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.
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.
- (1) Chittoria B, Rini BI. Renal cell carcinoma. Cleveland clinic, Center for continuing education 2013
- (2) Cancer research UK 2015. Kidney cancer incidence statistics.
- (3) NICE (August 2009). Bevacizumab (first-line), sorafenib (first- and second-line), sunitinib (second-line) and temsirolimus (first-line) for the treatment of advanced and/or metastatic renal cell carcinoma