Renal cell carcinoma

For other uses, see RCC (disambiguation).
Renal cell carcinoma
Micrograph of the most common type of renal cell carcinoma (clear cell)—on right of the image; non-tumour kidney is on the left of the image. Nephrectomy specimen. H&E stain
SpecialtyOncology

Renal cell carcinoma (RCC) is a kidney cancer that originates in the lining of the proximal convoluted tubule, a part of the very small tubes in the kidney that transport primary urine. RCC is the most common type of kidney cancer in adults, responsible for approximately 90–95% of cases.[1] It is more common in men (with a male-to-female ratio of up to 2:1).[2] It is most commonly diagnosed in the elderly (especially in people over 75 years of age).[3]

Initial treatment is most commonly either partial or complete removal of the affected kidney(s).[4] Where the cancer has not metastasised (spread to other organs) or burrowed deeper into the tissues of the kidney, the five-year survival rate is 65–90%,[5] but this is lowered considerably when the cancer has spread.

The body is remarkably good at hiding the symptoms and as a result people with RCC often have advanced disease by the time it is discovered.[6] The initial symptoms of RCC often include blood in the urine (occurring in 40% of affected persons at the time they first seek medical attention), flank pain (40%), a mass in the abdomen or flank (25%), weight loss (33%), fever (20%), high blood pressure (20%), night sweats and generally feeling unwell.[1] When RCC metastasises, it most commonly spreads to the lymph nodes, lungs, liver, adrenal glands, brain or bones.[7] Immunotherapy and targeted therapy have improved the outlook for metastatic RCC.[8][9]

RCC is also associated with a number of paraneoplastic syndromes (PNS) which are conditions caused by either the hormones produced by the tumour or by the body's attack on the tumour and are present in about 20% of those with RCC.[1] These syndromes most commonly affect tissues which have not been invaded by the cancer.[1] The most common PNSs seen in people with RCC are: high blood calcium levels, high red blood cell count, high platelet count and secondary amyloidosis.[7]

  1. ^ a b c d Curti, B; Jana, BRP; Javeed, M; Makhoul, I; Sachdeva, K; Hu, W; Perry, M; Talavera, F (26 February 2014). Harris, JE (ed.). "Renal Cell Carcinoma". Medscape Reference. WebMD. Archived from the original on 7 March 2014. Retrieved 7 March 2014.
  2. ^ EAU Guidelines: Renal Cell Carcinoma – limited update March 2023 (PDF). European Association of Urology. 2023. ISBN 978-94-92671-19-6.
  3. ^ Znaor A, Lortet-Tieulent J, Laversanne M, Jemal A, Bray F (March 2015). "International variations and trends in renal cell carcinoma incidence and mortality". European Urology. 67 (3): 519–30. doi:10.1016/j.eururo.2014.10.002. PMID 25449206.
  4. ^ Rini BI, Rathmell WK, Godley P (2008). "Renal cell carcinoma". Curr Opin Oncol. 20 (3): 300–6. doi:10.1097/CCO.0b013e3282f9782b. PMID 18391630.
  5. ^ "Kidney cancer". nhs.uk. 2017-10-23. Archived from the original on 3 October 2017. Retrieved 19 March 2018.
  6. ^ Fausto, V; Abbas, A; Fausto, N (2004). Robbins and Cotran Pathologic Basis of disease (7th ed.). Philadelphia, PA: Elsevier/Saunders. ISBN 978-0721601878.
  7. ^ a b Cite error: The named reference MM was invoked but never defined (see the help page).
  8. ^ Singer, Eric A.; Gupta, Gopal N.; Marchalik, Daniel; Srinivasan, Ramaprasad (2013). "Evolving therapeutic targets in renal cell carcinoma". Current Opinion in Oncology. 25 (3): 273–80. doi:10.1097/CCO.0b013e32835fc857. PMID 23455028. S2CID 11526724.
  9. ^ Syn, Nicholas L; Teng, Michele W L; Mok, Tony S K; Soo, Ross A (2017). "De-novo and acquired resistance to immune checkpoint targeting". The Lancet Oncology. 18 (12): e731–e741. doi:10.1016/s1470-2045(17)30607-1. PMID 29208439.