Download Update Renal Cell Carcinoma (RCC) 2012—National Cancer

Update Renal Cell Carcinoma (RCC) 2012—National Cancer Institute Summary Timothy Mulholland, MD Incidence and Mortality
There are an estimated 64,770 new cases of renal cell (kidney and renal pelvis) cancer and an estimated 13,570 deaths from renal cell cancer in the United States in 2012. The probability of cure is directly related to the stage or the degree of tumor dissemination. Surgical resection is the mainstay of treatment of this disease.
Cellular Classification of RCC Approximately 85% of RCC are adenocarcinoma and most of those are of proximal tubular origin. Most of the remainder are transitional cell carcinomas of the renal pelvis. Stage Information for RCC Please refer to the seventh edition of the American Joint Committee on Cancer’s AJCC Cancer Staging Manual. The staging system for RCC is based on the degree of tumor spread beyond the kidney. T1—Tumor <7cm in greatest dimension, limited to the kidney T1a—Tumor < 4cm in greatest dimension, limited to kidney T1b—Tumor >4cm, but not >7cm, limited to kidney T2—Tumor >7cm, limited to kidney T2a—Tumor >7cm but <10cm, limited to the kidney T2b—Tumor >10cm, limited to the kidney
T3—Tumor extends into major veins or perinephric tissues, but not into adrenal gland or outside Gerota’s fascia T3a—Tumor extends grossly into renal vein or its segmental branches, or invades perirenal sinus fat but not beyond Gerota’s T3b—Tumor extends grossly into vena cava below diaphragm T3c—Tumor extends grossly into vena cava above diaphragm or invades wall of vena cava T4—Tumor invades beyond Gerota’s fascia Treatment Option Overview Stage 1 RCC (T1) Surgical Resection is the accepted therapy for Stage 1 RCC. In patients who are not candidates for surgery, external beam radiation therapy (EBRT) can provide palliation. Stage 2 RCC (T2) Surgical resection is the accepted therapy for stage 2 RCC. In patients who are not candidates for surgery, external beam radiation therapy (EBRT) can provide palliation. Stage 3 RCC (T3) or (T1 or T2 with regional lymph node metastasis—N1)
Radical resection is the accepted therapy for Stage 3 RCC. In the case of T3b disease, surgery is extended to remove the entire renal vein and caval thrombus and a portion of the vena cava if necessary. Stage 4 RCC (T4) or (any T with metastatic disease) Stage 4 RCC is almost always incurable. The prognosis for any treated RCC that has relapsed or is recurring or progressing is poor, regardless of cell type or stage. Carefully selected patients may benefit from surgical resection of localized metastatic disease or from cytoreductive nephrectomy. EBRT benefit inconclusive other than palliation. Clinical trials are available. EBRT or embolization may aid in palliation. There are also clinical trials involving cytokine therapy and some newer anti‐angiogenic drugs or drugs that affect growth pathways. Responses to cytotoxic chemotherapy generally have not exceeded 10% for any regimen that has been studied in adequate numbers of patients.