Renal cancer

Renal cell carcinoma (RCC) represents 2-3% of all malignancies and approxim ately 50% of patients develop metastatic disease. The 5-year survival rate is 60%; for patients with metastatic disease, the 2-year survival is 0-20%. A geographical variation exists and there is also evidence of a genetic pr edisposition. The most common cause of inherited RCC is von Hipple-Lindau ( VHL) disease, a dominant inherited cancer syndrome; 70% of patients with VH L will develop RCC by the age of 60. A number of precursor lesions in RCC h ave been identified, although their clinical significance is unknown. Intra tubular epithelial dysplasia has been reported in 23-28% of patients with R CC and is typified by characteristic features, including epithelial crowdin g, large nuclei and an increased nucleus:cytoplasm ratio. Clearly, this hig h incidence implies that not all precursor lesions progress to RCC. The mos t viable treatment option for small RCC is a radical nephrectomy, while par tial nephrectomy has proven of value in elective conditions. It is importan t in the partial procedure to remove the tumor with a healthy margin. The m ost common complication of surgery is urinary fistula. Cytoreductive therap y prior to immunotherapy can offer several theoretical advantages. Prospect ive randomized trials have shown a significant survival advantage as well a s a significantly longer time to disease progression in patients treated wi th reductive surgery prior to immunotherapy.