His story moves us forward.

Sickle cell trait means inheriting one usual hemoglobin gene (A) and one sickle hemoglobin gene (S). Sickle cell disease involves two genes that make abnormal hemoglobin, such as HbSS or HbSC, and can cause serious health problems.

To learn your status, ask a healthcare professional about hemoglobin electrophoresis, a blood test that identifies hemoglobin types. You can also ask whether your newborn screening result is available.

RMC is a rare, aggressive cancer of the kidney’s inner region, called the medulla. Most reported cases involve sickle cell trait (HbAS). It can also occur with sickle cell disease, including HbSS and HbSC. Most people with these conditions will never develop RMC.

The medulla has low oxygen and other conditions that can make red blood cells sickle. Researchers are studying whether repeated tissue injury there contributes to RMC and changes involving a gene called SMARCB1 and its INI1 protein. This is a developing explanation, not a proven sequence for every patient.

• RMC is seen most often in teens and young adults. In the United States, it is diagnosed more often in young Black people because sickle hemoglobin conditions are more common in this population. People of any background can be affected.
• Men are diagnosed more often than women, and the right kidney is affected more often than the left. MD Anderson explains these patterns ↗

Knowing your trait status matters, but having sickle cell trait does not mean you need routine RMC screening. Discuss your own questions and symptoms with a healthcare professional.

Why this matters to 4Troy

Troy Anthony Haynes Jr. was an athlete and received care at MD Anderson Cancer Center. His treatment team included Dr. Pavlos Msaouel, an RMC physician-scientist who designed Troy’s clinical trial. We share this information to honor Troy and help athletes, families, coaches, and healthcare professionals recognize concerns early. It does not suggest that sports caused Troy’s cancer.

What researchers are studying

The inner kidney naturally has low oxygen and other conditions that can encourage red blood cells to sickle in someone with sickle cell trait. Very intense exertion and dehydration may add stress. Researchers are studying whether repeated injury there contributes to RMC and changes involving SMARCB1/INI1. This is a developing explanation, not a proven sequence for every case.

A carefully scoped observation: MD Anderson reports that about 60%–70% of the young Black men with sickle cell trait who developed RMC described in its explanation also had a history of high-intensity exercise. That figure is not a percentage of all people with RMC. It does not prove that exercise caused anyone’s cancer or establish an individual athlete’s risk. Dr. Msaouel and colleagues have studied the possible association in patients and experimental models.

Signs athletes should not dismiss

• Visible blood in the urine, even after a workout, needs prompt medical evaluation.
• Persistent side or back pain near the kidney should be discussed with a healthcare professional.
• If unusual fatigue, weakness, cramping, or breathing difficulty occurs during activity, stop and seek appropriate help. These symptoms have many possible causes.

Do not assume blood in the urine is “just training” or diagnose RMC yourself. A clinician can investigate the cause.

Training with sickle cell trait

Having sickle cell trait does not mean an athlete must stop playing sports. To reduce exercise-related illness:

• Build conditioning gradually and set a manageable pace.
• Stay hydrated and allow rest and recovery breaks.
• Do not push through concerning symptoms; get help promptly for cramping, unusual weakness, or breathing difficulty.

These precautions are for exercise-related illness. They have not been proven to prevent RMC. In the United States, RMC is seen more often in young Black people in part because sickle hemoglobin conditions are more common in that population; people of other backgrounds can also be affected.

Sources: MD Anderson and Dr. Pavlos Msaouel on RMC and exercise ↗ · Published RMC and exercise research ↗ · CDC guidance for athletes with sickle cell trait ↗

This information is for education, not a diagnosis or a personal training or treatment plan.

• Blood in the urine: It may look pink, red, brown, or tea-colored.
• Pain: An ache or sharp pain in the side or back near a kidney.
• Other signs: An abdominal lump, fever or night sweats, fatigue, or unexplained weight loss.

When cancer has spread: Symptoms depend on where it has spread and can include a persistent cough, chest pain, or bone pain. These symptoms do not automatically mean RMC.

Blood in the urine or side pain can also have other causes, including infection or kidney stones. Seek prompt medical evaluation, especially for visible blood in the urine, rather than trying to diagnose the cause yourself.

• History and tests: The team reviews symptoms and sickle cell status. Blood and urine tests help assess health and kidney function. Hemoglobin electrophoresis or another suitable hemoglobin test can clarify trait or disease status.
• Imaging: Ultrasound may be used; CT or MRI can help locate a mass and look for possible spread. The exact tests and order depend on the person.
• Biopsy: A small tissue sample is examined by a pathologist, ideally one experienced with RMC.
• INI1/SMARCB1: Loss of the INI1 protein is an important clue. It does not prove RMC by itself because other cancers may also lack INI1; additional review and tests may be needed.

RMC is often advanced when found. Treatments used for more common kidney cancers may not work well for it. For most patients, an RMC-experienced team begins with chemotherapy and considers surgery later when appropriate. The plan depends on the person and the extent of the cancer.

Questions to ask the care team:

• Could this be RMC?
• Has my sickle cell status been confirmed?
• Can an RMC-experienced team review the imaging and biopsy?

This toolkit is for education. It is not a diagnosis or a personal treatment plan.