Introduction
Papillary renal cell carcinoma (PRCC) is a type of kidney cancer that develops from cells lining the kidney's small tubules. It is the second most common major subtype of renal cell carcinoma after clear cell renal cell carcinoma.
The treatment of papillary renal cell carcinoma depends on several factors, including the size and location of the tumor, whether it is confined to the kidney, whether lymph nodes or distant organs are involved, the tumor's grade and subtype, kidney function, and the patient's overall health.
For localized disease, surgery is often the main treatment. In advanced or metastatic PRCC, systemic treatments such as targeted therapy or immunotherapy may be considered depending on the specific clinical situation.
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, a super specialist nephrologist, provides comprehensive kidney-function assessment and kidney-focused care for patients undergoing evaluation or treatment for kidney cancer, with coordination with appropriate urology and oncology specialists.
What Is Papillary Renal Cell Carcinoma?
Papillary renal cell carcinoma is a malignant tumor that originates in the kidney's tubular cells.
Under the microscope, the cancer cells may form characteristic papillary structures, which is where the name comes from.
PRCC is broadly divided into different pathological patterns. Historically, it was commonly described as type 1 and type 2, but modern classification recognizes greater biological diversity and includes additional molecularly defined categories.
This distinction is important because tumor biology can influence prognosis and treatment decisions.
Types of Papillary Renal Cell Carcinoma
Papillary Renal Cell Carcinoma Type 1
Type 1 tumors are generally characterized by cells with a relatively lower-grade appearance, although individual tumors can behave differently.
Papillary Renal Cell Carcinoma Type 2
Type 2 was historically considered a single category, but modern classification recognizes that these tumors are biologically diverse and may include several distinct molecular entities.
Therefore, treatment should be based on the complete pathology report rather than tumor type alone.
What Causes Papillary Renal Cell Carcinoma?
The exact cause of PRCC is not always known.
Risk factors may include:
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Smoking
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Obesity
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High blood pressure
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Certain occupational exposures
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Chronic kidney disease
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Long-term dialysis in some patients
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Certain inherited genetic conditions
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Family history of kidney cancer
One inherited condition strongly associated with papillary kidney cancer is hereditary papillary renal cell carcinoma (HPRCC).
Not everyone with these risk factors develops kidney cancer.
Symptoms of Papillary Renal Cell Carcinoma
Small kidney tumors may cause no symptoms and may be discovered incidentally during imaging.
Possible symptoms include:
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Blood in the urine
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Persistent pain in the side or back
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A lump or fullness in the abdomen
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Unexplained weight loss
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Fatigue
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Loss of appetite
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Recurrent fever without an obvious infection
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Anemia
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High blood pressure
These symptoms can also occur with other medical conditions and do not confirm kidney cancer.
How Is Papillary Renal Cell Carcinoma Diagnosed?
Accurate diagnosis and staging are essential before treatment.
Medical Evaluation
The healthcare team may review:
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Symptoms
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Previous kidney disease
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Family history
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Smoking history
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Blood pressure
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Medication history
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Previous imaging
Blood Tests
Tests may include:
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Serum creatinine
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eGFR
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Complete blood count
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Electrolytes
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Liver function tests
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Calcium
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Other tests based on the clinical situation
Kidney function is particularly important when surgery or systemic treatment is being considered.
Imaging Tests
Imaging may include:
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Contrast-enhanced CT scan
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MRI when appropriate
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Chest imaging
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Additional scans when clinically indicated
These tests help determine the size and extent of the tumor and whether lymph nodes or distant organs may be involved.
Kidney Tumor Biopsy
A biopsy may be recommended in selected patients when tissue diagnosis will influence management.
However, not every kidney mass requires a biopsy before surgery.
The decision depends on imaging findings and the planned treatment strategy.
Papillary Renal Cell Carcinoma Stages
Kidney cancer is generally staged using the TNM system.
Stage 1
The tumor is confined to the kidney and is relatively small.
Stage 2
The tumor remains within the kidney but is larger.
Stage 3
The cancer has extended into nearby major veins, surrounding tissues, or regional lymph nodes but has not spread to distant organs according to the staging criteria.
Stage 4
The cancer has spread to distant organs or has more extensive local or regional involvement meeting stage 4 criteria.
Treatment becomes more complex as the disease progresses.
Papillary Renal Cell Carcinoma Treatment
There is no single treatment that is appropriate for every patient. Management depends on the stage and biology of the cancer.
1. Partial Nephrectomy
For selected localized kidney tumors, partial nephrectomy removes the cancer while preserving as much healthy kidney tissue as possible.
It may be considered when:
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The tumor is technically suitable
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Complete tumor removal can be achieved
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Adequate healthy kidney tissue can be preserved
Kidney-sparing surgery can be particularly valuable for patients with pre-existing kidney disease, a solitary kidney, or tumors affecting both kidneys.
2. Radical Nephrectomy
A radical nephrectomy involves removing the entire affected kidney along with surrounding structures as required.
It may be considered when:
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The tumor is large
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The tumor location makes partial nephrectomy unsuitable
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The cancer has extensive local involvement
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Complete removal cannot safely be achieved through kidney-sparing surgery
Surgery is generally performed by a qualified urologic surgeon.
3. Ablation
For selected small kidney tumors, minimally invasive treatments such as thermal ablation may be considered.
Examples include:
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Cryoablation
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Radiofrequency ablation
These approaches are generally more relevant to carefully selected small renal masses and may not be appropriate for larger or advanced PRCC.
Treatment for Advanced or Metastatic Papillary Renal Cell Carcinoma
When PRCC has spread beyond the kidney, systemic therapy may be necessary.
Treatment selection depends on:
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Disease extent
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Tumor biology
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Previous treatments
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Overall health
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Kidney function
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Current clinical guidelines
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Availability of clinical trials
Targeted Therapy
Some targeted medicines inhibit pathways involved in kidney cancer growth.
Cabozantinib, for example, has demonstrated activity in advanced non-clear-cell renal cell carcinoma, including papillary RCC.
Other targeted approaches may be considered depending on the patient's specific disease characteristics.
Immunotherapy
Immune checkpoint inhibitors may be considered for selected patients with advanced renal cell carcinoma.
Depending on the clinical situation, immunotherapy may be used alone or in combination with other treatments.
The evidence and recommended regimens can differ between clear-cell and non-clear-cell kidney cancers, so treatment should be determined by an experienced oncology team.
Clinical Trials
Because papillary renal cell carcinoma is biologically diverse and less common than clear-cell RCC, clinical trials can be an important option for some patients with advanced disease.
Trials may investigate:
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New targeted therapies
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Combination treatments
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Immunotherapy
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Molecularly targeted approaches
An oncologist can determine whether a suitable clinical trial is available.
Hereditary Papillary Renal Cell Carcinoma
Some patients develop PRCC because of inherited genetic changes.
Hereditary papillary renal cell carcinoma (HPRCC) is associated with pathogenic variants involving the MET gene.
Genetic counseling and testing may be considered when there is:
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A strong family history of kidney cancer
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Multiple kidney tumors
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Bilateral kidney tumors
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Kidney cancer at an unusually young age
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Other findings suggesting an inherited cancer syndrome
Genetic assessment can also help determine whether family members may benefit from appropriate screening.
Papillary Renal Cell Carcinoma and Kidney Function
Cancer treatment should consider kidney function before and after therapy.
Kidney function may be affected by:
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Removal of one kidney
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Pre-existing CKD
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High blood pressure
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Diabetes
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Cancer-related complications
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Certain systemic therapies
Monitoring may include:
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Serum creatinine
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eGFR
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Blood pressure
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Urine protein or albumin
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Electrolytes
A nephrologist can help reduce kidney-related risks and manage CKD before and after cancer treatment.
Recovery After Kidney Cancer Surgery
Recovery depends on the surgical procedure, overall health, and whether complications occur.
Patients may be advised to:
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Follow postoperative instructions
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Attend follow-up appointments
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Gradually return to physical activity
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Avoid strenuous activity until medically cleared
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Take prescribed medicines
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Monitor blood pressure
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Have kidney function checked regularly
Patients should contact their medical team if they develop fever, worsening pain, significant bleeding, difficulty urinating, or other concerning symptoms after surgery.
Follow-Up After Papillary Renal Cell Carcinoma Treatment
Regular surveillance is important because kidney cancer can recur.
Follow-up may involve:
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Physical examination
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Kidney-function blood tests
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CT or MRI imaging
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Chest imaging
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Monitoring blood pressure
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Monitoring for treatment-related complications
The follow-up schedule depends on the original tumor stage, grade, pathology, treatment, recurrence risk, and current clinical recommendations.
Can Papillary Renal Cell Carcinoma Come Back?
Yes. PRCC can recur after treatment, although recurrence risk varies widely.
The risk depends on factors such as:
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Tumor stage
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Tumor grade
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Histological subtype
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Lymph-node involvement
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Surgical margins
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Vascular invasion
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Other pathological features
Long-term follow-up helps detect recurrence or new kidney tumors at an earlier stage.
Prognosis of Papillary Renal Cell Carcinoma
The outlook for PRCC depends primarily on the stage and biological characteristics of the tumor.
Patients with cancer confined to the kidney generally have a better prognosis than patients with metastatic disease.
Important prognostic factors include:
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Stage
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Tumor grade
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Histological and molecular subtype
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Lymph-node involvement
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Distant metastases
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Response to treatment
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Overall health
A personalized prognosis should be discussed with the treating cancer team after reviewing the pathology and staging results.
How Can You Protect Your Kidney After Treatment?
After kidney cancer treatment, protecting remaining kidney function becomes important.
Helpful measures include:
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Maintain healthy blood pressure.
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Manage diabetes if present.
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Avoid smoking.
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Maintain a healthy weight.
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Stay physically active as medically appropriate.
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Avoid unnecessary NSAID painkillers.
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Follow a balanced diet.
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Take medicines exactly as prescribed.
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Attend scheduled kidney and cancer follow-ups.
There is no proven herbal or dietary treatment that can eliminate papillary renal cell carcinoma.
When Should You Consult a Specialist?
Seek specialist evaluation if you have:
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Blood in the urine
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Persistent flank pain
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An abnormal kidney mass on imaging
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Unexplained weight loss
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Unexplained anemia
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A family history of kidney cancer
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Multiple kidney tumors
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Bilateral kidney tumors
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Abnormal kidney-function tests
Early assessment can help establish the diagnosis and determine the appropriate treatment pathway.
Papillary Renal Cell Carcinoma Care at Prabhakar Bhurke Clinic
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, a super specialist nephrologist, provides kidney-focused care for patients with kidney cancer and related kidney-function concerns.
Services may include:
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Comprehensive kidney-function assessment
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Review of creatinine and eGFR
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Blood-pressure management
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Evaluation of proteinuria
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Assessment of pre-existing CKD
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Kidney monitoring before and after nephrectomy
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Management of kidney-related complications
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Guidance on kidney-protective measures
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Coordination with urology specialists for surgical treatment
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Coordination with oncology specialists for systemic cancer treatment
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Long-term kidney health monitoring
The goal is to support kidney health throughout the cancer-treatment journey.
Frequently Asked Questions
What is the best treatment for papillary renal cell carcinoma?
Treatment depends on the stage and characteristics of the tumor. Surgery, particularly partial or radical nephrectomy, is commonly used for localized disease. Advanced disease may require targeted therapy, immunotherapy, clinical trials, or combinations of treatments.
Is papillary renal cell carcinoma curable?
Localized PRCC can often be treated with curative intent when the tumor can be completely removed. Advanced or metastatic disease is more difficult to cure, but systemic treatments can help control the cancer in appropriate patients.
Does papillary renal cell carcinoma require kidney removal?
Not always. Partial nephrectomy may be possible for selected tumors. Radical nephrectomy may be recommended when the tumor is too large, complex, or invasive for safe kidney-sparing surgery.
Is papillary renal cell carcinoma hereditary?
Most cases are not hereditary. However, hereditary papillary renal cell carcinoma is a recognized inherited condition associated with certain genetic changes, including pathogenic variants in the MET gene.
Can papillary renal cell carcinoma spread?
Yes. PRCC can spread to lymph nodes or distant organs, particularly when it is advanced. Accurate staging helps determine the appropriate treatment.
Can papillary renal cell carcinoma affect kidney function?
The cancer itself may not always reduce kidney function, but surgery, pre-existing kidney disease, and some cancer treatments can affect kidney function. Monitoring by a nephrologist can be valuable.
Is chemotherapy used for papillary renal cell carcinoma?
Traditional chemotherapy is generally not the main treatment for PRCC. Treatment for advanced disease more often involves targeted therapies, immunotherapy, combinations, or clinical trials depending on the patient's situation.
Which doctors treat papillary renal cell carcinoma?
Treatment may involve a multidisciplinary team including a urologic surgeon, medical oncologist, and nephrologist. The urologic surgeon manages cancer-directed surgery, the oncologist manages systemic cancer therapy, and the nephrologist helps assess and protect kidney function.
Conclusion
Papillary renal cell carcinoma treatment depends on the tumor's stage, size, location, pathological characteristics, molecular features, kidney function, and overall health.
For localized disease, partial nephrectomy or radical nephrectomy may be considered depending on whether kidney-sparing surgery is technically appropriate. Selected small tumors may also be treated with ablation. For advanced or metastatic PRCC, targeted therapy, immunotherapy, and clinical trials may provide important treatment options.
Because treatment can affect kidney function, kidney-focused monitoring is an important part of comprehensive care.
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, a super specialist nephrologist, provides individualized kidney-function assessment, CKD management, blood-pressure control, and kidney-protective care for patients undergoing evaluation or treatment for papillary renal cell carcinoma. When cancer-directed surgery or systemic treatment is required, appropriate urology and oncology specialists can be involved.
Book an Appointment Today
If you have been diagnosed with papillary renal cell carcinoma, have an abnormal kidney mass, undergone nephrectomy, or are concerned about kidney function during cancer treatment, schedule a consultation at Prabhakar Bhurke Clinic.
Dr. Sandip Prabhakar Bhurke, a super specialist nephrologist, can assess your kidney function, identify kidney-related risk factors, and provide an individualized kidney-care plan alongside your cancer treatment team.
Medical Disclaimer
This article is intended for general educational purposes only and does not replace professional medical advice, diagnosis, or treatment. Papillary renal cell carcinoma treatment varies according to cancer stage, pathology, molecular characteristics, kidney function, overall health, and current clinical guidelines. Cancer-directed surgery and systemic treatment should be planned with appropriately qualified urology and oncology specialists. Do not delay diagnosis or treatment based solely on information in this article.
