RCC stands for renal cell carcinoma, the most common type of kidney cancer in adults. It accounts for about 90% of all kidney cancers and originates in the lining of the small tubes inside the kidney that filter blood and produce urine. An estimated 80,980 new cases of kidney cancer will be diagnosed in the United States in 2025, with about 14,510 deaths expected from the disease.
Main Subtypes of RCC
Not all renal cell carcinomas behave the same way. The cancer is classified into subtypes based on how the cells look under a microscope, and these subtypes differ in how aggressive they tend to be.
Clear cell RCC is by far the most common, making up 70% to 75% of all cases. The tumor cells appear “clear” because they’re packed with fats and sugars. This subtype arises from the part of the kidney closest to where blood first gets filtered.
Papillary RCC is the second most common subtype at roughly 10% of cases. These tumors can contain areas of internal bleeding and cyst-like changes, especially as they grow larger.
Chromophobe RCC accounts for about 5% of cases and is most often diagnosed in people in their 50s. It tends to be less aggressive than clear cell or papillary types. Together, these three subtypes represent more than 90% of all renal cell carcinomas.
Symptoms and How It’s Found
RCC has a reputation as a “silent” cancer. The classic combination of flank pain, blood in the urine, and a mass you can feel in the abdomen occurs in fewer than 10% of people at diagnosis. Many kidney cancers are now discovered incidentally, picked up on imaging scans done for unrelated reasons like back pain or abdominal complaints. When symptoms do appear, they can include blood in the urine (which may come and go), persistent pain on one side of the lower back, unexplained weight loss, fatigue, or intermittent fevers.
Risk Factors
Three risk factors stand out most consistently in research: cigarette smoking, obesity, and high blood pressure. Smoking is considered a moderate but established cause. Obesity is linked to RCC in virtually every major study examining the connection, including large investigations in the United States, the Netherlands, and Norway. Rising rates of high blood pressure, particularly among Black Americans and women, may partly explain why kidney cancer incidence has been climbing. Evidence suggests it’s the high blood pressure itself, rather than the medications used to treat it, that increases risk.
Only about 3% to 4% of renal cell cancers are caused by inherited genetic conditions, but kidney cancer has more known hereditary forms than almost any other cancer. These include Von Hippel-Lindau disease (linked to clear cell RCC), hereditary papillary carcinoma, Birt-Hogg-Dubé syndrome (linked mainly to chromophobe tumors), and several others. If multiple family members have had kidney cancer or if it appears at an unusually young age, genetic counseling can help clarify whether an inherited syndrome is involved.
How RCC Develops at the Cellular Level
The biology of clear cell RCC centers on a gene called VHL. In a healthy kidney cell, the VHL gene produces a protein that acts like a cleanup crew. Under normal oxygen levels, this protein tags certain growth-promoting molecules for destruction so they don’t accumulate. When the VHL gene is damaged or lost, those growth signals pile up unchecked. The cell essentially behaves as if it’s starved of oxygen, even when oxygen is plentiful, and responds by cranking out signals that promote new blood vessel growth and cell division. This is why clear cell tumors tend to be highly vascular, rich in blood supply.
Staging and What It Means
RCC staging describes how far the cancer has grown, and it directly shapes treatment decisions. The system focuses on tumor size, whether nearby lymph nodes are involved, and whether the cancer has spread to distant organs.
- Stage T1: The tumor is 7 cm or smaller and confined entirely to the kidney. Tumors 4 cm or smaller fall into T1a, while those between 4 and 7 cm are T1b.
- Stage T2: The tumor is larger than 7 cm but still contained within the kidney.
- Stage T3: The cancer has grown into major veins near the kidney or into the fat surrounding the kidney, but hasn’t crossed a key tissue boundary called Gerota’s fascia.
- Stage T4: The tumor has broken through Gerota’s fascia or invaded the adrenal gland sitting on top of the kidney.
Lymph node involvement is classified separately. N0 means no cancer in nearby lymph nodes, while N1 means cancer has reached at least one regional node.
Survival Rates by Stage
Prognosis depends heavily on how far the cancer has progressed at the time of diagnosis. Based on data from people diagnosed between 2015 and 2021, the five-year relative survival rates break down as follows:
- Localized (confined to the kidney): 93%
- Regional (spread to nearby structures or lymph nodes): 76%
- Distant (spread to other organs): 19%
The overall death rate from kidney cancer is 3.4 per 100,000 people per year. Because so many cases are now caught early through incidental imaging, the proportion of people diagnosed at a localized stage has been rising, which improves overall survival statistics.
Treatment Options
Surgery remains the primary treatment for RCC that hasn’t spread. The two main surgical approaches are removing only the tumor and a margin of healthy tissue (partial nephrectomy) or removing the entire kidney (radical nephrectomy). For tumors 4 cm or smaller, a partial nephrectomy is now the standard of care. This approach preserves more kidney function, which matters for long-term health. Studies have found that even for some tumors up to 7 cm, a partial nephrectomy can deliver survival outcomes comparable to removing the whole kidney, provided the tumor’s location allows it.
For cancer that has spread beyond the kidney, treatment typically involves systemic therapies. The understanding of RCC biology, particularly the role of the VHL gene and its downstream effects on blood vessel growth, has led to targeted therapies that block those specific pathways. Combination approaches pairing immune checkpoint therapies with targeted drugs have become a cornerstone of treatment for advanced disease. Treatment guidelines are updated regularly as new combinations are tested and refined.
For small, slow-growing tumors in older adults or people with other serious health conditions, active surveillance with regular imaging is sometimes a reasonable approach. Not every kidney tumor requires immediate intervention, and the risks of surgery can sometimes outweigh the benefits in carefully selected patients.