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Renal cell carcinoma

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Renal cell carcinoma (RCC) is the most common malignant neoplasm of the renal parenchyma accounting for 90% to 95% of cases (1). Adenocarcinoma is the preferred term as it reflects the tumour's origins.

Renal cell carcinoma is divided into different pathologic subtypes, of which the clear cell subtype represents about 75%

The cause of RCC is unknown. It mainly affects the elderly and exhibits a diverse range of presentations.

Most kidney cancer cases occur in the kidney, with much smaller proportions in the renal pelvis, ureter and urethra and paraurethral gland. In the UK, percentage distribution of cases diagnosed by anatomical site is as follows (2010-2012)

  • kidney - 85.6%
  • renal pelvis - 6.6%
  • ureter - 5,7%
  • urethra and paraurethral glands - 1.3%

The American Joint Committee on Cancer (AJCC) tumour node metastases (TNM) system is used to grade RCC into stages I to IV

  • advanced RCC, in which the tumour is either locally advanced and/or has spread to regional lymph nodes, is generally defined as stage III
  • metastatic RCC, in which the tumour has spread beyond the regional lymph nodes to other parts of the body, is generally defined as stage IV
  • in 2006, of people presenting with RCC in England and Wales for whom staging information was available, an estimated 26% and 17% had stage III and stage IV disease, respectively
    • about half of those who have curative resection for earlier stages of the disease also go on to develop advanced and/or metastatic disease

Metastatic RCC is largely resistant to chemotherapy, radiotherapy and hormonal therapy.

The incidence represents about 2.2% of all invasive cancers and has a projected 2018 population age-standardised mortality rate of 1.8 per 100,000 (4,5).

Two-thirds of cases occur in men.

It is known that 30% of clear cell RCC will develop progressive disease after surgical treatment (6)

  • these patients with high-risk ccRCC require adjuvant therapy after nephrectomy or resection of metastases


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