
- What is the schedule and what are the components of follow-up tests after treatment?
Examples of Disease-Specific Questions
- Based on the size and location of my tumor (imaging findings), is partial nephrectomy (nephron-sparing surgery) possible? If not, why not?
- Based on my disease risk (e.g., the IMDC risk group), what first-line systemic therapy is recommended (e.g., ICI combination therapy vs. TKI monotherapy), and what are the reasons for that choice and the expected adverse effects?
(If necessary, bringing test results or imaging findings to the appointment can facilitate more specific and personalized counseling.)