Can Renal Cell Cancer Come Back?

If you or someone you love has had renal cell carcinoma, aka kidney cancer, you know how tough the treatment can be. The last thing anyone would want is to go through that experience again.

But what are the chances you will? Is there anything you can do to keep your kidneys (or kidney) healthy? We can’t make the uncertainty go away. But we can empower you with the information you need to assess your risk and improve your odds.

To do that, we turn to genitourinary medical oncologist Amanda Nizam, MD. She shares the factors associated with kidney cancer’s return, plus what you can do about them and symptoms to look out for.

Can renal cell carcinoma come back?

Yes, renal cell carcinoma (RCC) can come back. This is called a recurrence. Studies show that among people who have surgery to remove kidney cancer that hasn’t spread beyond the kidney, about 1 in every 5 people will develop cancer again.

The cancer may occur in the same spot as last time. But it could also appear someplace else on the kidney or even in the other one. In some cases, the cancer can spread to different parts of your body. That’s called metastatic disease.

About half of all RCC recurrences happen in the first two years after surgery. But recurrence can happen at any time, even after the five-year mark.

So, yes, RCC can come back. But you can’t know for sure whether it will. Luckily, Dr. Nizam explains that there is a way to assess your risk of recurrence. It’s called the ASSURE Nomogram.

Factors that predict kidney cancer recurrence

The ASSURE Nomogram is a mathematical model that healthcare providers use to estimate your chances of different kidney cancer outcomes.

“It’s like a risk calculator,” Dr. Nizam explains. “We input information about the specific findings from your cancer that was removed.”

The results help guide conversations about any additional treatment you may need after surgery to lower the risk of recurrence. Let’s take a look at the information that the ASSURE nomogram uses to estimate your RCC recurrence risk.

Your age at diagnosis

Age is a factor for two main reasons. The first is time: The younger you are, the more time the cancer has to come back. The second is genetics.

“Anyone who is diagnosed with renal cell cancer before age 50 should see a genetic counselor,” Dr. Nizam urges. “It’s important to determine if there’s a hereditary syndrome involved.”

Your family history

Speaking of hereditary syndromes, has anybody else in your biological family had kidney cancer? What about other cancers like urothelial or pancreatic cancer, or a history of uterine fibroids?

If you answered “yes,” you could have a genetic condition that makes RCC more likely, like von Hippel-Lindau syndrome, Birt-Hogg-Dubé syndrome and others.

Dr. Nizam also recommends telling your provider about any personal or family history of cancers, as some other cancers may share risk factors with RCC.

The type of nephrectomy you had

There are two types of kidney removal surgeries (nephrectomies) you can have to remove kidney cancer:

• Partial nephrectomy. When your surgeon removes the tumor from the kidney, you lose some kidney tissue, but not enough to prevent it from doing its job. This is a good option for people who have smaller tumors, like stage I and stage II RCC, and for people who only have one kidney. It may also be an option if you have chronic health conditions that would make removing an entire kidney dangerous to your health.
• Radical nephrectomy. This is a simpler procedure in which your surgeon removes your whole kidney. This is the right move if the tumor is large, complex or aggressive. It may also be the right decision if your kidney is already damaged and causing significant pain.

Research suggests that the procedure you have doesn’t significantly change your risk. But Dr. Nizam says it’s slightly more common to have a local recurrence if you had a partial nephrectomy. “Local” means the cancer might grow back at the site of the original tumor or in the remaining kidney tissue.

“If there are still cancer cells remaining in the kidney where your surgeon removed the tumor, your risk of recurrence goes up,” she explains. “It’s like there are still little weeds in the garden. And at some point, those weeds could start to grow again.”

As scary as that sounds, getting a partial nephrectomy is usually a sign that your recurrence risk is on the lower side to begin with.

Tumor size, stage and grade

At the time of your nephrectomy, how large was your tumor? Was it invading blood vessels attached to your kidney? Had it already started to spread? Did the cancerous cells look like normal kidney cells, or were they different enough to be obvious under a microscope?

The answers to these questions help providers determine the cancer’s stage and grade.

Renal cell carcinoma has four stages. One is the mildest (a stage I [one] tumor is less than 7 cm and confined to the kidney), while stage IV (four) is the most advanced. When you have stage IV RCC, the cancer has already spread to farther away organs like your lungs or brain.

The smaller and less advanced the tumor, the lower the chances it’ll come back.

Cancer type (histology)

After your nephrectomy, a pathologist looks at the cells from the tumor under a microscope. Based on what they see, they can determine what type of RCC you have. This is called the histology.

Clear cell renal cell carcinoma (ccRCC) is the most common type of kidney cancer, making up 85% of all cases. But there are several other subtypes of RCC, and some are more aggressive than others. Dr. Nizam says that if the pathologist finds sarcomatoid or rhabdoid features, which are associated with rapid growth and spread, you may have an increased risk of your cancer coming back.

Other features

When your provider evaluates your risk of RCC recurrence, they’ll also consider these characteristics:

• Tumor necrosis. When a tumor is necrotic, it’s grown so much that it can’t sustain itself. The core of the tumor doesn’t have enough blood to survive, so it begins to die. That’s a sign that the cancer is aggressive and could (or may already have) spread to other areas of your body. Tumor necrosis raises the chance of both recurrence and metastasis.
• Nodal involvement. When you have a nephrectomy, your surgeon may also remove any suspicious-seeming lymph nodes next to your kidney. If tests show that these lymph nodes contain cancer cells, it means the cancer has (or could) spread to other parts of your body. Lymph node (nodal) involvement raises your risk of the cancer returning or spreading.
• Vascular invasion. This means the pathologist has found cancer cells in the blood vessels that are directly attached to your kidney. Because blood travels throughout the body, this significantly raises your risk of recurrence, or metastasis.

How to decrease the risk of renal cell cancer recurrence

Anyone can get cancer, and it isn’t something you can control. But focusing on the things you can control may help ease your anxiety about cancer recurrence.

Dr. Nizam says doing the following may increase your odds of staying cancer-free:

• Stay active and manage your weight. Obesity is a significant risk factor for RCC and other cancers. “Obesity promotes a state of chronic inflammation, which leads to changes in your body that raise your risk of cancer in the long term,” Dr. Nizam explains. Studies show that in people with cancer, those who exercise appear to live longer and have a lower risk of dying from cancer or other chronic health conditions. Talk to your healthcare team to find out what a healthy weight looks like for you. They can help you create an eating and exercise plan to support your efforts to stay RCC-free.
• Quit smoking. Every time you take a drag, you’re inhaling cancer-causing chemicals. “Even if you’ve smoked for years, it’s never too late to quit,” Dr. Nizam reassures. “The sooner you quit smoking, the more your risk of new or recurrent cancer decreases.”
• Limit alcohol. Studies show that heavy alcohol consumption is linked to a higher risk of several cancers.
• Avoid carcinogens. Tobacco contains carcinogens, or cancer-causing substances. But so do ultra-processed foods, especially processed meats, as well as chemicals like pesticides, formaldehyde and asbestos. “Try reducing exposures to known carcinogens,” Dr. Nizam recommends.
• Manage your health conditions. If you had a kidney removed, it’s very important to be sure your remaining kidney works as well as possible. “Manage your blood sugar and blood pressure and stay well hydrated,” Dr. Nizam urges.
• Attend your surveillance appointments. Most RCC recurrences happen within the first few years after surgery, so your provider may want to see you every three to six months for several years after your nephrectomy to run scans and labs. “Kidney cancer is one of those cancers that can come back years down the road, even beyond five years,” Dr. Nizam explains. “So, it’s really important to adhere to your follow-up schedules, including any imaging and blood tests we order.”

When to see your specialist

When people with recurrent RCC have symptoms, it’s often because of the tumor’s size or location. A large mass on the kidney can press on the muscles, organs and nerves in your abdomen — and inflammation can make the pressure build even further. This can:

• Make it painful for you to move
• Interfere with your kidney function
• Affect your digestion
• Disturb blood flow, causing high blood pressure
• Cause blood in your urine (pee)

But most of the time, RCC doesn’t bring symptoms. In fact, Dr. Nizam says that most people diagnosed with early-stage RCC only find out they’re sick when they have a medical test done for an unrelated issue.

That means that if the cancer does come back, it probably won’t be obvious for some time, which is just one more reason it’s important to keep up with your surveillance appointments in the months and years after a nephrectomy.

The RCC triad

If you read about kidney cancer recurrence online, you may notice references to an “RCC triad.” Medical experts use this term as a shorthand for the three most prominent symptoms of advanced kidney cancer.

They aren’t the only symptoms, and it’s rare to have all three at the same time. But each symptom, on its own, is a reason to contact your doctor.

1. Blood in your pee

Are you noticing a new pink, red or brown color or a smell when you pee? Contact your provider, even if it isn’t much and even if it comes and goes. Bloody urine (hematuria) could be a sign of RCC recurrence or something else that’s impacting your kidney or bladder.

2. Chronic pain in your back or side

Pain in your back or on your side (flank) could mean you have a kidney tumor that’s pressing on neighboring muscles, nerves and organs. It could also mean the cancer has spread to other areas of your abdomen. Pay close attention to pain that:

• Feels new or different
• Doesn’t go away
• Is only on one side of your body

Pain can be a complicated symptom. After all, there are several reasons your back or side can hurt that have nothing to do with RCC recurrence. And recovering from a nephrectomy isn’t easy. Some people develop complications like flank bulges, incisional hernias or nerve damage, which can cause or mimic back or abdominal pain.

To be clear: Surgical complications don’t raise your risk of cancer recurrence. But pain is your body’s way of sending a message. And living with chronic post-surgical discomfort could muddy those messages.

Dr. Nizam recommends talking to your urologist about any new symptoms after your nephrectomy.

3. A lump or mass in your abdomen that you can feel

“Depending on how big the tumor is, you may be able to actually feel it in your abdomen,” Dr. Nizam notes. You may also notice that a specific area of your abdomen feels tender or swollen.

Most of the time, if you develop a mass that’s large enough to feel, it’ll be close to the site of the original surgery. But no two cancers act the same. Always contact your doctor if you notice a mass, no matter where it is.

Other symptoms to tell your doctor about

The RCC triad covers the three most prominent symptoms of kidney cancer recurrence. But there are other red flags, too. Contact your oncologist or urologist if you experience:

• Decreased appetite
• Unexplained weight loss
• New or worsening high blood pressure
• Fatigue or weakness
• Shortness of breath

If RCC has spread to other parts of your body, you might have symptoms in those areas first. So, treat any new or changing symptoms seriously, wherever and whatever they may be.

You aren’t in this alone

If you’re reading this article trying to figure out if you should be worried — or because you can’t stop worrying — reach out to your medical team for help.

Fear of recurrence is a natural part of cancer recovery, and it’s also a medical phenomenon. Take it seriously, and don’t be afraid to share your feelings with the people treating you. They don’t just want you to be cancer-free. They also want you to live a full, happy life. And they’ll make sure you get the mental health support you need to do just that.

Dr. Nizam also encourages you to join patient support and advocacy organizations like The Kidney Cancer Association, KCCure and KidneyCAN. They offer a wide range of expert-reviewed resources and can connect you with other people and families who are going through the same thing.

A little hope can go a long way, and there’s a big community out there, ready and willing to share their experiences with you. Until then, give yourself the space and grace you need.