Renal Cell Carcinoma (RCC) Treatment in Delhi, India

Depending on its characteristics and prognosis, renal cell carcinoma can be categorised into several types. Here are the main types of renal cell carcinoma. 

Clear Cell Renal Cell Carcinoma (ccRCC)

The most common subtype of RCC (accounts for around 70%-80% of RCC cases), ccRCC occurs when kidney cells undergo malignant transformation. Clear cell renal cell carcinoma is characterised by increased glycogen levels in the tumour cells. This type of RCC is more aggressive than many other subtypes (has a high tendency to metastasise).

Papillary Renal Cell Carcinoma (pRCC)

Accounting for around 10%-15% of RCC cases, pRCC is the second most common type of renal cell carcinoma. This type of renal cell carcinoma can lead to the formation of papillary or finger-like projections in the kidneys. Though less aggressive than clear cell RCC, pRCC can still metastasise.

Chromophobe Renal Cell Carcinoma

This type of renal cell carcinoma accounts for around 5% of cases. It arises from the intercalated cells of the renal collecting duct, and causes the cytoplasm to appear translucent or finely granular. Renal cell carcinoma is usually less aggressive than clear cell RCC and is relatively less likely to metastasise.

Collecting Duct Carcinoma (CDC)

Accounting for less than 1% of RCC cases, collecting duct carcinoma is a very rare form of renal cell carcinoma. In this health condition, tumour cells form irregular tubules and infiltrate surrounding kidney tissue. Often diagnosed at an advanced stage with poor prognosis, CDC is more aggressive than ccRCC.

Medullary Renal Cell Carcinoma

A rare and aggressive subtype of renal cell carcinoma, medullary cell carcinoma accounts for almost 0.5% of diagnosed RCC cases. This type of RCC is characterised by reticular, trabecular, or solid growth patterns. It spreads rapidly, is extremely aggressive (more aggressive than ccRCC) and in many cases, does not respond to conventional therapies.

There are several causes of RCC-ranging from unhealthy lifestyle habits to underlying health conditions. A clear understanding of RCC causes is crucial for early detection, prevention, and effective management of the disease.

An Unhealthy Lifestyle

A sedentary lifestyle is a common cause of obesity, which can cause hormonal imbalances. If a hormonal imbalance leads to increased insulin and insulin-like growth factor (IGF) levels, a malignant tumour can develop. Smokers are more likely to develop RCC as tobacco smoke is made up of several chemicals that damage kidney cells, leading to mutations and tumour formation.

Underlying Conditions

Studies show that the following underlying health conditions can lead to RCC:

• Hypertension: Damages kidney blood vessels and causes oxidative stress.
• Chronic kidney disease (CKD): Leads to prolonged inflammation and renal fibrosis.
• Diabetes: Type 2 diabetes causes chronic inflammation, insulin resistance, and obesity, which can lead to development of malign kidney tumours.

Genetic Mutations and Hereditary Disorders

Mutations in the VHL gene can lead to uncontrolled cell growth, increasing the risk of clear cell RCC. Some inherited disorders that can cause RCC include:

• Hereditary Leiomyomatosis and Renal Cell Cancer (HLRCC): Caused by mutations in the FH gene.
• Birt-Hogg-Dubé Syndrome: Caused by mutations in the FLCN gene.
• Hereditary Papillary Renal Cell Carcinoma (HPRCC): Linked to MET gene mutations.

Exposure to Carcinogens

Exposure to the following carcinogens can lead to the development of a malignant tumour in the affected kidney:

• Trichloroethylene: Used to remove contaminants such as oils and grease from metal surfaces.
• Asbestos: Used in roofs, insulation, cement, floor tiles, and fireproofing materials.
• Cadmium: A metal found in batteries, plastics, and paints.

Radiation Exposure

Some types of ionising radiation such as X-rays, gamma rays, and nuclear radiation can cause direct damage to DNA by breaking chemical bonds in the double-stranded structure. Ionising radiation can also generate reactive oxygen species (ROS), which indirectly damage DNA by causing oxidative stress. In many cases, radiation exposure leads to chromosomal translocations, deletions, and duplications, disrupting normal cellular functions.

Here are some risk factors that increase an individual's likelihood of developing the disease:

• An Unhealthy Diet: A diet consisting of processed foods and red meat can lead to increased oxidative stress and inflammation, which can cause uncontrolled cell growth and eventually cancer. When red meat is cooked at high temperatures HCAs and PAHs form. Both HCAs and PAHs have been shown to damage DNA, increasing the risk of RCC.
• Long-term Use of NSAIDs: Long-term, regular use of ibuprofen, naproxen and other non-steroidal anti-inflammatory drugs may lead to kidney damage and oxidative stress, increasing one’s risk of developing renal cell carcinoma.
• Gender and Age: Men have higher levels of testosterone and other androgens than women and are twice more likely to develop RCC. As one ages, their risk factor for RCC increases as ageing can lead to mutations in tumour suppressor genes such as VHL, PBRM1, and TP53.
• Dialysis: Many patients on dialysis develop acquired cystic kidney disease, a condition that causes chronic kidney damage, leading to the formation of multiple cysts in the kidneys. These cysts have a higher chance of undergoing malignant transformation, leading to RCC.

In the early stage of RCC, many patients may not have any noticeable symptoms.As the tumor grows, one may experience a wide range of symptoms including: 

• Blood in the Urine: RCC can affect nearby blood vessels in the kidney, leading to blood in the urine (can cause the urine to look pink or red). Bleeding may stop temporarily and then recur later, depending on how the tumour behaves. In some cases, red blood cells present in the urine are only visible under a microscope.
• Flank or Lower Back Pain: As a malignant tumour grows, it can press against surrounding tissues causing a persistent, dull ache or sharp pain in the side (flank) or lower back. Lower back pain caused by RCC is usually not severe and does not come in waves. 
• A Mass or Lump in the Abdomen or Side: As the cancerous cells multiply, the tumour grows large enough to be felt as a lump in the abdomen or side (flank). In some cases, this lump may not be noticeable, especially in obese individuals. Doctors often use imaging tests such as ultrasound and CT scan to see whether a lump has formed. 
• Unexplained Weight Loss: In people with renal cell carcinoma, weight loss can occur due to increased metabolic activity (tumours release cytokines which lead to loss of appetite and muscle breakdown). Sudden, unexplained weight loss is one of the first noticeable symptoms of RCC. 
• Fatigue and Weakness: RCC can cause excessive blood loss or disrupt erythropoietin (EPO) production in the kidneys, leading to anemia, which results in fatigue and weakness. Like other cancers, RCC triggers an immune response, resulting in the release of inflammatory cytokines such as IL-6 and TNF-alpha, causing persistent fatigue.

Early detection of RCC improves treatment outcomes. Doctors perform clinical evaluations, imaging techniques, and laboratory tests to detect malignant kidney tumours.

Clinical Evaluations

A thorough physical examination can help doctors identify swollen nodes. During a physical examination, a doctor may palpate the patient’s abdomen to detect large, potentially malignant kidney tumours.

Imaging Tests

Doctors use the following imaging tests to detect tumours, determine their size, and find out if cancer has spread:

• CT Scan (Computed Tomography): Uses contrast dye to highlight kidney masses.
• MRI (Magnetic Resonance Imaging): Generates detailed images of the kidneys and surrounding structures, helping doctors identify malignant tumours.
• Ultrasound: Generates real-time images of the kidneys, helping identify solid renal masses.
• PET Scan: Helps detect metabolic activity in kidney tumours and potential metastases.

Lab Tests

Below are some laboratory tests used to diagnose RCC:

• Urinalysis: Helps detect blood in urine (hematuria), a common sign of RCC
• Complete Blood Count (CBC): Helps measure the number of red blood cells in blood. An abnormally high or low RBC count can indicate RCC
• Lactate Dehydrogenase (LDH) & Calcium blood test: Can help detect increased LDH and calcium blood levels, which are often associated with malignant tumours

Biopsy

A biopsy can help determine the type of RCC the person has, and how aggressive the cancer is, as well as predict how cancer cells will behave and respond to treatment. A biopsy is usually used when:

• The tumour is small, and doctors are not sure if surgery is needed
• The patient has multiple kidney tumours, caused by genetic disorders

Genetic and Molecular Testing

Genetic and molecular testing can help identify MET mutations, FH mutations, BAP1 mutations, and other mutations that can cause RCC. Doctors often use genetic and molecular testing to predict how tumours will react to RCC treatment.

Depending on the stage of RCC, the patient’s overall health, and their medical history, a doctor may use one or more of the following RCC treatment options:

Surgery

Two types of surgeries performed to treat RCC are partial and radical nephrectomy. A partial nephrectomy involves removing the tumour and a small part of healthy tissue. If the cancerous tumour measures more than 7 cm or partial nephrectomy isn’t feasible, doctors may perform a radical nephrectomy to remove the affected kidney, surrounding fat, adrenal gland (in some cases), and nearby lymph nodes.

Targeted Therapy

Targeted therapy for renal cell carcinoma (RCC) focuses on specific molecular pathways and proteins that promote the growth of kidney cancer cells and help them survive. Here are some drugs that attack cancer-specific pathways

• Sunitinib (Sutent),Pazopanib (Votrient), Axitinib: Block signals that promote tumour growth
• Everolimus (Afinitor) and Temsirolimus (Torisel): Inhibit unchecked cell growth
• Bevacizumab: Block blood supply to tumours

Immunotherapy

Immune checkpoint inhibitors such as PD-1/PD-L1 Inhibitors block PD-1 or PD-L1 proteins, which cancer cells use to "turn off" immune responses.CTLA-4 Inhibitors, another type of immune checkpoint inhibitors activate T-cells by blocking CTLA-4.

Radiation Therapy

Radiation therapy can help relieve pain caused by metastatic RCC, particularly in the bones, brain, or spinal cord.If surgery is not an option, radiation may help reduce tumour size and relieve RCC symptoms.

Ablative Therapies

Ablative therapies are minimally invasive treatments that use extreme heat or cold to destroy cancerous tissue in the kidney. Here are the two main types of ablative therapies: 

• Radiofrequency ablation (RFA): A probe delivers high-energy radio waves to heat and destroy the tumour
• Cryoablation: Uses extreme cold to freeze and destroy the tumour

One can significantly reduce their risk of developing RCC by following these simple, yet effective RCC prevention tips:

Maintain a Healthy Lifestyle

Obesity and lifestyle diseases such as diabetes and hypertension can cause RCC. A healthy lifestyle can help prevent obesity and lifestyle diseases. People at high risk of developing RCC must quit smoking and cut down on alcohol as both tobacco and alcohol can damage kidney cells.

Stay Hydrated

Water helps the kidneys function properly and may reduce the risk of kidney cancer by flushing out toxins. To ensure adequate hydration, an individual should drink at least two litres of water everyday unless otherwise instructed by their doctor.

Limit Exposure to Harmful Substances

One should avoid prolonged exposure to asbestos, cadmium, organic solvents, and other carcinogens that can lead to formation of kidney tumours. People who work in high-risk environments and are exposed to carcinogens regularly should use protective gear when working.

Go for Regular Health Checkups

Routine health screenings can help detect kidney issues early, paving the way for timely intervention. Timely diagnosis and treatment improves patient outcomes. People with medical conditions that can lead to RCC and those with a family health history of the disease should get kidney function tests regularly (as advised by their doctor).

How does renal cell carcinoma affect kidney function?

RCC can impair kidney function by causing obstruction, reducing filtration ability, or leading to kidney failure in severe cases. If one kidney is affected, the other usually compensates unless both are involved.

Can renal cell carcinoma spread to other parts of the body?

Yes, RCC can metastasise to the lungs, liver, bones, or brain if not detected early. Metastatic RCC requires more aggressive treatment, including targeted therapy or immunotherapy.

What is the survival rate for renal cell carcinoma?

Survival depends on the stage at diagnosis. Early-stage RCC has a high survival rate, while advanced stages have lower survival due to metastasis. Advances in treatment have improved outcomes.

Does renal cell carcinoma affect urine production or quality?

In some cases, RCC can cause blood in the urine (hematuria) or changes in urine output. However, symptoms may not appear until the disease is advanced.

Is renal cell carcinoma hereditary?

While most RCC cases are sporadic, some genetic conditions like von Hippel-Lindau disease increase the risk. A family history of kidney cancer may also raise susceptibility.

How does renal cell carcinoma impact overall health and well-being?

RCC can cause fatigue, weight loss, and pain, affecting daily life. Treatment side effects may also impact physical and mental well-being, requiring supportive care.

Can renal cell carcinoma recur after treatment?

Yes, RCC can recur, especially if diagnosed at a later stage. Regular follow-ups, imaging tests, and lifestyle changes can help in early detection of recurrence.

Are there alternative or complementary therapies for renal cell carcinoma?

While medical treatment is primary, some patients explore complementary approaches like acupuncture, dietary changes, and stress management. These should be used alongside standard care, not as replacements.

How does renal cell carcinoma affect daily activities?

Fatigue, pain, and treatment side effects can make routine activities difficult. Adjusting work schedules, staying active, and seeking support can help maintain quality of life.

Can renal cell carcinoma be managed without surgery?

In some cases, especially in elderly patients or those with small tumours, active surveillance or targeted therapy may be considered instead of surgery. However, surgery remains the primary treatment for localised RCC.

How does renal cell carcinoma impact kidney donors or recipients?

RCC is rare in kidney transplant recipients but requires careful monitoring. Kidney donors are thoroughly screened to ensure they do not have kidney cancer before donation.

What lifestyle modifications can help after a renal cell carcinoma diagnosis?

Maintaining a healthy diet, staying physically active, avoiding smoking, and managing stress can support recovery and overall health. Regular medical check-ups are also essential.

Does renal cell carcinoma cause pain?

Some patients experience flank pain or discomfort, but others may have no symptoms. Pain may increase as the tumour grows or spreads.

How does renal cell carcinoma affect blood pressure?

RCC can lead to high blood pressure (hypertension) due to kidney dysfunction or hormone secretion. Managing blood pressure is an important part of treatment.

What support resources are available for renal cell carcinoma patients?

Patients can access support groups, counselling, and financial aid programs through hospitals and cancer organisations. Online communities also provide emotional and practical support.

Reviewed by Dr. Rohit Kaushal, Senior Consultant - Urology, Kidney Transplant, Robotics and Uro-Oncology, Robotic Surgery, on 02 September 2025.

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