Renal cell carcinoma

Renal cell carcinoma (RCC) is a malignancy arising from the renal parenchyma/cortex. Clear cell RCC accounts for the majority (80% to 90%) of primary renal malignancies.

Incidence is increasing along with stage migration to more early-stage diagnosis due to the frequent use of sensitive imaging. Often asymptomatic and diagnosed incidentally.

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

Assessment of primary tumor, regional lymph nodes, distant metastasis, and classification of histologic 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 revolutionized 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 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 80% to 90% of kidney cancers.[1]American Urological Association. Renal mass and localized renal cancer: evaluation, management, and follow up. 2021 [internet publication]. https://www.auanet.org/guidelines/guidelines/renal-mass-and-localized-renal-cancer-evaluation-management-and-follow-up [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 ​