Current treatment of renal cell carcinoma

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Abstract
The accidental diagnosis of RCC has increased due to the extensive use of ultrasonography, leading to an earlier diag- nosis and probably better prognosis. Today about 70 -80% of patients present with localized disease of whom approximately 50% will develop metastatic disease. According to the Surveil- lance, Epidemiology and End Results (SEER) data, the 5-year survival of localized disease is 89% (54% of all patients), 61% in regionally advanced disease and only 9% in the case of metastatic disease (1). The tumour mainly affects adults aged 50 -70 years with a male to female ratio of 1.6:1 (2). Several risk factors have been described for RCC. Tobacco smoking doubles the risk of RCC and there is a positive linear relation between body weight and the risk for RCC, especially in women. Other factors associated with higher risk for RCC are exposure to asbestos or chemicals, thiazide and urinary tract infections. The majority of RCC is adenocarcinomas originating from the proximal tubular cells, but malignant tumours can also arise from other structures such as the collecting duct and the epithelium of the pyelum. Most adenocarcinomas are of the clear cell type and are considered the most sensitive subtype for systemic therapy. At the onset of RCC there are only a few early warning signs. The classical triad of Virchow (2a), consisting of an abdominal mass together with flank pain and macroscopic haematuria, is nowadays only seen in approximately 5% of patients with RCC. At presentation, the disease may be accompanied by non-specific signs such as fatigue, weight loss, malaise, fever and/or night sweats. The primary treatment consists of a radical nephrectomy and in selected cases a par- tial nephrectomy. The role of nephrectomy in metastatic patients will be discussed later

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