Renal cell carcinoma

Renal malignancy arising from the renal parenchyma/cortex. Clear cell renal cell carcinoma accounts for majority (>80%) of primary renal malignancies.

Sixth to eighth most common malignancy in males; risk in general North American population is 1 in 10,000. Incidence increasing along with stage migration to more early-stage diagnosis due to the frequent use of sensitive imaging.

Most cases are sporadic, although positive family history increases risk 4-fold.

Often asymptomatic and diagnosed incidentally.

TNM assessment of primary tumour (T), regional lymph nodes (N), and distant metastasis (M) is made by pathology and imaging studies.

Surgery for early/local disease can be curative in up to 90% of patients; potential increasing role for surveillance and/or biopsy of small renal masses. Risk of distant relapse remains 30% for curatively resected renal cell carcinoma.

Metastatic disease has traditionally had poor 5-year survival (10%). However, targeted systemic therapies have revolutionised treatment for metastatic disease, with median overall survivals improving across all risk groups. Ongoing strategies on combinations of therapies and optimal sequencing of therapies will likely further improve outcomes.

Future directions in management include integrating molecular biomarkers into prognostic models, evaluating the role of targeted treatments in the adjuvant and neoadjuvant settings, examining the sequencing and combinations of targeted treatments in advanced disease, and evaluating new imaging modalities for assessing treatment response.

Renal cell carcinoma (RCC) is renal malignancy arising from the renal parenchyma/cortex, and accounts for about 85% of renal cancers.