Renal Cell Carcinoma

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Renal Cell Carcinoma

Disease Overview
Treatment Overview

To learn more about Renal Cell Carcinoma (RCC) and Treatment, please visit our resources by clicking on the link below.

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Incidence

Age-standardised incidence rates of kidney cancer in the UK are 7.2 and 12.4 new cases per 100,000 women and men, respectively (2019 data)⁷

RCC accounts for ~90% of all kidney cancer cases^1–4

Cause

While the exact cause of RCC is unknown,⁵ three major risk factors have been identified:

Cigarette smoking^1–3

Obesity^1–3

Hypertension^1–3

Additional risk factors include:

Chronic kidney disease³

Dialysis³

Kidney transplantation³

Acquired kidney cystic disease³

Family history of RCC^1,3

Diabetes mellitus^1,3

Approximately 2–3% of RCC cases are hereditary and several autosomal dominant syndromes have been described, with the most common one being von Hippel-Lindau disease⁶

Survival

The natural clinical course in RCC varies among patients depending on the extent of disease, histology, grading, and clinical factors.⁶

5-year disease-specific survival across RCC patient risk groups (University of California Los Angeles Integrated Staging System)⁶

Symptoms

Patients with small tumour masses (<3 cm) are usually asymptomatic, with ~60% of all cases being discovered incidentally.^1,4,5

Given that patients may remain asymptomatic for long periods of time, ~20–30% of patients present with metastatic disease at diagnosis.⁴

The classic triad of flank pain, gross haematuria, and a palpable abdominal mass is not commonly found at presentation in patients with RCC, being observed in 4–17% of cases and generally indicating aggressive disease.^1,4,5

As tumours grow and spread to different locations in the body, patients may experience a range of symptoms.^4,5 In addition, symptoms may be caused at any stage of the disease by the excretion of hormones or cytokines by tumour cells, or due to an immune response against the tumour.^3,4

Potential signs, symptoms, and complications of RCC

Visible haematuria^1–5

Flank pain^1–5

Palpable abdominal mass^1–3

Fatigue^4,5

Fever^3–6

Weight loss^4,5

Hypercalcaemia^3,6

Anaemia^4,5

Bone pain^1,4

Persistent cough^1–4

Diagnosis

Historically, patients were diagnosed with RCC after presenting with the classic triad of flank pain, gross haematuria, and a palpable abdominal mass.³ In contrast, nowadays most diagnoses result from incidental findings during routine imaging studies.^1,3,5

When RCC is suspected based on symptoms or from incidental radiological findings, patients should undergo laboratory examinations, comprehensive imaging studies, and ultimately a core kidney biopsy to obtain histopathological confirmation of the malignancy.^1–4,6

Diagnostic components in RCC

Suspicion of RCC

Incidental discovery of an abdominal mass in a routine imaging study suggestive of a kidney neoplasm^1,3,5

Medical history and physical examination to evaluate for potential symptoms of RCC and a family history of the condition^1,4,5

Laboratory tests

Tests include:

Serum creatinine²
Haemoglobin²
Leukocyte and platelet counts²
Lymphocyte-to-neutrophil ratio²
Serum-corrected calcium²

Imaging studies

Computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound are the imaging modalities used to characterise renal masses (RMs)¹

Contrast-enhanced chest, abdominal, and pelvic CT is necessary for accurate staging of RCC tumours of all stages²

A high-resolution CT scan of the chest without contrast agent with an abdominal MRI is recommended for staging patients with an allergy to CT contrast agent, or in those with kidney insufficiency⁶

Biopsy or resection

A kidney tumour core biopsy or partial/radical nephrectomy specimen is required to obtain histopathalogical confirmation of malignancy^2,3

Core biopsies of solid renal masses have a high diagnostic yield (78-97%), high specificity (98-100%), and high sensitivity (86-100%) for the diagnosis of RCC malignancy¹

If an initial biopsy is non-diagnostic, a second biopsy or surgical resection should be considered¹

CT, computed tomography; ECOG, Eastern Cooperative Oncology Group; EU, European Union; MRI, magnetic resonance imaging; RCC, renal cell carcinoma; RM, renal mass; UK, United Kingdom.

References:

Ljungberg B et al. Eur Urol. 2022;82(4):399–410.
Powles T et al. Ann Oncol. 2024;S0923-7534(24)00676-8.
Hsieh JJ et al. Nat Rev Dis Primers. 2017:3:17009.
Bahadoram S et al. G Ital Nefrol. 2022;39(3):2022-vol3.
Garfield K, LaGrange CA. Treasure Island (FL): StatPearls Publishing. 2024.
Escudier B et al. Ann Oncol. 2019;30(5):706–720.
Jani C et al. Sci Rep. 2022;12(1):22368.

To learn more about Renal Cell Carcinoma (RCC) and Treatment, please visit our resources by clicking on the link below.

EXPLORE RESOURCES

Treatment of localised RCC

Surgery is the only curative treatment intervention for patients with localised RCC.^1,3

Surgery

PN is the preferred treatment option for patients with organ-confined T1 tumours ≤7 cm^1–4
PN can be carried out via open, laparoscopic, or robot-assisted laparascopic approaches²
A nephron-sparing strategy (including PN) is the standard of care irrespective of tumour size in patients with compromised kidney function, one kidney remaining, or bilateral tumours²

Conventional or robot-assisted laparascopic RN is recommended if PN is not technically feasible for the treatment of patients with T1 tumours²
Minimally invasive RN is the preferred treatment option for patients with T2 tumours (>7 cm)²
Open RN is the standard of care for patients with locally advanced T3 or T4 tumours²

Ablative therapies

Ablative therapies are options in patients with small cortical tumours (≤3 cm), especially for frail patients who present a high surgical risk, those with a single kidney, compromised kidney function, or bilateral tumours^1–3,6

Ablative therapies include radiofrequency ablation, microwave ablation, laser ablation, and cryoablation^1–3

Active surveillance

Active surveillance is an option for elderly patients with multiple comorbidities, in those with a short life expectancy, and for patients with small kidney tumours measuring ≤4 cm^2–5

Patients are monitored to track the size of their tumour(s) with imaging studies (ultrasound, computed tomography, or magnetic resonance imaging), with delayed intervention reserved for those showing clinical progression at follow-up^1,3

An upfront kidney biopsy is recommended to select patients with small masses for active surveillance^1,6

Treatment of metastatic RCC (mRCC)

Most patients with metastatic disease require systemic therapy, with local interventions such as cytoreductive nephrectomy (CN) and radiotherapy being generally for palliative use.¹

Local therapy

CN may be considered in select patients with low-volume single-organ metastatic disease with a large primary tumour, or for patients who have had a near complete response to upfront systemic therapy²

Radiotherapy (especially stereotactic radiotherapy) may provide substantial relief from local symptoms in patients with bone and brain metastases¹

Systemic therapy

Since the introduction of targeted agents in 2006, disease stabilisation or regression and prolonged survival have been possible in patients with mRCC.¹

Several agents have been approved for the treatment of mRCC, including VEGF inhibitors, ICIs, mammalian target of rapamycin (mTOR) inhibitors, and an anti-VEGF antibody (bevacizumab).^1–3

Several treatment regimens are recommended for the treatment of mRCC in first line, but there is no preferred combination and indirect cross-trial comparisons are not recommended.²

About FOTIVDA (tivozanib)

FOTIVDA is indicated for the first-line treatment of adult patients with advanced RCC and for adult patients who are VEGFR and mTOR pathway inhibitor-naïve following disease progression after one prior treatment with cytokine therapy for advanced RCC.⁷

To learn more about Renal Cell Carcinoma (RCC) and Treatment, please visit our resources by clicking on the link below

VIEW RESOURCES

ccRCC, clear-cell renal cell carcinoma; CN, cytoreductive nephrectomy; ICI, immune checkpoint inhibitor; IFN, interferon alfa; mTOR, mammalian target of rapamycin; mRCC, metastatic renal cell carcinoma; PN, partial nephrectomy; RCC, renal cell carcinoma; RN, radical nephrectomy.

References:

Ljungberg B et al. Eur Urol. 2022;82(4):399–410.
Powles T et al. Ann Oncol. 2024;S0923-7534(24)00676-8.
Hsieh JJ et al. Nat Rev Dis Primers. 2017:3:17009.
Bahadoram S et al. G Ital Nefrol. 2022;39(3):2022-vol3.
Garfield K, LaGrange CA. Treasure Island (FL): StatPearls Publishing. 2024.
Escudier B et al. Ann Oncol. 2019;30(5):706–720.
FOTIVDA (tivozanib) Summary of Product Characteristics.

IE-NPS-0121 | June 2026

Renal Cell Carcinoma

Renal Cell Carcinoma

Incidence

Cause

Additional risk factors include:

Survival

Symptoms

Potential signs, symptoms, and complications of RCC

Diagnosis

Diagnostic components in RCC

Treatment of localised RCC

Treatment of metastatic RCC (mRCC)

About FOTIVDA (tivozanib)

Adverse event reporting