Kidney cancer

Abstract

Renal cell cancer is the most malignant urologic cancer, eventually killing more than 35% of affected patients. Renal cell cancer is actually a group of cancers with a common cellular origin, distinct genetic abnormalities and unique morphologic features. The clinical presentation and management of renal cell cancer are changing very rapidly, driven by advances in medical imaging, genetics, molecular pathology, surgery, and a new generation of targeted cancer therapeutics.The incidence of renal cell cancer worldwide is upwards of 208,000 new cases per year, and continues to rise at approximately 2% per year with the highest rate seen in North America, Australia, New Zealand and Europe. This increased incidence is felt to reflect more than detection of a greater number of incidental cases via modern imaging techniques and remains largely unexplained. Despite contemporary imaging technologies and earlier detection, kidney cancer presents in more than 30% of cases at an advanced stage with local and distant metastases. Up to 30% of patients treated by radical or partial nephrectomy for localized disease will eventually relapse. The five-year survival rate for all incident cases of renal cancer has doubled in the past forty years but the five-year survival for metastatic renal cell cancer prior to the advent of new targeted therapies was no better than 10% (3). New agents began to become available in 2006 and updated five-year survival rates will be forthcoming in the near future.Insights into the genetics of sporadic and hereditary renal cancer, growing use of partial nephrectomy as an alternative to radical nephrectomy, and an increasing number of novel, often ‘targeted’, medical treatments have created new roles for internists, nephrologists, and urologists in the management of patients with this disease. Renal cancer is also in the vanguard of contemporary concepts about cancer staging, highlighted by recent advances that integrate traditional anatomic staging with genetic and biologic factors to provide vastly better prognostic information and guidance for patient selection for medical therapy, including clinical trials.This chapter will present an overview of kidney cancer from the perspective of the medical oncologist, focusing on renal cell cancer and emphasizing those areas in which practice is rapidly evolving. This chapter will not discuss the less common malignancies of the kidney, including Wilms’ tumor (nephroblastoma, nearly always a disease of childhood), cancer of the renal pelvis (usually transitional cell cancer, often related to tobacco exposure), or renal sarcomas.