Renal Cell Carcinoma

Abstract

Two percent of all new cancers diagnosed in the US (54,390 new cases 2008). Steady increase in incidence not explained by incidental diagnoses (∼7% of cases) made from increased diagnostic imaging. Male predominance (M:F 1.5:1). Most common in sixth to eighth decades; peak incidence in sixth decade. Ninety-five percent diagnoses made with imaging – characteristic solid, hypervascular mass. Metastatic disease in 30% at diagnosis, and eventually in 50% (lung, liver, bone, distant LN, adrenal, brain, opposite kidney, soft tissue). Stage at diagnosis is the most important prognostic factor. Predominant histologic type: adenocarcinoma arising from tubular epithelium. Adenocarcinoma subtypes: clear cell (75–85%), chromophilic/papillary (10–15%), chromophobe (5–10%), oncocytic (rare) Sarcomatoid (1–6%; poor prognosis) Risk factors: tobacco, urban environmental toxins (cadmium/asbestos/petrols), obesity, high dietary fat intake, acquired cystic renal disease from renal failure (premalignant condition with 4–9% incidence RCC; US surveillance q2 years). Association with von Hippel-Lindau disease: autosomal dominant, loss of 3p, >70% chance developing RCC (almost all clear cell histology) in addition to risk of developing multiple other benign and malignant tumors (retinal angiomas, CNS hemangioblastomas, pheochromocytoma, pancreatic cancer). Possible association with lymphoma, based on two large cancer database studies. RCC has low response rates to traditional chemotherapy (∼6–7%). Response rates to immunotherapy (IL-2, interferon alpha) are slightly higher (∼10–15%).