Renal Cell Carcinoma

Kidney cancer is the 10th most common cancer in Europe with overall mortality rates increasing until the late 1980s and early 1990s and thereafter, stabilised. Until recently, renal cell carcinoma (RCC) was thought to represent a monomorphic disease; however, modern genetic characterisation has demonstrated different subtypes with specific cell types and molecular metabolism. Imaging diagnostic methods are basic for staging and for new treatment strategies. Moreover, tumour biopsy has been reintroduced in the diagnostic armamentarium, mainly in patients with small masses but also when disseminated tumours need to be treated with new target therapies. Although TNM stage, Fuhrman grade and Eastern Oncology Group (ECOG) performance status are the most recognised prognostic factor in RCC, active research continues to determine new prognostic factors to classify different risks for death from RCC. Laparoscopy has gained widespread popularity because of a less morbidity and a faster post-operative convalescence. Partial laparoscopic nephrectomy is a demanding operation that can be made depending on the experience of the surgeon, the size or location of the tumour in the kidney. New robotic approaches are being introduced for nephron sparing surgery. Conversely, cardiac bypass can be necessary for resection of tumours with thrombus extending into the inferior vena cava above the level of hepatic veins. With the advent of modern ablative energies (cryotherapy or radiofrequency) for renal tumours in selected patients with percutaneous or laparoscopic techniques, it is now possible to achieve long cancer specific survival with decreased morbidity. A need for standardisation of follow-up after surgery with lifelong protocols has been recognised in last years. Finally, angiogenesis inhibitors have demonstrated a high probability of disease control in patients with metastatic renal carcinomas. Their indication as adjuvant in local advanced tumours as well as the role of nephrectomy in patients with metastatic disease is being evaluated in current clinical trials.