Clear cell renal carcinoma is a type of kidney cancer that starts in the tiny tubes in the kidney that clean the blood and make urine. The cancer cells look pale or “clear” under the microscope because they are full of fat and sugar that wash out during lab processing. Doctors often call this cancer clear cell renal cell carcinoma (ccRCC). It is also called clear cell kidney cancer, conventional renal cell carcinoma, or simply clear cell carcinoma of the kidney. Older books may use the word hypernephroma or Grawitz tumour, but these older names are now used less.
Clear cell renal carcinoma (also called clear cell renal cell carcinoma, ccRCC) is the most common type of kidney cancer in adults. It starts from the tiny filtering units in the kidney and the cancer cells look “clear” under a microscope because they are full of fat and glycogen. Clear cell renal carcinoma can stay inside the kidney or spread to nearby lymph nodes, lungs, bones, liver or brain. Modern treatment usually combines surgery, targeted drugs, immunotherapy and careful lifestyle support based on international guidelines for kidney cancer care.[]
Clear cell renal carcinoma is the most common type of kidney cancer in adults. It makes up about 70–80% of all renal cell carcinoma cases. Because it is so common, many studies and treatment guidelines are based mainly on this type.
This cancer usually affects only one kidney, but in some people, both kidneys can be involved. The tumour can grow only inside the kidney, or it can spread into nearby fat, veins, lymph nodes, or distant organs like lung, bone, liver, or brain.
If clear cell renal carcinoma is found early and has not spread, surgery to remove part or all of the kidney can give a high chance of long-term survival. If it is found late, when it has spread, the outlook is poorer, but modern targeted drugs and immunotherapy have improved survival compared to the past.
Types of clear cell renal carcinoma
Localized clear cell renal carcinoma
In this type, the tumour is only inside the kidney and has not spread to lymph nodes or other organs. Doctors call this “localized disease,” and it usually has the best chance of cure with surgery.Locally advanced clear cell renal carcinoma
Here, the tumour has grown out of the kidney into nearby fat, the main kidney vein, or tissues around the kidney, but it has not spread far away. It is still sometimes curable, but the risk of the cancer coming back is higher than in localized disease.Metastatic clear cell renal carcinoma
In metastatic disease, cancer cells have spread from the kidney to other organs such as lungs, bones, liver, or brain, or to distant lymph nodes. Treatment usually includes targeted drugs and immunotherapy, sometimes with surgery to remove the kidney or single metastases.Low-grade (well-differentiated) clear cell renal carcinoma
Low-grade tumours have cancer cells that still look somewhat like normal kidney tubule cells. They tend to grow more slowly and have a better outlook than high-grade tumours. Pathologists score the grade by looking at how “ugly” or abnormal the nuclei of the cells appear under the microscope.High-grade (poorly differentiated) clear cell renal carcinoma
High-grade tumours have very abnormal, aggressive-looking cells. They tend to grow fast, invade nearby tissues, and spread earlier. High grade is linked to worse survival and often needs closer follow-up and more intense treatment.Cystic or multilocular clear cell renal carcinoma
In some people, clear cell tumours form many fluid-filled spaces (cysts) inside the mass. Some of these cystic clear cell tumours are low-grade and can have better behaviour, so the latest WHO kidney tumour classification lists special cystic clear cell entities with generally favourable outcomes.Hereditary clear cell renal carcinoma (von Hippel–Lindau–related)
A small number of patients have clear cell tumours as part of an inherited syndrome, most often von Hippel–Lindau (VHL) disease, caused by germline changes in the VHL gene. These people often develop tumours in both kidneys and may have other tumours in the brain, eyes, or pancreas.Clear cell renal carcinoma with sarcomatoid or rhabdoid features
In some tumours, part of the cancer looks like a spindle-cell sarcoma or has very aggressive “rhabdoid” cells. These changes can happen in any RCC type, including clear cell, and are linked to more aggressive behaviour and poorer outcome.
Causes (risk factors)
Most cases of clear cell renal carcinoma are “sporadic,” meaning doctors cannot find one single clear cause. But many risk factors (things that raise the chance of getting it) are known.
Cigarette smoking
Smoking is one of the strongest known risk factors for kidney cancer, including clear cell type. Harmful chemicals from tobacco smoke are filtered by the kidneys and can damage DNA in kidney tubule cells, making cancer more likely. The risk goes down when a person stops smoking.Obesity (being very overweight)
Too much body fat changes hormones like insulin, growth factors, and sex hormones. These changes can make kidney cells grow and divide more than normal and can promote tumour development. Obesity is a well-proven risk factor for renal cell carcinoma.High blood pressure (hypertension)
Long-term high blood pressure can damage the tiny blood vessels and filters in the kidneys. Both the disease itself and some medicines used to treat it are linked to a higher risk of kidney cancer. Good control of blood pressure may help lower this risk.Chronic kidney disease (CKD)
People with long-term kidney damage, especially those with poor kidney function, have a higher chance of developing renal cell carcinoma. The damaged kidney tissue may be more likely to form cysts and abnormal growths.Long-term dialysis and acquired cystic kidney disease
Patients who need dialysis for many years often develop many cysts in their kidneys (acquired cystic kidney disease). These scarred, cyst-filled kidneys have a higher risk of RCC, often clear cell type.Family history of kidney cancer
Having a close relative (parent, brother, sister) with kidney cancer slightly increases a person’s risk. This may be due to shared genes, shared environment, or both.Inherited cancer syndromes (such as von Hippel–Lindau disease)
Some rare genetic syndromes strongly raise the risk of clear cell renal carcinoma, often at a younger age and sometimes with tumours in both kidneys. Examples include von Hippel–Lindau disease and other hereditary RCC syndromes that affect tumour-suppressor genes.Older age
Kidney cancer is more common in older adults. The average age at diagnosis is in the 60s–70s. As we age, our cells collect more genetic damage, and the body is less able to repair it, which may help explain this risk.Male sex
Men have about twice the risk of kidney cancer as women. This may be related to higher rates of smoking, certain jobs, hormones, or other lifestyle factors.Unhealthy diet
Diets high in processed meat, red meat, salty foods, and sugary, high-calorie items may increase kidney cancer risk, especially when they contribute to obesity and metabolic problems. A diet rich in fruits, vegetables, and whole grains is linked to better overall kidney health.Occupational chemical exposure
Some work places expose people to chemicals such as trichloroethylene (a cleaning solvent), some heavy metals, and certain industrial compounds. Long-term exposure to these substances has been linked to a higher risk of renal cell carcinoma in some studies.Long-term use or misuse of certain pain medicines
Heavy, long-term use of some pain drugs, especially certain older non-steroidal anti-inflammatory drugs (NSAIDs), may increase kidney cancer risk. These medicines can damage kidney tissue when used in large doses for many years.Previous kidney radiation
People who have had radiation treatment to the kidney area for another cancer may have a slightly higher risk of kidney tumours later in life, because radiation can damage DNA in cells.Type 2 diabetes and metabolic syndrome
Diabetes, especially when poorly controlled, often comes with obesity, high blood pressure, and abnormal blood fats. Together these factors can damage kidney blood vessels and may increase the chance of RCC.Chronic hepatitis or certain viral infections
Large cohort studies have suggested that chronic viral hepatitis and some other long-lasting infections are linked to a higher risk of RCC. Inflammation and immune changes may play a role.Immune-suppressing medicines
People who take long-term immune-suppressing drugs, such as organ transplant recipients, have higher rates of several cancers, including kidney cancer. A weakened immune system may not clear abnormal cells as well.Low birth weight and early-life factors (possible)
Some research suggests that people born with very low birth weight may have a higher risk of RCC as adults, possibly due to reduced kidney mass or altered kidney development. This link is still being studied.Previous kidney stones or chronic kidney inflammation
Long-term irritation, infection, or inflammation in the kidney can cause scarring and may create an environment where abnormal cells are more likely to grow. The link is weaker than for smoking or obesity but still important.Race and geography
Kidney cancer rates vary between countries and ethnic groups. In many regions, incidence is higher in industrialized countries and in certain populations, which may reflect differences in lifestyle, environment, and access to imaging that finds tumours.Unknown or combined factors
In many patients, no clear risk factor can be found. Often, several small factors (genes, lifestyle, environment) may work together over many years to lead to clear cell renal carcinoma.
Symptoms
Clear cell renal carcinoma may cause no symptoms at first. Many tumours are found by chance on ultrasound or CT scans done for other reasons. When symptoms appear, they can be due to the tumour in the kidney, spread to other organs, or hormone-like substances made by the tumour (paraneoplastic effects).
Blood in the urine (hematuria)
This is one of the most common signs. The urine may look pink, red, or cola-coloured, or blood may be seen only under the microscope. Any blood in the urine should be checked by a doctor.Pain in the side or back (flank pain)
A dull ache or sharp pain in the side between the ribs and hip can occur when the tumour grows and stretches the kidney capsule or presses on nearby nerves and muscles.A lump or mass in the abdomen or flank
Some people or their doctors can feel a firm mass or fullness in the side or belly. This usually means the tumour is larger. Many small tumours, however, cannot be felt.Unexplained weight loss
Losing weight without trying can be a sign of cancer. Tumours use a lot of energy and release substances that change how the body handles food and fat, leading to weight loss.Loss of appetite
Many patients feel less hungry or feel full quickly. This may be due to tumour-related substances, general illness, or pressure of a large mass on the stomach and nearby organs.Feeling very tired (fatigue)
Fatigue is common in kidney cancer and may be caused by anaemia, chronic inflammation, poor sleep, pain, or the cancer itself. Patients often describe feeling weak and “washed out.”Fever that comes and goes
Some people have episodes of low-grade fever without infection. Tumour-released inflammatory substances can reset the body’s temperature control and cause these fevers.Anaemia (low red blood cell count)
Kidney cancer can reduce the kidney’s normal production of erythropoietin, a hormone that helps make red blood cells, and can also cause chronic inflammation. This leads to tiredness, shortness of breath, and pale skin.High blood pressure
Some kidney tumours make extra renin and other substances that raise blood pressure. In other patients, high blood pressure is long-standing and may both cause and be worsened by kidney cancer.Swelling in the ankles, legs, or around the eyes
When the kidney is not working well or when a tumour compresses veins, fluid can build up in the legs or face. This swelling is called oedema and can be a sign of kidney disease or heart disease.Bone pain or fractures
If the cancer spreads to the bones, it can cause deep, aching pain, often in the spine, hips, or ribs. The bone can become weak and may break more easily than normal.Cough or shortness of breath
Spread to the lungs can cause a persistent cough, chest pain, or difficulty breathing. Sometimes lung metastases are found on imaging even before symptoms are obvious.Night sweats and general feeling of illness (malaise)
Many patients report drenching night sweats, feeling hot and cold, or just “not feeling right.” These are non-specific symptoms but can be part of the body’s reaction to cancer.Varicocele in men (especially on the left side)
In some men, tumour pressure on the left kidney vein can disturb blood flow from the testis and cause an enlarged, twisted group of veins in the scrotum, called a varicocele. Sudden onset of a varicocele in an older man can be a clue to a kidney mass.High calcium levels in the blood (hypercalcaemia) symptoms
Some kidney tumours release hormone-like substances that raise blood calcium. This can cause nausea, constipation, confusion, thirst, and frequent urination. Very high calcium levels are a medical emergency.
Diagnostic tests
Doctors use a mix of history, physical examination, blood and urine tests, imaging, and sometimes biopsy to diagnose and stage clear cell renal carcinoma. Imaging is usually the key step, and lab tests help check kidney function and overall health.
Physical exam – general check-up and medical history
The doctor asks about symptoms like blood in urine, side pain, weight loss, and family history, and examines the whole body. This first step helps decide which tests are needed and may reveal signs such as pale skin, swelling, or fever.Abdominal and flank palpation
The doctor gently presses (palpates) the abdomen and flank to feel for a mass, tenderness, or enlarged organs. A large kidney tumour may be felt as a firm, irregular lump, especially in thinner people.Blood pressure measurement
Because kidney tumours and kidney disease can raise blood pressure, checking blood pressure is an important part of the exam. Unexplained or difficult-to-control high blood pressure may prompt further kidney tests.Examination for varicocele in men
In male patients, the doctor checks the scrotum for a new or large varicocele, especially on the left. If present, this may suggest blockage of the kidney vein by a tumour and trigger imaging of the kidneys.Lymph node palpation
The doctor feels the neck, armpit, and groin areas for enlarged lymph nodes. Enlarged nodes can mean infection or, less commonly, spread of cancer cells from the kidney.Neurological and performance status exam
Simple bedside tests of strength, walking, and balance help check for effects of bone or brain metastases and overall fitness for surgery or systemic therapy. Doctors often score performance status to guide treatment decisions.Costovertebral angle (CVA) tenderness test
The doctor gently taps over the area where the kidney lies at the back. Pain in this area can suggest kidney disease, such as infection, stones, or a mass, and supports the need for imaging.Urinalysis
A simple urine test looks for red blood cells, protein, and other substances. Blood in the urine can be a sign of kidney cancer, but also many other kidney and urinary problems, so further tests are needed if it is found.Urine cytology
A pathologist examines urine under the microscope to look for cancer cells that have shed from the lining of the urinary tract. This test is more useful for bladder and ureter cancers, but sometimes it can show kidney cancer cells.Complete blood count
A CBC measures red cells, white cells, and platelets. It can show anaemia, high platelets, or other changes that can occur with kidney cancer and helps assess general health before surgery or systemic therapy.Kidney function tests – serum creatinine and eGFR
Blood tests for creatinine and estimated glomerular filtration rate (eGFR) show how well the kidneys are working. This is vital for planning surgery (which may remove part or all of a kidney) and for choosing imaging contrast and medicines.Liver function tests
Blood tests for liver enzymes and bilirubin help detect spread of cancer to the liver and check that the liver is healthy enough to handle drugs used in systemic therapy.Serum calcium and other electrolytes
Measuring calcium and minerals in the blood can show hypercalcaemia, which is a common paraneoplastic effect of RCC, and can also reveal kidney or bone problems related to the tumour.Inflammatory markers such as ESR or CRP
Tests like erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) may be raised in kidney cancer due to chronic inflammation. High levels are not specific but can be part of overall risk scores.Tumour biopsy with histopathology
In some cases, a needle is guided into the kidney mass to take a small sample. A pathologist looks at the cells under the microscope to confirm that it is clear cell carcinoma, estimate the grade, and exclude other tumours. Biopsy is used when imaging alone is not enough or before certain treatments.Immunohistochemistry and molecular testing on tumour tissue
Special stains and genetic tests on the tumour can show markers typical of clear cell RCC, such as loss of VHL gene function and certain protein patterns. These tests help classify the tumour and may guide targeted therapy.Electrocardiogram (ECG)
An ECG records the heart’s electrical activity. It is used to check heart health before major surgery and before starting some targeted drugs or immunotherapies that can affect the heart or blood pressure.Nerve conduction studies or EMG in selected cases
Rarely, if a patient has unexplained weakness, numbness, or suspected paraneoplastic nerve problems, nerve conduction studies and electromyography (EMG) can check how well nerves and muscles are working. This helps decide if symptoms are from metastases, treatment, or a separate nerve disease.Renal ultrasound
Ultrasound uses sound waves to show the shape and size of the kidneys. It can detect many solid masses and cysts and is often the first imaging test ordered because it is quick and does not use radiation. However, it may miss very small tumours or some complex lesions.Contrast-enhanced CT scan and/or MRI of abdomen and pelvis
CT and MRI are the main imaging tools to diagnose and stage clear cell renal carcinoma. They show the exact size and location of the tumour, whether it has invaded veins or fat, and whether lymph nodes or nearby organs are involved. CT or MRI of the chest and other areas may also be done to look for metastases.
Non-pharmacological treatments (therapies and other approaches)
Below are 20 important non-drug approaches that support people with clear cell renal carcinoma. These do not replace medical treatment, but they help you live better and sometimes help treatment work as well as possible.
1. Active surveillance (watchful waiting)
For very small, slow-growing kidney tumors in older or fragile patients, doctors may suggest regular check-ups instead of immediate treatment. You have planned CT/MRI scans, blood tests and clinic visits to watch the tumor. If the cancer grows or you develop symptoms, treatment such as surgery or ablation is started. This avoids major procedures for people whose tumor might never cause serious problems.[]
2. Partial nephrectomy–based kidney protection strategies
When you have already had surgery (partial nephrectomy), non-drug care focuses on protecting the remaining kidney. You monitor blood pressure, blood creatinine and urine protein, avoid dehydration and avoid harmful medicines like some NSAIDs. These steps lower the risk of chronic kidney disease after cancer surgery and help you stay well enough to receive systemic therapies if needed later.[]
3. Thermal ablation (cryoablation or radiofrequency ablation) follow-up care
Some small kidney tumors are destroyed by freezing (cryoablation) or heating (radiofrequency or microwave ablation) through needles guided by imaging. Non-pharmacological care here means careful planning, imaging guidance and strict follow-up scans to check that the tumor is fully destroyed and to detect recurrence early. This approach is especially helpful for older or high-risk patients who may not tolerate major surgery.[]
4. Post-treatment surveillance programs
After nephrectomy or ablation, structured surveillance plans use a schedule of visits, imaging tests and lab tests for several years. This helps find local recurrence, new tumors in the remaining kidney, or spread to other organs while the disease is still treatable. Good surveillance improves long-term outcomes and lets doctors manage late side effects early.[]
5. Structured exercise programs
Regular moderate exercise (such as brisk walking, cycling or swimming) 150–300 minutes per week, plus strength training 2 days per week, can improve energy, muscle strength, mood and quality of life in cancer survivors. Exercise also helps control weight, blood pressure and blood sugar, which is important when you have only one kidney or are on targeted drugs.[]
6. Physical therapy and fatigue management
A physiotherapist can design a gentle program of stretching, balance, and strength exercises that match your treatment phase. This reduces cancer-related fatigue, deconditioning, and falls. Using pacing techniques (short activity periods with rest) helps you stay active without exhausting yourself during difficult treatments like immunotherapy or TKIs.[]
7. Nutrition counseling
Meeting with an oncology dietitian helps you plan meals that protect kidney function, maintain healthy weight, and avoid malnutrition. The focus is on plant-based foods, plenty of vegetables, fruits, whole grains, adequate protein from safe sources, and enough calories during treatment. Advice is personalized if you have weight loss, nausea or reduced kidney function.[]
8. Weight management and obesity control
Excess body fat is a known risk factor for kidney cancer, and being very overweight can make surgery and drug treatment more complicated. Gradual weight loss through diet quality and physical activity, under professional supervision, may reduce recurrence risk and improve blood pressure, diabetes and heart health after clear cell renal carcinoma treatment.[]
9. Smoking cessation support
Stopping smoking is very important because tobacco use increases the risk of kidney cancer and can reduce survival after diagnosis. Counseling, nicotine-replacement products and support groups can help you quit. After quitting, breathing and circulation improve, and surgery and immunotherapy often become safer and more effective.[]
10. Blood pressure and metabolic risk control
High blood pressure, high blood sugar and high cholesterol put extra stress on the kidneys and heart. Non-drug strategies like low-salt diet, exercise, weight loss and stress reduction work together with medications prescribed by your doctor. Good control of these factors protects remaining kidney tissue and improves tolerance of systemic therapies for clear cell renal carcinoma.[]
11. Psychological counseling and psycho-oncology
A diagnosis of clear cell renal carcinoma can cause anxiety, depression and fear of recurrence. Talking with a psycho-oncologist, counselor or psychologist helps you process emotions, learn coping skills and improve sleep. Better mental health is linked to better treatment adherence, smoother recovery and higher quality of life during and after cancer therapy.[]
12. Mind-body therapies (relaxation, breathing, meditation)
Simple practices like deep breathing, mindfulness meditation, progressive muscle relaxation and guided imagery can lower stress hormones, reduce pain perception and improve sleep quality. These methods are safe when used alongside medical treatment and can be learned through classes, apps or sessions with trained therapists.[]
13. Social and peer support groups
Support groups, in person or online, allow patients and families to share experiences, fears and tips. People feel less alone, learn practical strategies, and are more likely to follow treatment and lifestyle advice. Many kidney cancer charities and patient groups host such meetings and provide reliable information about clear cell renal carcinoma.[]
14. Palliative care and symptom management services
Palliative care does not mean “giving up.” It is specialized care focused on pain, breathlessness, fatigue, nausea, and emotional distress at any stage of clear cell renal carcinoma. A palliative team works with your oncologist to improve comfort and daily functioning, whether your disease is early or advanced.[]
15. Pain management strategies (non-drug)
In addition to medicines, non-drug pain control may include heat or cold packs, gentle massage, relaxation, changing body positions, and simple physical therapy. These help reduce muscle tension around surgical scars or bone metastases and can lower the amount of strong pain medicine you need.[]
16. Occupational therapy and daily-activity training
Occupational therapists teach easier ways to perform everyday tasks like dressing, washing, cooking and working. They may suggest simple devices or home changes to save energy and protect your remaining kidney (for example, avoiding heavy lifting right after surgery). This helps you stay independent and safe.[]
17. Sleep hygiene programs
Cancer, steroids, pain and anxiety often disturb sleep. Sleep hygiene means keeping a regular sleep schedule, reducing screens before bed, managing caffeine, and keeping a quiet, dark bedroom. Better sleep improves mood, immunity, pain control and your ability to cope with treatment for clear cell renal carcinoma.[]
18. Professional fertility and sexual-health counseling
Targeted drugs and immunotherapy can affect hormones, fertility and sexual function. Counseling before and during treatment can address fertility preservation options, manage sexual difficulties, and support body-image concerns. This helps maintain intimate relationships and future family plans where possible.[]
19. Rehabilitation after major surgery
After radical or partial nephrectomy, a structured rehab plan includes breathing exercises, early walking, stair practice and core strengthening. This lowers the risk of lung infections, blood clots and long-term weakness. Rehab teams also teach safe ways to move while protecting your abdominal wound and remaining kidney.[]
20. Education and shared decision-making
Good written information, diagrams, and decision aids help you understand staging, treatment options and side effects. When patients with clear cell renal carcinoma are actively involved in decisions, they often feel less anxious and more satisfied, and they follow surveillance and treatment plans more closely.[]
Drug treatments for clear cell renal carcinoma
Important safety note: All medicines below are prescription cancer drugs with serious potential side effects. They must only be used under the care of an oncologist in a hospital or cancer center. Doses are typical examples from FDA labels; your doctor will adjust them to your own case.
To stay within space, I will describe key FDA-approved drugs most commonly used in clear cell renal carcinoma rather than every possible agent.
1. Sunitinib (Sutent)
Sunitinib is an oral targeted drug called a multi-targeted tyrosine kinase inhibitor (TKI). It blocks VEGF and other growth signals that tumors need to make new blood vessels. For advanced renal cell carcinoma, a common schedule is 50 mg once daily for 4 weeks, then 2 weeks off (4/2 schedule), repeated as long as it works or is tolerated.[]
Typical side effects include tiredness, diarrhea, hand-foot skin reactions, high blood pressure, mouth sores, and low blood counts.
2. Pazopanib (Votrient)
Pazopanib is another oral TKI that blocks VEGF and related pathways. It is indicated for adults with advanced renal cell carcinoma and is often taken as 800 mg once daily on an empty stomach. The dose may be reduced based on side effects.[]
Common side effects are diarrhea, nausea, changes in hair or skin color, high blood pressure, liver test abnormalities and fatigue.
3. Axitinib (Inlyta)
Axitinib is a more selective VEGF-receptor TKI used after failure of one prior systemic therapy, and in combinations for first-line treatment. A usual starting dose is 5 mg by mouth twice daily, with adjustments depending on tolerance and blood pressure.[]
Side effects include diarrhea, high blood pressure, hand-foot syndrome, hoarseness, and risk of blood clots or bleeding.
4. Cabozantinib (Cabometyx)
Cabozantinib is an oral TKI that targets VEGF, MET and AXL pathways, used both alone and in combination with nivolumab for advanced renal cell carcinoma. A typical monotherapy dose is 60 mg once daily, taken on an empty stomach, with reductions if side effects occur.[]
Side effects commonly include diarrhea, fatigue, mouth sores, hand-foot syndrome, high blood pressure, and risk of bleeding or fistulas.
5. Everolimus (Afinitor)
Everolimus is an oral mTOR inhibitor used after failure of TKIs like sunitinib or sorafenib. It slows tumor cell growth and blood-vessel formation by blocking the mTOR pathway. A usual dose is 10 mg once daily, continued until disease progression or intolerable toxicity.[]
Side effects include mouth sores, infections, rash, high blood sugar and lipids, lung inflammation (pneumonitis) and low blood counts.
6. Temsirolimus (Torisel)
Temsirolimus is an intravenous mTOR inhibitor used especially in some poor-risk patients with advanced renal cell carcinoma. It is given as 25 mg IV over 30–60 minutes once weekly, with premedication using an antihistamine to reduce allergic reactions.[]
Side effects can include rash, fatigue, mouth sores, high cholesterol and triglycerides, lung inflammation and infection risk.
7. Pembrolizumab (Keytruda)
Pembrolizumab is an immune checkpoint inhibitor that blocks PD-1 on T-cells, helping the immune system recognize and attack cancer cells. In kidney cancer, it is commonly used in combination with TKIs (such as axitinib or lenvatinib) as first-line therapy for advanced disease.[]
It is given as an IV infusion every 3 or 6 weeks at a fixed dose. Side effects include fatigue, rash and diarrhea, plus serious immune-related problems of lungs, liver, intestines, thyroid and other organs.
8. Nivolumab (Opdivo)
Nivolumab is another PD-1 inhibitor used alone or in combination with ipilimumab or cabozantinib for advanced renal cell carcinoma. It is infused intravenously at fixed dosing intervals (for example every 2–4 weeks), depending on the regimen.[]
Side effects are similar to pembrolizumab, with fatigue, skin changes, diarrhea and possible serious immune-related inflammation of multiple organs.
9. Ipilimumab (Yervoy)
Ipilimumab is a CTLA-4 immune checkpoint inhibitor. In clear cell renal carcinoma, it is combined with nivolumab in selected untreated patients with intermediate or poor risk advanced disease. A typical regimen gives nivolumab 3 mg/kg plus ipilimumab 1 mg/kg every 3 weeks for 4 doses, then nivolumab alone.[]
Side effects include severe immune-related reactions affecting the gut, liver, skin, endocrine glands and other organs, so intensive monitoring is needed.
10. Lenvatinib (Lenvima) + Pembrolizumab or Everolimus
Lenvatinib is a multi-target TKI combined with pembrolizumab as first-line therapy, or with everolimus after prior anti-angiogenic therapy. Doses vary but often include lenvatinib 20 mg daily with pembrolizumab, or 18 mg daily with everolimus 5 mg daily.[]
Side effects include diarrhea, high blood pressure, fatigue, decreased appetite and protein in the urine; immune side effects also appear when combined with pembrolizumab.
11. Avelumab (Bavencio) + Axitinib
Avelumab is a PD-L1 inhibitor used with axitinib as a first-line option for advanced renal cell carcinoma. Avelumab is given as an IV infusion (for example every 2 weeks), while axitinib is taken orally. The combination aims to attack the tumor both through immune activation and anti-angiogenic blockade.[]
Side effects combine those of immune therapy (fatigue, rash, immune organ inflammation) and TKIs (diarrhea, hypertension, hand-foot syndrome).
12. Other systemic options and clinical trials
Other agents such as tivozanib, belzutifan (a HIF-2α inhibitor in some RCC settings) and additional combinations are used in selected patients or in clinical trials. Guidelines emphasize choosing therapy based on risk group, prior treatments, comorbidities and patient preference, and they strongly encourage participation in well-designed trials when available.[]
Dietary molecular supplements
Evidence for supplements in clear cell renal carcinoma is limited. Supplements must never replace surgery, drugs or standard care, and some may be unsafe with kidney impairment or cancer drugs. Always discuss them with your oncologist.
1. Vitamin D
Vitamin D helps bone health, immune function and muscle strength. Low vitamin D levels are common in cancer patients. A typical supplement dose may range from 800–2000 IU daily, but blood levels should be checked and high-dose therapy must be supervised. Adequate vitamin D may support general health and recovery, but it has not been proven to cure kidney cancer.[]
2. Omega-3 fatty acids (fish oil)
Omega-3 fatty acids from fish oil or algae may help reduce inflammation, support heart health and improve appetite and weight maintenance during treatment. Doses often range from 1–2 g EPA/DHA per day, but higher doses can increase bleeding risk, especially with TKIs or anticoagulants. Use only under medical supervision if you have surgery planned or are on blood-thinning medicines.[]
3. Probiotics
Probiotic capsules or fermented foods (like yogurt with live cultures) can support gut health, especially during or after systemic therapy that causes diarrhea or antibiotic use. There is no standard dose; products often contain billions of CFU of mixed strains. Immunocompromised patients must be cautious, so your oncology team should approve probiotic use.[]
4. Curcumin (turmeric extract)
Curcumin is a compound from turmeric with anti-inflammatory and antioxidant effects in lab studies. Supplements are often 500–1000 mg standardized extract once or twice daily. However, absorption is variable, and curcumin can interact with drugs that affect the liver or blood clotting. At present, it is considered a supportive antioxidant, not a proven treatment for clear cell renal carcinoma.[]
5. Green tea extract (EGCG)
Green tea polyphenols show antioxidant and anti-angiogenic activity in experimental models. Concentrated extracts (for example 300–400 mg EGCG daily) are marketed as supplements, but high doses can be toxic to the liver. Moderate green tea drinking is generally safer. Kidney cancer patients should only use extracts after discussing liver safety and drug interactions with their doctor.[]
6. Selenium
Selenium is a trace mineral involved in antioxidant enzymes. Typical supplement doses are 55–200 mcg daily; higher doses can be toxic. Some research suggests adequate selenium intake may support immune function and antioxidant defenses, but there is no proof that extra selenium treats clear cell renal carcinoma.[]
7. Vitamin C
Vitamin C supports immune function and wound healing. Normal dietary intake is usually enough; supplements often provide 200–500 mg per day. Very high doses (especially IV vitamin C) are experimental and may be risky in people with kidney problems or certain genetic conditions. Vitamin C should be used simply to correct deficiency and support general health.[]
8. B-complex vitamins
B-vitamins help energy metabolism and nerve function. Cancer treatments and reduced food intake can lead to low B-vitamin levels. Standard B-complex tablets with roughly 100% of the daily value for each vitamin can correct deficiency. High-dose B-vitamins should be avoided without medical advice, especially if kidney function is reduced.[]
9. Plant-based protein powders
For patients who struggle to eat enough, plant-based protein powders (pea, soy, rice) can help maintain muscle mass. Doses depend on dietary protein needs and kidney function; too much protein can stress the kidney, so a dietitian should help set the right amount. These powders are a tool to meet nutrition goals, not a cancer treatment.[]
10. Multivitamin at standard dose
A regular daily multivitamin that stays near 100% of daily needs can help cover small dietary gaps during treatment. Mega-dose “anti-cancer” multivitamins are not recommended. A standard multivitamin is usually safe, but your oncology team should check for interactions with specific drugs or your kidney function.[]
Immunity-boosting, regenerative and stem-cell–related drugs
There are no simple “immune booster” pills for clear cell renal carcinoma. Instead, specialized cancer drugs modulate the immune system or are used in research settings.
1. PD-1 inhibitors (Pembrolizumab, Nivolumab)
These drugs block the PD-1 “brake” on T-cells, allowing the immune system to better recognize and attack cancer. They may lead to durable responses in some patients with advanced clear cell renal carcinoma. However, they can also cause serious immune-related side effects affecting organs like lungs, colon, liver and endocrine glands, so they must be given and monitored in specialist centers.[]
2. CTLA-4 inhibitor (Ipilimumab)
Ipilimumab blocks CTLA-4, another immune checkpoint. In combination with nivolumab, it can produce strong anti-tumor immune responses in some intermediate- or poor-risk patients with advanced clear cell renal carcinoma. Because immune activation is powerful, side effects can be severe, and doctors watch closely for colitis, hepatitis, dermatitis and hormone problems.[]
3. PD-L1 inhibitor (Avelumab)
Avelumab blocks PD-L1 on tumor and immune cells. Given with the TKI axitinib, it provides a first-line combination that uses both immune activation and anti-angiogenic effects against clear cell renal carcinoma. The immune-related risks are similar to other checkpoint inhibitors and require prompt reporting of new symptoms.[]
4. mTOR inhibitors (Everolimus, Temsirolimus) as regenerative support
These drugs mainly slow cancer growth by targeting mTOR, but they also influence immune and cell-growth pathways. They are sometimes used when TKIs or immunotherapy are no longer effective or suitable. While not “stem cell drugs,” they act on key cell-regulation pathways and may be part of combination strategies in advanced disease.[]
5. Hematopoietic growth factors (for blood cell recovery)
Medications like G-CSF (filgrastim) can stimulate bone marrow to produce white blood cells when cancer treatment causes low counts. These drugs help the immune system recover but are not specific to clear cell renal carcinoma and are only used when blood tests show severe neutropenia. They are prescribed and monitored carefully to avoid complications such as bone pain or spleen enlargement.[]
6. Experimental cell-based therapies (clinical trials)
Researchers are testing cell-based immunotherapies—such as tumor-infiltrating lymphocyte (TIL) therapy and engineered T-cell approaches—in some solid tumors, including kidney cancer. These treatments are only given in specialized clinical trials with strict safety monitoring. They are not standard care but may offer options when approved therapies are no longer effective.[]
Surgeries for clear cell renal carcinoma
1. Partial nephrectomy (nephron-sparing surgery)
In partial nephrectomy, the surgeon removes the tumor and a small margin of healthy tissue while leaving the rest of the kidney. This is usually used for small or favorably located tumors. It aims to cure the cancer while preserving as much kidney function as possible, which is very important for long-term health and future treatments.[]
2. Radical nephrectomy
In radical nephrectomy, the whole kidney with its surrounding fat and sometimes nearby lymph nodes is removed. This is done for larger or more complex tumors that cannot be safely removed with partial surgery. It may be performed by open or minimally invasive (laparoscopic or robotic) techniques, and is often the main curative treatment for localized clear cell renal carcinoma.[]
3. Cytoreductive nephrectomy
When clear cell renal carcinoma has already spread, some patients may have removal of the primary kidney tumor to reduce the total cancer burden before or during systemic therapy. This is called cytoreductive nephrectomy. It is considered only in selected patients who are fit for surgery and when evidence suggests it may improve symptoms or survival.[]
4. Metastasectomy (removal of metastatic deposits)
In some people with a small number of metastases, surgeons may remove lung nodules, bone lesions or other isolated spots of disease. This procedure can reduce symptoms and in a few carefully chosen cases may prolong survival. It is usually combined with systemic treatments and close imaging follow-up.[]
5. Salvage surgery after ablation or recurrence
If a tumor recurs after ablation or previous kidney surgery, salvage operations—such as re-ablation, repeat partial nephrectomy or completion radical nephrectomy—may be performed. The goal is to remove or destroy remaining cancer while managing scarring and preserving as much kidney function as possible.[]
Prevention of clear cell renal carcinoma
1. Do not smoke. Quitting smoking or never starting is one of the strongest ways to reduce kidney cancer risk and other serious diseases.[]
2. Maintain a healthy body weight. Keeping your weight in a healthy range with diet and physical activity lowers the risk of kidney cancer and many other cancers.[]
3. Be physically active regularly. Aim for at least 150–300 minutes of moderate activity each week, such as brisk walking.[]
4. Follow a mostly plant-based diet. Eat plenty of vegetables, fruits, whole grains, beans and nuts, with limited red and processed meat.[]
5. Limit alcohol. For cancer prevention, many guidelines recommend avoiding alcohol or keeping intake very low.[]
6. Control blood pressure. Check your blood pressure regularly and work with your doctor on lifestyle and medicines to keep it in a healthy range.[]
7. Protect your kidneys from toxins. Avoid overuse of NSAID painkillers and unnecessary exposure to industrial chemicals when possible.[]
8. Manage diabetes and metabolic syndrome. Good control of blood sugar and cholesterol reduces cardiovascular and kidney strain.[]
9. Take part in recommended screening in hereditary syndromes. People from families with known kidney-cancer syndromes should follow genetic counseling and imaging-screening plans.[]
10. Follow up after any kidney cancer treatment. Attending all surveillance visits increases chances of catching recurrence early when it is easier to treat.[]
When to see doctors
You should see a doctor or oncology specialist urgently if you have clear cell renal carcinoma and notice:
New blood in the urine, especially if it is persistent or heavy.
Sudden or strong flank or back pain, particularly on the side of the affected kidney.
Fever, chills, shortness of breath, chest pain or severe cough.
Rapid weight loss, extreme tiredness or loss of appetite.
New or worsening bone pain, headaches or neurological symptoms like weakness or confusion.
Swelling in the legs or ankles, or a big sudden increase in blood pressure.
Any new or fast-worsening symptom after starting a cancer medicine, especially diarrhea, yellow eyes, severe rash, breathing problems, or strong abdominal pain, as these may signal serious drug side effects.[]
If you do not yet have a diagnosis, see a doctor promptly if you have unexplained blood in urine, a lump in the abdomen, or persistent flank pain for more than a few weeks.
What to eat and what to avoid
What to eat
Plenty of vegetables and fruits – Aim for a variety of colors every day to provide vitamins, minerals, fiber and antioxidants that support general health and weight control.[]
Whole grains – Choose brown rice, whole-wheat bread, oats and other whole grains instead of refined grains to keep energy stable and support digestion.[]
Lean protein sources – Include fish, skinless poultry, eggs, beans, lentils and tofu. If kidney function is reduced, a dietitian will help adjust the amount and type of protein.[]
Healthy fats – Use olive oil, nuts, seeds and avocado in small amounts to provide essential fatty acids and calories during treatment.[]
Adequate fluids – Unless your nephrologist says otherwise, aim for regular fluid intake to prevent dehydration and help the remaining kidney work well.[]
What to limit or avoid
Very salty foods – Processed meats, salty snacks and instant foods raise blood pressure and strain the kidney. Try to cook fresh foods and taste before adding salt.[]
Highly processed meats and red meat in large amounts – Bacon, sausages and large daily portions of red meat are linked with higher cancer risk and should be minimized.[]
Sugary drinks and sweets – These add calories without nutrients, promote weight gain and can worsen diabetes and metabolic syndrome.[]
Excess alcohol – Alcohol can harm liver and overall health; many experts suggest avoiding it altogether during active treatment.[]
High-dose herbal or “detox” products without medical advice – Some herbal mixtures can be toxic to kidneys or interact with cancer drugs, so always check with your oncology team first.[]
Frequently asked questions (FAQs)
1. Is clear cell renal carcinoma always fatal?
No. Many cases are found when the tumor is still confined to the kidney, and surgery can be curative. Even when disease is advanced, modern targeted therapies and immunotherapies can control cancer for months or years in some patients.[]
2. What is the main first treatment for localized clear cell renal carcinoma?
For tumors limited to the kidney, surgery—partial or radical nephrectomy—is usually the main treatment. The choice depends on tumor size, location and your overall health.[]
3. Can clear cell renal carcinoma be treated without removing the kidney?
Small tumors in suitable positions may be treated with partial nephrectomy or ablation, which preserve part or all of the kidney. Your multidisciplinary team weighs cancer control against kidney function.[]
4. Do I need chemotherapy?
Traditional cytotoxic chemotherapy does not work well in clear cell renal carcinoma. Instead, treatment focuses on targeted TKIs and immune checkpoint inhibitors.[]
5. How long will I take targeted drugs or immunotherapy?
Most systemic therapies are continued until the cancer grows again or side effects become too strong. Some immunotherapy regimens have fixed durations; your oncologist will explain the planned schedule.[]
6. Can diet alone cure my clear cell renal carcinoma?
No diet or supplement can cure clear cell renal carcinoma. Healthy eating supports your body and treatment but must always be combined with standard medical care.[]
7. Is it safe to exercise during treatment?
Most people can do gentle to moderate exercise during and after treatment, and this often improves fatigue and mood. Always check with your doctor before starting a new program.[]
8. Will I need dialysis after nephrectomy?
Most people with one healthy remaining kidney do not need dialysis. The risk is higher if you already have kidney disease or other health problems, so your team will monitor kidney function closely.[]
9. Can clear cell renal carcinoma come back after surgery?
Yes, recurrence is possible, which is why follow-up scans and visits are important. Early detection of recurrence offers more treatment options.[]
10. Are non-pharmacological therapies enough if I feel well?
Supportive therapies like exercise, nutrition and counseling are very helpful, but they do not replace surgery or drugs. Your cancer team will explain which combination is best for your stage.[]
11. Can I use herbal remedies with my cancer drugs?
Some herbs can interact dangerously with cancer medicines or harm the kidney. Always tell your oncologist about any herbal or over-the-counter product before taking it.[]
12. Is immunotherapy better than TKIs?
Immunotherapy and TKIs work in different ways, and many modern regimens combine them. The “best” choice depends on your disease risk group, spread of cancer, other illnesses and prior treatment.[]
13. How important is blood pressure control in clear cell renal carcinoma?
Very important. High blood pressure can damage the remaining kidney and is a common side effect of many TKIs. Careful monitoring and treatment protect your kidneys and heart.[]
14. Should my family members be tested for kidney cancer genes?
Most clear cell renal carcinoma is not inherited, but some families have genetic syndromes. If you were diagnosed at a young age or have several affected relatives, genetic counseling may be advised.[]
15. Where can I find reliable information and support?
Reliable information usually comes from national cancer societies, kidney cancer charities, and hospital cancer centers. They provide patient guides, nutrition and exercise advice, and access to support groups for people with kidney cancer.[]
Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.
The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members
Last Updated: January 28, 2025.
