Clear cell renal cell carcinoma (ccRCC) is the most common type of kidney cancer. If you or a loved one has recently been diagnosed with clear cell renal cell carcinoma, it’s natural to have questions about what comes next.

This article will break down the basics of clear cell RCC, including what causes it, what symptoms you might have, and how it’s diagnosed and treated. It will also cover life expectancy and ways to take care of yourself while living with this disease. If you still have more questions, reach out to your healthcare team directly.

Overview of Clear Cell RCC

Clear cell renal cell carcinoma begins in the lining of the small tubes in the kidney. This is where waste is filtered from your blood. The term “clear cell” refers to how these cancer cells look under a microscope. They often appear pale or transparent, like tiny bubbles.

Clear cell RCC accounts for approximately 75 percent to 85 percent of all renal cell carcinoma cases. Each year, about 65,000 people in the United States are diagnosed with this type of kidney cancer. Males are nearly twice as likely to develop ccRCC as females, according to Wolters Kluwer UpToDate. The average age at diagnosis is around 64 years. It’s uncommon for ccRCC to occur in people under 40.

Risk Factors for Clear Cell RCC

Doctors don’t always know what causes ccRCC, but certain risk factors can make it more likely to develop. The most common ones include:

• Cigarette smoking or other forms of tobacco use
• Hypertension (high blood pressure)
• Overweight or obesity
• Chronic (long-term) kidney problems or being on dialysis (machine-assisted blood-filtering)
• Long-term use of certain over-the-counter pain medicines, like acetaminophen and aspirin
• Chronic hepatitis C infection
• Sickle cell disease
• Kidney stones

People exposed to certain chemicals, such as cadmium, asbestos, or byproducts of petroleum, may also be at increased risk of ccRCC. In females, the use of oral contraceptives (birth control) may reduce the risk, according to Wolters Kluwer UpToDate.

Genetic Risk Factors

Sometimes, clear cell RCC may run in families or be caused by genetic mutations (changes) in someone’s DNA.

One rare condition called von Hippel-Lindau disease (VHL) is strongly associated with ccRCC. People with VHL are born with a change in a gene that helps control cell growth. When this gene doesn’t work properly, tumors can form in the kidneys and other parts of the body.

Even without VHL, some people may be at higher risk if they have a family history of kidney cancer. This is especially true if a close relative had it before the age of 40 or if there are multiple cases in the family. If your doctor thinks your cancer might be inherited, they may recommend genetic counseling and testing to learn more.

Symptoms of Clear Cell RCC

Many people with ccRCC don’t feel sick at first. In fact, most kidney tumors are found by accident, during imaging tests, like a CT scan or ultrasound, done for unrelated health problems.

When symptoms do appear, they can be mild or hard to notice at first. Possible signs and symptoms of clear cell renal cell carcinoma include:

• Hematuria (blood in the urine)
• Pain in the lower back on the flanks (back sides) that’s not caused by an injury
• A mass (lump) near the kidney area (lower back)
• Unintentional weight loss
• Fatigue (extreme tiredness that does not approve with rest)
• Edema (swelling caused by fluid buildup) in the legs or ankles
• Anemia (low red blood cell count)

These symptoms can arise from other causes, too, not just cancer. However, if you notice any of them, it’s a good idea to bring them up with your doctor.

Diagnosing Clear Cell RCC

Clear cell RCC is most often found during tests for other health problems. Since most people don’t have symptoms right away, doctors may discover a kidney tumor by chance when doing an ultrasound, CT scan, or MRI for another reason.

If a kidney tumor is suspected, your doctor may order imaging tests, such as:

• CT scan or MRI — These are detailed scans that can show the size and location of the tumor.
• Ultrasound — This is sometimes used as a first look, especially if other scans aren’t available.
• Bone scans — These may be used if there’s concern that the cancer has spread to the bones.

In addition to imaging tests, your doctor may order blood tests to check your kidney function, red blood cell counts, and calcium levels. Urine tests may also be used to look for blood in the urine or signs of infection.

A biopsy involves using a needle to remove a small piece of the tumor for examination under a microscope. It’s usually done with the help of a CT scan or ultrasound to guide the needle safely into the right spot. A biopsy helps confirm the diagnosis of kidney cancer, although this procedure is rarely necessary. It can also determine whether it’s the clear cell type or another subtype, such as papillary renal cell carcinoma or chromophobe renal cell carcinoma.

Treatment of Clear Cell RCC

Treatment for ccRCC depends on the size of the tumor, whether it has spread, and your overall health. In many cases, treatment can remove or shrink the cancer and help you live longer with a better quality of life.

Surgery

When the cancer is limited to just the kidney, surgery is the most common treatment. The two main types of surgery include:

• Partial nephrectomy — This procedure removes the tumor along with a small margin of healthy kidney tissue. It helps preserve kidney function and is usually used for smaller tumors or when protecting kidney health is especially important.
• Radical nephrectomy — This surgery removes the entire kidney. Surrounding fatty tissue, nearby lymph nodes, and sometimes the adrenal gland may also be removed. It’s typically used for larger or centrally located tumors or those that are invading nearby structures.

Ablation

Some people aren’t good candidates for major surgery because of their age or overall health. In these cases, ablation may be used. This involves destroying the tumor with heat (radiofrequency ablation) or cold (cryoablation).

Systemic Therapy

Systemic therapy is a treatment that works throughout your whole body, not just where the tumor is located. It might be used if the cancer has metastasized (spread) to other parts of the body. Treatments can include:

• Immunotherapy — This helps the body’s immune system recognize and attack cancer cells.
• Targeted therapy — This approach blocks certain proteins or genes that help the tumor grow. In ccRCC, targeted therapies often include antiangiogenic drugs, which stop the tumor from forming new blood vessels that feed its growth.

Some people may also be able to join clinical trials to test new treatments that aren’t yet widely available. If you’re interested in taking part in a clinical trial, visit ClinicalTrials.gov or talk to your healthcare team. They can help you find studies that may be recruiting in your area.

Outlook and Life Expectancy for People With Clear Cell RCC

Doctors estimate life expectancy using five-year survival rates. This number tells us the percentage of people still alive five years after being diagnosed with cancer. It doesn’t mean the cancer goes away in five years, and it can’t predict what will happen to any one individual person.

Your prognosis (outlook) depends on several factors. These include the stage and grade of your tumor, your overall health, and how well your body responds to treatment.

Cancer staging is a way to describe how much the cancer has spread in the body. There are four stages for kidney cancer, and they are sometimes rendered with Roman numerals, e.g., stage IV instead of stage 4. The stages are:

• Stage 1 and 2 (localized stage) — The tumor is only in the kidney.
• Stage 3 (regional stage) — The cancer has spread to nearby lymph nodes or surrounding tissues.
• Stage 4 (distant or metastatic stage) — The cancer has spread to distant parts of the body, like the lungs or bones.

Five-year survival rates based on kidney cancer stage are:

• Localized stage — About 93 percent
• Regional stage — About 75 percent
• Distant stage — About 18 percent

This means that, for example, about 93 percent of people with localized clear cell RCC were still alive five years after their diagnosis.

Grading describes how the cancer cells look under a microscope. A low-grade tumor looks more like normal kidney cells and usually grows more slowly. A high-grade tumor looks more abnormal and is likely to spread quickly. Five-year survival rates based on kidney tumor grade are:

• Grade 1 — 83 percent
• Grade 2 — 66 percent
• Grade 3 or 4 — 63 percent

Thanks to new treatments, people with advanced ccRCC are living longer than in the past. With early diagnosis, proper treatment, and the right support, you can live a fulfilling life with clear cell renal cell carcinoma.

Talk With Others Who Understand

On MyKidneyCancerTeam, people with kidney cancer and their loved ones come together to ask questions, give advice, and share their stories with others who understand life with kidney disease.

Have you been diagnosed with clear cell renal cell carcinoma? What tests led to your diagnosis? Share your story in the comments below, or start a conversation by posting on your Activities page.