Sarcomatoid Renal Cell Carcinoma - Causes, Symptoms, Diagnosis, and Treatment

What Is Sarcomatoid Renal Cell Carcinoma?

First, let us define what renal cell carcinoma is. Renal cell carcinoma is a type of cancer that develops in the tubules of the kidneys, where blood is cleansed and purified. Sarcomatoid renal cell carcinoma is a type of RCC in its most aggressive form.

In general, renal cancer cells will be clear, but in sarcomatoid RCC, the cancer cells will appear different and may resemble sarcoma cells.

Additionally, the unfortunate aspect is that sarcomatoid renal cells grow at a faster rate and spread to other parts of the body. So, by the time doctors confirm the diagnosis, the cancer could have spread to other parts of the body, making the treatment difficult and the prognosis poor.

How Common Is Sarcomatoid Renal Cell Carcinoma?

Sarcomatoid features are uncommon and are found in about 5 to 10 % of people with renal cell carcinoma. Although rare, this form of RCC is more serious and often diagnosed at an advanced stage.

What Are the Causes and Risk Factors of Sarcomatoid Renal Cell Carcinoma?

Experts are still unclear about what exactly causes the disease. But they have found out some risk factors that might increase your risk of getting this aggressive form of cancer.

The risk factors include:

• A habit of smoking.

• Family history of renal cell carcinoma.

• Excess weight.

• Increased blood pressure.

• Improper use or misuse of pain relievers, particularly over-the-counter pain medications.

What Are the Symptoms of Sarcomatoid Renal Cell Carcinoma?

Sarcomatoid RCC may exhibit symptoms, but some individuals may not experience any symptoms initially. The symptoms depend on how advanced your cancer is, and they also vary between individuals.

Common symptoms include:

• Pain in the side or back.

• Blood in the urine.

• Bone pain.

• Weight loss.

• Fever.

• Cough.

• Shortness of breath.

• Feeling very tired.

On the other hand, some individuals may not exhibit any symptoms at the time of diagnosis. This fact makes it necessary to have proper check-ups and medical tests to diagnose the condition early and for prompt treatment.

How to Diagnose Sarcomatoid Renal Cell Carcinoma?

To diagnose sarcomatoid renal cell carcinoma, the doctor will first inquire about your medical history, your symptoms, and any other health problems you may have. They will also do a physical examination.

Next, your doctor may order some medical tests. While these tests cannot confirm cancer on their own, they help check how well your kidneys are working and rule out other causes of your symptoms. Tests such as blood tests, creatinine levels, alkaline phosphatase levels, and urine tests can provide useful clues.

Imaging tests are usually very important. Your doctor may recommend a CT (computed tomography) scan, MRI (magnetic resonance imaging), ultrasound, or IV (intravenous) pyelogram. These tests help detect any abnormal growths or changes in your kidneys.

In some cases, a biopsy may be done before surgery. During a biopsy, a small piece of tissue is removed and examined under a microscope to detect cancer. Sometimes, if the tests strongly suggest cancer, your doctor may recommend surgery without a biopsy.

One common surgery is a partial nephrectomy, where the doctor removes the tumor along with some nearby kidney tissue. In some cases, nearby fat, lymph nodes, or the adrenal gland may also be removed. The removed tissue is then analyzed by a pathologist to confirm the type and extent of the cancer.

Staging and Grading of Sarcomatoid RCC

By understanding the staging and grading of sarcomatoid RCC, you will know how far your cancer has spread and how severe it is. This will help doctors determine the kind of treatment you will need and your recovery.

Sarcomatoid RCC is usually high-grade or aggressive and often diagnosed at the advanced stage of the disease.

How to Treat Sarcomatoid Renal Cell Carcinoma?

Treating sarcomatoid renal cell carcinoma depends on how advanced the cancer is and your overall health. Your doctor will explain the options and help you choose the best plan for you.

Surgery

In case of renal cell carcinoma without sarcomatoid features, surgery is often the main treatment. This usually involves a nephrectomy, where your surgeon removes the cancer along with part or all of the kidney.

However, surgery alone is usually less effective for people with sarcomatoid RCC. Studies have shown that even after a nephrectomy, the cancer often comes back. In fact, about 77 to 80 % of patients experience a recurrence within 5 to 26 months after surgery. Because of this high risk of recurrence, doctors often recommend additional treatments and close follow-up for people with sarcomatoid RCC.

Medications

Our immune system is so clever that it has proteins called checkpoints to prevent it from attacking our own cells. These checkpoints are present in immune cells. Sometimes, cancer cells exploit these checkpoints to evade detection by the immune system.

Immune checkpoint inhibitors are medicines that block these checkpoints. By doing this, they help your own immune system recognize and attack cancer cells.

Studies suggest that immune checkpoint inhibitors may work well for sarcomatoid RCC. This may be because sarcomatoid RCC tumors have higher levels of certain checkpoint proteins compared to other types of RCC.

However, doctors still require further research to fully understand the effectiveness of these treatments and identify which patients benefit the most from them.

Radiation

Radiation therapy does not cure sarcomatoid RCC, but it can still help you feel more comfortable. Doctors usually use it as palliative treatment, which means it focuses on reducing your symptoms rather than treating the cancer itself.

Radiation therapy may help reduce your pain, ease nerve-related symptoms, and lower the amount of blood in your urine. These can improve your quality of life while you are living with sarcomatoid RCC.

Studies show that other systemic treatments, such as chemotherapy, targeted therapy, and combination therapies, are generally not very effective for sarcomatoid RCC. Because of this, your doctor may focus more on managing your symptoms and considering newer treatment options while closely monitoring your condition.

Latest Research and Advances in Sarcomatoid RCC

Several studies are going on to determine the right treatment for sarcomatoid RCC. This research focuses on immunotherapy (a kind of treatment that uses your own immune cells to fight against cancer) and combined treatment to accelerate outcomes.

Several studies suggest that this cancer type responds better to immune-based treatments compared to older therapies. Clinical trials are currently underway, leading to the development of more effective therapies in the near future.

Living With Sarcomatoid Renal Cell Carcinoma

If you have sarcomatoid renal cell carcinoma, living with it is emotionally and physically challenging. Routine monitoring, symptom management, and continuous support from your care team are crucial. Along with medications and therapies, counselling, support groups, and lifestyle changes may also help improve your overall health and quality of life.

Conclusion

Sarcomatoid RCC is a rare type of renal cell carcinoma, which is often diagnosed in the advanced stage. The exact cause of the condition is unknown, but certain risk factors increase your likelihood of developing it. Not all individuals will experience the symptoms associated with this disease; some may not exhibit any symptoms at all. Therefore, it is advisable to undergo regular medical tests if you are at risk of developing the disease. To know about the exact tests to identify your kidney health, you can consult a cancer specialist. Diagnosis depends on physical examination, imaging, and biopsy. Treatment includes surgery, medications, and palliative care.

Key Takeaways

• Sarcomatoid renal cell carcinoma is an aggressive type of renal cell carcinoma.

• Smoking, excess weight, increased blood pressure, and a family history of RCC increase your risk of sarcomatoid renal cell carcinoma.

• This condition is often diagnosed at an advanced stage, which makes it difficult to treat and often has a poor prognosis.