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 tumor (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 revolutionized 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.
History and exam
- nonspecific systemic symptoms
- signs of hepatic dysfunction
- lower limb edema
- scrotal varicocele
- dermatologic manifestation (hereditary syndromes)
- dental pits (tuberous sclerosis)
- nail manifestations (tuberous sclerosis)
- vision loss (von Hippel Lindau)
- male gender
- age 55 to 84 years
- residence in developed countries
- black/American-Indian ethnicity
- positive family history (FHx) of RCC
- history of hereditary syndromes
- history of acquired renal cystic disease
- asbestos/cadmium/petroleum exposure
- obstetric history/estrogen exposure
- pelvic radiation
Genitourinary Medical Oncology
MD Anderson Cancer Center
AYS has an unpaid advisory role for Merck pharmaceuticals.
Dr Amishi Y. Shah would like to gratefully acknowledge Dr Sonal Gandhi and Jennifer J. Knox, previous contributors to this topic. SG and JJK declare that they have no competing interests.
Fox Chase Cancer Center
SAB has been reimbursed by Pfizer for serving on its speakers bureau. SAB is co-author of a reference cited in the monograph.
Assistant Professor of Urology and Surgery
The Hospital of the University of Pennsylvania
TJG declares that he has no competing interests.
Professor of Oncology
JW declares that he has no competing interests.
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