Renal cell carcinoma

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

Incidence increasing along with stage migration to more early-stage diagnosis due to the frequent use of sensitive imaging. Often asymptomatic and diagnosed incidentally. Approximately 60% to 70% of incidentally diagnosed lesions are less than 4 cm in size.

Most cases are sporadic, although at least four hereditary clinical kidney cancer syndromes have been identified.

Assessment of primary tumour, regional lymph nodes, distant metastasis, and classification of histological subtypes are of paramount importance for making treatment decisions.

Surgery for early/local disease can be curative in over 90% of patients; surveillance and/or biopsy may be the most appropriate strategy in some patients with small renal masses. Risk of distant relapse remains 30% for curatively resected RCC.

Metastatic disease has traditionally had poor 5-year survival (10%). However, targeted systemic therapies have revolutionised treatment for metastatic disease, with median overall survival improving across all risk groups. Combination therapy (dual immune checkpoint inhibitors or an immune checkpoint inhibitor plus a tyrosine kinase inhibitor) is now recommended as first-line therapy.

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

Renal cell carcinoma (RCC) is a renal malignancy arising from the renal parenchyma/cortex, and accounts for about 85% of kidney cancers.[1]Campbell S, Uzzo RG, Allaf ME, et al. Renal mass and localized renal cancer: AUA guideline. J Urol. 2017 Sep;198(3):520-9. https://www.auajournals.org/doi/10.1016/j.juro.2017.04.100 http://www.ncbi.nlm.nih.gov/pubmed/28479239?tool=bestpractice.com [2]Escudier B, Porta C, Schmidinger M, et al. Renal cell carcinoma: ESMO clinical practice guidelines for diagnosis, treatment, and follow-up. Ann Oncol. 2019 May;30(5):706-20. https://www.annalsofoncology.org/article/S0923-7534(19)31157-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/30788497?tool=bestpractice.com