The Basics of Cancer Immunotherapy by Haidong Dong & Svetomir N. Markovic

Author:Haidong Dong & Svetomir N. Markovic
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Renal Cell Carcinoma

Introduction

Historically known as hypernephroma or “Grawitz tumor ”, renal cell cancer was originally believed to arise from ectopic adrenal tissue (Grawitz 1883). It was not until late 1950s when the true renal origin of these tumors was unequivocally established (Foot et al. 1951; Oberling et al. 1960), and the term renal cell carcinoma (RCC) was proposed to more accurately describe these malignancies. Eighty-five to ninety percent of all adult kidney cancers originate in the renal parenchyma, while tumors arising in the renal pelvis account for less than 10% of all cases and are usually of transitional urothelial cell type, and these are managed similarly to bladder cancers (Chow et al. 1999). Most parenchymal tumors are clear-cell renal cell carcinomas (ccRCC). Non-clear-cell histologies constitute 20–25% of RCCs; however, this group is quite heterogeneous, with each individual subtype (i.e., papillary, chromophobe, collecting duct, medullary, translocation carcinoma, etc.) being relatively rare and thus difficult to study in large prospective studies. Sarcomatoid carcinoma is not considered a separate entity, but rather a form of rapidly progressing, poor prognosis RCC, as high-grade sarcomatoid changes may be seen in all subtypes.

Kidney cancer accounts for about 4% of cancer incidence and 2% of cancer mortality in the USA, with approximately 64,000 new cases and almost 14,000 deaths recorded from RCC each year (Siegel et al. 2017). In the USA, the incidence rate of RCC is highest in African Americans, compared to whites and Hispanics, while Asians/Pacific Islanders have the lowest incidence rate (about half of other racial/ethnic groups) (Chow and Devesa 2008). The incidence rates are also higher among men than women, with rates previously reported as twice as high for all racial and ethnic origins (Chow and Devesa 2008), although more recent data suggests that the gap may be narrowing (Jemal et al. 2009). In general, men tend to present with larger, higher grade, and higher stage tumors, and they have a higher incidence of regional and metastatic spread (Aron et al. 2008). RCC is commonly diagnosed in the seventh or eighth decade of life, with less than 5–10% of patients presenting before age 40 years (Gillett et al. 2005; Thompson et al. 2008). Recent studies suggest that younger patients are less likely to have ccRCC (Gillett et al. 2005; Thompson et al. 2008) and are more likely to be symptomatic at presentation and be diagnosed at an earlier stage compared to their older counterparts, despite having tumors of similar size (Verhoest et al. 2007). In the USA, the incidence of RCC has risen consistently over time in all races and sex groups (Chow et al. 1999), which has been in part attributed to increased detection of presymptomatic (incidental) tumors through widespread use of imaging modalities such as ultrasonography, computed tomography, and magnetic resonance imaging performed for the diagnostic work-up of other abdominal disorders (Sanchez-Martin et al. 2008). Indeed, RCC is being increasingly diagnosed at an earlier stage, with marked increases in incidence seen in localized stage tumors, particularly small tumors (< 2 cm) and tumors 2–4 cm in size (Chow and Devesa 2008).

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