What is Sarcomatoid Renal Cell Carcinoma?

Sarcomatoid renal cell carcinoma is a rare type of kidney cancer. People with it tend to do worse than people with some other kidney cancers.

The term “sarcomatoid” comes from the shape and appearance of these cells. When examined under a microscope, they tend to have a rounded middle with a tapering end. Scientists first described the disease in the 1960s.

Types of

Sarcomatoid renal cell carcinoma belongs to a broader group of kidney cancers called renal cell carcinoma (RCC). “Kidney” means “kidney”. “Cancer” refers to cancer that begins in cells of internal organs. About 90% of cancers that originate in the kidneys are classified as renal cell carcinomas.

Through research, scientists eventually learned that some kidney cancers behave a little differently than others. That is, if someone’s cancer cells look a certain way under a microscope, they will classify them into different categories. These cancers appear to have certain similarities, such as how they respond to certain treatments.

The most common types of RCC include:

  • clear cell
  • papillary
  • chromophore
  • clear cell papillary
  • collection tube
  • medulla
  • uncategorized

These different categories can get very confusing, and as a result, they will look different. For example, clear cell renal cell carcinoma, the most common subtype of renal cell carcinoma, Named for how cells look under a microscope when they are stained with certain dyes.

What type of sarcomatoid renal cell carcinoma?

Sarcomatoid RCC is not technically considered a specific subtype of RCC. Instead, people often have one of these subtypes (such as clear cell carcinoma) as well as sarcomatoid RCC.

For these people, many of their cells look like a subtype of RCC (such as clear cell carcinoma). However, they also have some cancer cells that look different (called sarcomatoid). This is also sometimes referred to as having sarcomatoid features.

These sarcomatoid features can be found in some individuals in most subtypes of RCC. Less commonly, some people have only sarcomatoid RCC, for which no other classification applies.

About 4% to 5% of patients with renal cell carcinoma have sarcomatoid RCC. Unfortunately, approximately 60% to 80% of patients with sarcomatoid RCC have advanced disease at first diagnosis.

Symptoms of Sarcomatoid Renal Cell Carcinoma

Most patients with sarcomatoid renal cell carcinoma have symptoms when they are first diagnosed. Symptoms can vary depending on how far the cancer has spread and other factors. Some potential symptoms include:

  • Back, upper abdomen, or side pain (sometimes called “flank pain”)
  • blood in the urine
  • bone pain
  • lose weight
  • fever
  • cough or shortness of breath
  • fatigue
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However, some people diagnosed with sarcoid-like RCC have no symptoms at the time of diagnosis.

reason

Scientists are still studying what causes sarcomatoid renal cell carcinoma. There appear to be many complex genetic and environmental factors involved.

Like other types of cancer, sarcomatoid RCC develops in part due to changes in a person’s genetic material. Many factors can cause your genetic material — your DNA — to be slightly damaged throughout your life. This is called an acquired genetic mutation.

Usually, this is no big deal. However, if a particular cell in your kidney has multiple mutations (changes), it may start to behave abnormally. For example, it may start growing and multiplying when it normally shouldn’t. The cells are said to have become cancerous.

What factors increase risk?

Certain factors accelerate the development of dangerous mutations that increase the risk of developing renal cell carcinoma, including:

  • smokes
  • hypertension
  • other types of kidney disease
  • exposure to certain toxins

People who work in certain jobs are also more likely to be exposed to these toxins, such as mechanics or those who work in dry cleaning. However, in most cases, no clear reason can be found.

Researchers are still learning a lot about the specific genes that may be damaged in sarcomatoid RCC.

diagnosis

To diagnose this disease, first, a doctor will take your medical history, asking about your current symptoms and your other medical conditions. This, combined with a physical exam, may indicate kidney cancer as an underlying problem.

medical test

While they cannot be used for direct diagnosis, some medical tests can give some clues about your condition. They may also rule out other potential causes of your symptoms. Some of these may include:

  • Urine sample analysis (urinalysis, looking for blood and other characteristics)
  • Creatinine (to check kidney function)
  • Alkaline phosphatase (gives clues about potential spread to bone)

imaging test

Certain imaging tests are also important for diagnosis. These can often reveal whether there are abnormalities in the kidneys. For example, these may include one or more of the following:

  • Kidney computed tomography (CT) scan (most common)
  • Intravenous pyelogram (to show the urinary tract)
  • kidney ultrasound
  • MRI (magnetic resonance imaging) scan of the kidneys

Combined, these tests can give doctors a good idea of ​​whether a person has a certain type of kidney cancer. However, to make a definitive diagnosis, a specialist called a pathologist must examine a sample of the affected area under a microscope.

This can happen in different ways. Many times, clinicians can tell from all of these other indicators that there is a high probability of kidney cancer. If so, they may plan to continue surgery to remove the area. Surgical removal is usually a partial nephrectomy, which removes the cancer as well as some of the surrounding kidney tissue. The adrenal glands, nearby lymph nodes, and some fatty tissue around the kidneys may also be removed.

After that, they can send a portion of the affected area to the lab. A pathologist then examines the cells and determines whether cancer is present and what type it is.

After your lab results come back, you may be told you have renal cell carcinoma. The laboratory report will also contain specific information about the nature of the cancer. For example, you may be told that you have a specific subtype of RCC with sarcoid-like features (such as clear cell RCC).

biopsy

In other cases, a person may have a kidney biopsy before surgery if it’s not clear whether cancer is really the problem. In this case, a tissue sample is also taken and sent to the laboratory. There, specialists look under a microscope to definitively diagnose sarcoid-like RCC.

treat

Treatment for sarcomatoid renal cell carcinoma will depend on the stage of the cancer. This refers to the size of the tumor and whether the cancer has spread throughout your body.

Operation

If your cancer has not spread throughout the body (called metastases), surgery may be the main method.Your surgeon may recommend complete removal of the kidney (radical Nephrectomy).

For some people, this surgery can completely cure the disease. However, this is less effective in sarcomatoid RCC than in some other kidney cancer types. In about 80 percent of people, the cancer returns within a few years, even if your surgeon tries to remove it all.

If your doctor takes this approach, you may not need any further treatment. However, your doctor may want to monitor your kidneys for signs of cancer recurrence. For example, you may need periodic imaging tests, such as CT scans.

In people with more advanced disease, their cancer has spread more widely throughout their body. Surgery alone cannot cure the disease.

However, surgery can sometimes still be helpful, such as relieving symptoms in the short term, even if it doesn’t cure your disease.

Scientists are not entirely in agreement about the best way to treat more advanced sarcomatoid RCC. Unfortunately, many treatments are available, but they are often not as effective as other types of RCC.

drug

A group of drugs called angiogenesis inhibitors can be tried. These block the tumor’s ability to form new blood vessels, thereby slowing tumor growth. Some of them are:

  • Sutent (sunitinib)
  • Votrient (pazopanib)
  • Cometriq (cabozantinib)
  • Zortress (everolimus)

Another option is a group of drugs called checkpoint inhibitors. Scientists are hopeful about the potential of these new drugs. The options sometimes used are:

  • Kerida (pembrolizumab)
  • Avastin (bevacizumab)

Radiation Therapy

Another method that is sometimes used is radiation therapy or radiotherapy. This is often not very successful, but it may reduce the size of the tumor and temporarily relieve symptoms.

chemotherapy

Doctors have also tried chemotherapy as a treatment. But that’s not very efficient either. Some possible methods are:

  • Lipodox (doxorubicin)
  • Gemzar (Gemcitabine)

Your doctor may also combine one or more of these therapies, such as angiogenesis inhibitor drugs and checkpoint inhibitor drugs. You may also need to switch therapy if one option doesn’t seem to work.

Scientists are actively seeking better options for the treatment of sarcomatoid RCC.

prognosis

Unfortunately, being told you have sarcomatoid renal cell carcinoma is not good news. People with sarcomatoid renal cell carcinoma tend to do poorly. This is partly because they tend to be diagnosed at a later stage than some other RCCs. This is also partly because they do not respond as well to treatment as other cancer patients.

On average, people treated for sarcoid-like RCC live an average of 5 to 12 months after diagnosis.

generalize

Sarcomatoid renal cell carcinoma is a rare type of kidney cancer. In addition to the official subtypes of RCC, such as clear cell RCC, a person can have it. This type of cancer is difficult to treat and is often not diagnosed until after the cancer has spread.

VigorTip words

Receiving a cancer diagnosis of any type can be devastating. If you learn that your renal cell carcinoma has sarcomatoid features, you may be even more frustrated. Rely on your family, friends and your healthcare team. By fully answering all of your questions, you will feel better about your medical decisions.

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