Renal Cell Carcinoma

Abstract

Renal cell carcinoma is the common name applied to adenocarcinoma of the kidney, a tumor arising in the renal cortex and accounting for approximately 85% of malignancies of the kidney (1). Kidney cancer is the third most common malignancy of the urinary tract, after prostate cancer and bladder cancer. The American Cancer Society estimates that there will be 30,000 new cases and 11,900 deaths from kidney cancer in the United States in 1999 (2). The incidence of renal cell carcinoma was previously reported to have increased about 35% over the past two decades, with slightly decreased mortality rates (1). A more recent analysis, however, confirmed the increased incidence rates between 1975 and 1995, but also reported an increase in mortality rates for all race and sex groups (3). Both reports postulated that the increased incidence rates reflect earlier diagnosis at a earlier (and more treatable) stage, largely caused by more frequent and liberal use of modern radiological imaging techniques. Nonetheless, this tumor is still commonly diagnosed late because it is characterized by few symptoms and signs directly related to the renal primary site. It has been called the “internist’s tumor” because of its associated systemic effects. In the past, up to 40% of patients already had metastases when the initial diagnosis was made, but this figure does not reflect the contemporary increase in tumors diagnosed incidentally. The median age at presentation is 65 yr, and the ratio of men to women with kidney cancer is approximately three to two (17,800 to 12,200 in 1999, as estimated by the American Cancer Society) (1,2).