Renal Cell Carcinoma
The most common types of kidney and renal pelvis cancer are the following:
Renal cell carcinoma (RCC). RCC makes up 90% of kidney cancers. RCCs are classified on the basis of cancer cell morphology as either clear-cell RCC (the most common form of RCC) or nonclear-cell RCC.1,2
Transitional cell carcinoma (TCC). TCC makes up 5% to 10% of kidney cancers. TCCs are characterized by cancers that originate from the lining of the renal pelvis.1
Wilms tumor (nephroblastoma). Making up only ~1% of all kidney cancers, Wilms tumor usually occurs in children and only very rarely in adults.1,2
Renal sarcoma. Renal sarcoma makes up <1% of kidney cancers. The cancer cells of renal sarcoma originate in the blood vessels or connective tissue of the kidney.1
Incidence in the United States
In terms of projected newly diagnosed cancer cases in 2023, kidney cancer was the sixth most common cancer in men and the ninth most common in women.3 Moreover, it was projected that an estimated 81,800 individuals would be diagnosed and an estimated 14,890 individuals would die from kidney cancer in the United States in 2023.3
Epidemiology in the United States
The majority (82%) of patients diagnosed with RCC present with localized or regional disease. Among these patients, the 5-year survival rates are 93% and 72%, respectively (data from 2012-2018).4 However, for those 15% of patients who present with distant metastasis, 5-year survival drops to 15%.4
Risk Factors
Obesity is a well-established risk factor for RCC and is estimated to account for 40% of RCC cases in the United States.2 Cigarette smoking increases RCC risk by ~50% in men and by ~20% in women.2 Long-term hypertension also has been associated with an increased risk of kidney cancer.2 Genetic predisposition to clear-cell RCC is a major feature of von Hippel-Lindau disease.2 However, most RCC cases are sporadic, with familial cases accounting for approximately 2% to 4%.5,6 In a meta-analysis, individuals who had a first-degree relative diagnosed with kidney cancer were shown to have a higher risk of developing kidney cancer.7
Unmet Need
A significant proportion of patients (20% to 30%) present with metastatic RCC at diagnosis, and as many as 40% of patients with localized disease relapse after primary surgical treatment.8 Young individuals are more prone to have metastatic disease.9 In an RCC patient cohort from the Nationwide Inpatient Sample database from 1998 to 2007, 61% of patients were found to have a single-site metastasis, whereas 39% had 2 or more metastatic sites.9 Common metastatic sites in patients with RCC included lung (45%), bone (30%), lymph nodes (22%), liver (20%), adrenal gland (9%), and brain (8%).9
References: 1. American Cancer Society. What is Kidney Cancer? http://www.cancer.org/cancer/kidneycancer/detailedguide/kidney-cancer-adult-what-is-kidney-cancer. Accessed September 1, 2022. 2. Chow et al. Nat Rev Urol. 2010;7: 245-257. 3. American Cancer Society. Cancer Facts and Figures 2023. 4. National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Cancer Stat Facts: Kidney and Renal Pelvis Cancer. http://seer.cancer.gov/statfacts/html/kidrp.html. Accessed September 1, 2022. 5. Pascual and Borque. Adv Urol. 2008;2008:782381. 6. Woodward et al. J Med Genet. 2000;37:348–353. 7. Clague et al. Cancer Epidemiol Biomarkers Prev. 2009;18:801-807. 8. Kim. World J Urol. 2014;32:631-642. 9. Bianchi et al. Ann Oncol. 2012;23:973-980.
Resources
The Patient Journey in RCC
Renal cell carcinoma (RCC) can be a complex disease to diagnose. Here,...
Vivek Subbiah, MD, and Deepak Kilari, MD, discuss the diagnosis of RCC and the challenges of early detection.
Click to expand transcript
[Dr. Kilari]: In some scenarios, for instance, if they go in for—like I mean they might have, some fatigue... or not even fatigue, but they might go in for something else and they get a CAT scan, and we end up finding that they have metastatic disease purely incidentally—they didn’t go in for any symptoms related to cancer—I think that is something that we often see in clinical practice. It’s not very common, but most of the times they have some other symptoms and go to their primary care. Primary care ends up getting a CAT scan and found them to have low-volume metastatic disease, and that’s the reason why they are not symptomatic. I think that’s what we do see sometimes. And they are referred to the specialist based on the extent of disease and the burden of disease.
[Dr. Subbiah]: The early kidney cancers, right, usually do not cause any signs or symptoms. But if they are large, especially depending upon the location, they might cause some, some symptoms. Again, the classic symptoms that we see is hematuria, you know, pain, or loss of appetite. They may not manifest in all patients. They can be caused by other benign diseases and cancers. For instance, you know, take, for instance, blood in the urine. Blood in the urine, or hematuria, is most commonly caused by a urinary tract infection, a kidney stone, or, you know, some form of bladder cancer. You know, kidney cancers can manifest with blood in the urine as well. So, if any of these symptoms are persisting, patients do show up to their primary care doctor and, you know, the workup leads to ultimately a diagnosis of renal cell cancer.
The Educational Gaps in RCC
The treatment of renal cell carcinoma (RCC) has evolved rapidly in the last 15...
years, and there is a rise in the use of immunotherapy and targeted therapies. Here, Vivek Subbiah, MD, and Deepak Kilari, MD, discuss the educational gaps that exist in RCC.
Click to expand transcript
[Dr. Subbiah]: So, 10 to 15 years ago, kidney cancer had a few treatments. In 2022,
kidney cancer, especially that has spread, can be treated by multiple modalities. Now,
mainly they are called systemic therapies because they can reach the cancer cells
almost anywhere in the body.
[Dr. Subbiah]: So what are the top educational needs? Top educational needs are
targeted therapy treatments for kidney cancer: what are the options available? What
is the right sequence in these patients? And what are the side effects of these drugs,
and the side-effect management of these drugs? And the same thing for
immunotherapy: when do we administer the immunotherapy? Do we administer
immunotherapy as a single therapy or in combination? Side-effect management of
immunotherapeutic agents? And how to monitor these patients? Again, those are the top
educational priorities. Most importantly, clinical trials options are available for every
line of therapy. Physicians, oncologists, and the multidisciplinary care teams should know
what are the clinical trials available for patients at every line of therapy. So I think
these are the top educational needs for oncologists in terms of renal cell cancer.
[Dr. Kilari]: I agree with Dr. Subbiah that I think the field is evolving so rapidly. I mean,
like every day there is a poster, or everyday there is a publication that is clinically
meaningful. And, I mean, as a GU medical oncologist, sometimes I find it difficult to
keep up with the pace at which papers are being published and the data in the field is
evolving. So there—there's a lot of educational gaps unfortunately, but that's because
the field is evolving in a good way. I think education like what Dr. Subbiah pointed out
is very helpful in those categories.
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