Stage 4 Kidney Cancer

By Kathryn E. Vinson, MS, CCRC

Young adult female cancer patient with her daughter

The kidneys are one of our body’s most amazing filters.  They do so much for us – filtering various elements out of our blood, balancing our fluid loads, regulating the acid/base balance in our bodies – they are some serious workhorses.  When cancer develops in our kidneys (about 90% of the time it is known as renal cell carcinoma, so that’s what we’ll focus on), it can put our bodies in some pretty serious danger.  Let’s take some time today to talk about stage 4 kidney cancer, its symptoms, outlook, and treatment options.

What are the symptoms of stage 4 kidney cancer?

Stage 4 kidney cancer presents with symptoms similar to kidney cancer at other stages.  The most well known of these symptoms is blood in the urine, or hematuria.  Hematuria is a major warning sign regardless of the cause, so if you experience this – please see your physician immediately.  Other signs and symptoms of kidney cancer include:

  • Swelling or mass in the lower back
  • Pain in the back
  • Tiredness or fatigue
  • Appetite loss
  • Weight loss (when you aren’t trying to lose weight)
  • Unexplainable fever
  • Anemia

What is the prognosis for stage 4 kidney cancer?

Sadly, metastatic kidney cancer or stage 4 kidney cancer does not have an encouraging 5-year survival rate; the rate is only about 8%.  Despite this low number, I want to emphasize that all 5-year survival rates are based on diagnoses that occurred at least 5 years ago, so current/new treatments are not always reflected in these numbers.

The American Cancer Society also tells us of the UCLA Integrated Staging System.  This system uses indicators from the patient’s overall health to stratify them in to having good, intermediate or poor prognoses.  None of the factors listed below is considered a good prognosis, 1-2 an intermediate, and 3 or more a poor prognosis. (Directly quoted from cancer.org):

  • High blood lactate dehydrogenase (LDH) level
  • High blood calcium level
  • Anemia (low red blood cell count)
  • The cancer spread to 2 or more distant sites
  • Less than a year from diagnosis to the need for systemic treatment
  • Poor performance status (a measure of how well a person can do normal daily activities

How is stage 4 kidney cancer treated?

The current treatment method for stage 4 kidney cancer is surgical intervention, if possible, embolization and radiation treatment. I say “if possible” because surgery isn’t always an option. When a tumor can be removed without damaging surrounding structures, then it is a possibility.  Kidney cancer likes to spread to the lungs, and a partial lung removal is sometimes possible – but again, this depends on the overall health of the patient. Embolization is a method where the blood flow to the tumor is blocked. While this can kill the tumor by choking off its supply of nutrients, an embolization also runs the risk of cutting off blood to healthy cells.  Targeted therapies also exist, such as sunitinib, which is a standard of care.

As with any treatment, we urge you to have an open and frank discussion with your treatment team and loved ones about the purpose of treatments.  It is vital that you go in knowing the aim of the treatment – be it curative or palliative.

New findings on kidney cancer treatment

In February of 2019, doctors with the Dana Farber Cancer Institute revealed the results of a phase 3 clinical trial in patients with metastatic kidney cancer. Their results showed that patients receiving a combination of the immunotherapy drug avelumab plus the targeted therapy axitinib had a longer progression free survival time that those treated with sunitinib, which is the standard of care.  Those patients on the combination treatment also saw improvement in shrinkage of tumors compared to the control group.  While researchers warn that these are early results and more study is needed, it certainly provides great hope for those dealing with stage 4 kidney cancer.

As always, much love, many prayers, and abundant blessings to all of the warriors out there!!

Sources:
https://www.cancer.org/cancer/kidney-cancer.html
https://www.healthline.com/health/rcc/stage-4-renal-cell-carcinoma#treatment
https://www.sciencedaily.com/releases/2019/02/190217115910.htm

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