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Chapter 35: Renal Cell Cancer

David H. Aggen; Martin H. Voss

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INTRODUCTION

Epidemiology

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Epidemiology
Incidence:

Estimated new cases for 2020 in the United States: 73,750 (male: 45,520; female: 28,230)

Men: 22.1/100,000 Women: 10.9/100,000

 Stage at Presentation:
Localized 66.2%
Regional 15.8%
Deaths: Estimated deaths in 2020: 14,830 (Men: 9860; Women: 4970) Distant 13.9%
Unstaged 4.1%
Median age: 64 years
Male to female ratio: 1.6:1

Siegel R et al. CA Cancer J Clin 2020;70:7–30

Surveillance, Epidemiology and End Results (SEER) Program, available from http://seer.cancer.gov [accessed in 2020]

Work-up (For Suspicious Renal Mass)

  1. H&P

  2. CBC, chemistry profile, LDH

  3. Urinalysis

  4. Chest x-ray

  5. Abdominal and pelvic CT with contrast

  6. Chest CT if abnormal chest x-ray or advanced lesion

  7. MRI if CT suggests caval thrombosis or renal insufficiency

  8. Bone scan or brain MRI if clinically indicated

Pathology

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Pathology
Clear cell 70–80%
Papillary 10–15%
Chromophobe 5%
Collecting duct 0.4–2.6%
Zambrano NR et al. J Urol 1999;162:1246–1258

Staging

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Staging
Primary Tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Tumor 7 cm or less in greatest dimension, limited to the kidney
T1a Tumor 4 cm or less in greatest dimension, limited to the kidney
T1b Tumor more than 4 cm but not more than 7 cm in greatest dimension, limited to the kidney
T2 Tumor more than 7 cm in greatest dimension, limited to the kidney
T2a Tumor more than 7 cm but less than or equal to 10 cm in greatest dimension, limited to the kidney
T2b Tumor more than 10 cm, limited to the kidney
T3 Tumor extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond Gerota’s fascia
T3a Tumor extends into the renal vein or its segmental branches, or invades the pelvicalyceal system, or invades perirenal and/or renal sinus fat but not beyond Gerota’s fascia
T3b Tumor grossly extends into the vena cava below the diaphragm
T3c Tumor extends into the vena cava above the diaphragm or invades the wall of the vena cava
T4 Tumor invades beyond Gerota’s fascia (including contiguous extension into the ipsilateral adrenal gland)
Regional Lymph Nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis
Distant Metastasis (M)
M0 No distant metastasis
M1 Distant metastasis
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Staging
Staging Groups
  T N M
I T1 N0 M0
II T2 N0 M0
III T1 or T2 N1 M0
T3 NX, N0, or N1 M0
IV T4 Any N M0
Any T Any N M1

Amin MB et al (editors). AJCC Cancer Staging Manual. 8th ed. New York: Springer; 2017
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Staging
Relative 5-Year Survival
Localized 93%
Regional 70%
Distant 12%

National Cancer Institute, Surveillance, Epidemiology, and End Results ...

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