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Book contents

20 - Management of cancer of the kidney

Published online by Cambridge University Press:  05 November 2015

Rhian Sian Davies
Affiliation:
Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
Jason Lester
Affiliation:
Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
John Wagstaff
Affiliation:
Singleton Hospital, Swansea, UK
Louise Hanna
Affiliation:
Velindre Cancer Centre, Velindre Hospital, Cardiff
Tom Crosby
Affiliation:
Velindre Cancer Centre, Velindre Hospital, Cardiff
Fergus Macbeth
Affiliation:
Velindre Cancer Centre, Velindre Hospital, Cardiff
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Summary

Introduction

Cancer of the kidney represents 4% of adult malignancies. Men are more frequently affected than women, and it commonly occurs between the ages of 50 and 70 years. More than 30% of patients present with metastatic disease. The majority of malignant tumours are adenocarcinomas, arising from the proximal renal tubular epithelium. These tumours were previously called hypernephroma because it was believed that they originated from adrenal rests, but they are correctly termed renal cell carcinoma (RCC). The main focus of this chapter is the management of RCC. Transitional cell carcinoma of the renal pelvis accounts for 5% of all renal malignancies, and is covered separately at the end of the chapter.

Types of kidney tumour

Kidney tumours can be benign, malignant primary or metastatic. Benign tumours include cysts (simple, complex, multiple), inflammatory (infection, infarction), adenoma and oncocytoma. Malignant primary tumours include RCC, lymphoma, sarcoma and renal pelvis tumours (5% of malignant renal cancers arise from the renal pelvis, and more than 90% of these are transitional cell carcinoma).

Anatomy

The kidneys are retroperitoneal structures that lie between the eleventh rib and the transverse process of the third lumbar vertebral body, each approximately 11 cm in length, the right lying slightly lower than the left. Each kidney is surrounded by perinephric fat which in turn is covered by Gerota's fascia. The right kidney abuts the liver and stomach and the left, the spleen, stomach and pancreas. The lymphatics drain along the renal vessels, on the right draining to paracaval and aortocaval nodes, and on the left to the para-aortic region.

Incidence and epidemiology

Over 10,000 new cases of kidney cancer were diagnosed in the UK in 2011 resulting in approximately 4200 deaths (Cancer Research UK website accessed July 2014). In the last 10 years kidney cancer incidence rates in the UK have increased by almost a third, and unlike in some other cancers, the death rate is still rising. Kidney cancer occurs most commonly in people 50–80 years of age. Men are more frequently affected than women; the male-to-female ratio is 5:3. It is the seventh most common cancer in men and tenth most common cancer in women in the UK.

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Publisher: Cambridge University Press
Print publication year: 2015

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References

Aso, Y. and Homma, Y. (1992). A survey of incidental renal cell carcinoma in Japan. J. Urol., 147, 340–343.Google ScholarPubMed
Atkins, M., Regan, M., McDermott, D., et al. (2005). Carbonic anhydrase IX expression predicts outcome of interleukin 2 therapy for renal cancer. Clin. Cancer Res., 11, 3714–3721.CrossRefGoogle ScholarPubMed
Atzpodien, J., Kirchner, H., Illiger, H. J., et al. (2001). IL-2 in combination with IFN-alpha and 5-FU versus tamoxifen in metastatic renal cell carcinoma: long-term results of a controlled randomized clinical trial. Br. J. Cancer, 85, 1130–1136.CrossRefGoogle ScholarPubMed
Bell, E. T. (1950). Renal Diseases, 2nd edn. Philadelphia, PA: Lea and Febiger.Google Scholar
Bosniak, M. A. (1986). The current radiological approach to renal cysts. Radiology, 158, 1–10.CrossRefGoogle ScholarPubMed
Clark, J., Atkins, M., Urba, W., et al. (2003). Adjuvant high-dose bolus interleukin-2 for patients with high-risk renal cell carcinoma: a cytokine working group randomized trial. J. Clin. Oncol., 21, 3133–3140.CrossRefGoogle ScholarPubMed
Coppin, C., Porzsolt, F., Awa, A., et al. (2005). Immunotherapy for advanced renal cell cancer. Cochrane Database Syst. Rev., 1, CD001425.Google Scholar
Eble, J. N., Sauter, G., Epstein, J.I., et al. (2004). Pathology and Genetics. Tumors of the Urinary System and Male Genital Organs.Lyon: IARC Press.Google Scholar
Escudier, B., Pluzanska, A., Koralewski, P., et al. (2007). Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trial. Lancet, 370, 2103–2111.CrossRefGoogle ScholarPubMed
Escudier, B., Porta, C., Bono, P., et al. (2014). Randomized, controlled, double-blind, cross-over trial assessing treatment preference for pazopanib versus sunitinib in patients with metastatic renal cell carcinoma: PISCES study. J. Clin. Oncol., 32, 1412–1418.CrossRefGoogle ScholarPubMed
Finney, R. (1973). Radiotherapy in the treatment of hypernephroma: a clinical trial. Br. J. Urol., 45, 26–40.CrossRefGoogle ScholarPubMed
Flanigan, R. C., Salmon, S. E., Blumenstein, B. A., et al. (2001). Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N. Engl. J. Med., 345, 1655–1659.CrossRefGoogle ScholarPubMed
Fuhrman, S. A., Lasky, L. C., Limas, C., et al. (1982). Prognostic significance of morphological parameters in renal cell carcinoma. Am. J. Surg. Pathol., 6, 655–663.CrossRefGoogle Scholar
Gore, M. E., Griffin, C. L., Hancock, B., et al. (2010). Interferon alfa-2a versus combination therapy with interferon alfa-2a, interleukin-2, and fluorouracil in patients with untreated metastatic renal cell carcinoma (MRC RE04/EORTC GU 30012): an open-label randomised trial. Lancet, 375, 641–648.CrossRefGoogle ScholarPubMed
Heng, D. Y., Xie, W., Regan, M. M., et al. (2009). Prognostic factors for overall survival in patients with metastatic renal cell carcinoma treated with vascular endothelial growth factor-targeted agents: results from a large, multicenter study. J. Clin. Oncol., 27, 5794–5799.CrossRefGoogle ScholarPubMed
Heng, D. Y., Xie, W., Regan, M. M., et al. (2013). External validation and comparison with other models of the International Metastatic Renal Carcinoma Database Consortium prognostic model: a population-based study. Lancet Oncol., 14, 141–148.CrossRefGoogle ScholarPubMed
Hudes, G., Carducci, M., Tomczak, P., et al. (2007). Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N. Engl. J. Med., 356, 2271–2281.CrossRefGoogle ScholarPubMed
Janowitz, T., Welsh, S. J., Zaki, K., et al. (2013). Adjuvant therapy in renal cell carcinoma – past, present, and Future. Semin. Oncol., 40, 482–491.CrossRefGoogle ScholarPubMed
Jocham, D., Richter, A., Hoffmann, L., et al. (2004). Adjuvant autologous renal tumour cell vaccine and risk of tumour progression in patients with renal-cell carcinoma after radical nephrectomy: phase III, randomised controlled trial. Lancet, 363, 594–599.CrossRefGoogle ScholarPubMed
Kjaer, M. (1988). The role of medroxyprogesterone acetate (MPA) in the treatment of renal adenocarcinoma. Cancer Treat. Rev., 15, 195–209.CrossRefGoogle ScholarPubMed
Kjaer, M., Frederiksen, P. L. and Engelholm, S. A. (1987). Postoperative radiotherapy in stage II and III renal adenocarcinoma: a randomised trial by the Copenhagen Renal Cancer Study Group. Int. J. Radiat. Oncol. Biol. Phys., 13, 665–672.CrossRefGoogle Scholar
Leibovich, B. C., Blute, M. L., Cheville, J. C., et al. (2003). Prediction of progression after radical nephrectomy for patients with clear cell renal cell carcinoma: a stratification tool for prospective clinical trials.Cancer, 97, 1663.CrossRefGoogle ScholarPubMed
Messing, E., Manola, J., Wilding, G., et al. (2003). Phase III study of interferon alfa-NL as adjuvant treatment for resectable renal cell carcinoma: an Eastern Cooperative Oncology Group/Intergroup trial. J. Clin. Oncol., 21, 1214–1222.CrossRefGoogle ScholarPubMed
Mickisch, G. H., Garin, A., van Poppel, H., et al. (2001). Radical nephrectomy plus interferon-alfa-based immunotherapy compared with interferon-alfa alone in metastatic renal-cell carcinoma: a randomised trial. Lancet, 358, 966–970.CrossRefGoogle ScholarPubMed
Montie, J. E., Stewart, B. H., Straffon, R. A., et al. (1977). The role of adjunctive nephrectomy in patients with metastatic renal cell carcinoma. J. Urol., 117, 272–275.CrossRefGoogle ScholarPubMed
Motzer, R. J., Escudier, B., Oudard, S., et al. (2008). Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet, 372, 449–456.CrossRefGoogle ScholarPubMed
Motzer, R. J., Hutson, T.E., Tomczak, P., et al. (2009). Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J. Clin. Oncol., 27, 3584–3590.CrossRefGoogle ScholarPubMed
Motzer, R. J., Escudier, B., Tomczak, P., et al. (2013a). Axitinib versus sorafenib as second-line treatment for advanced renal cell carcinoma: overall survival analysis and updated results from a randomised phase 3 trial. Lancet Oncol., 14, 552–562.CrossRefGoogle ScholarPubMed
Motzer, R. J., Hutson, T. E., Cella, D., et al. (2013b). Pazopanib versus sunitinib in metastatic renal-cell carcinoma. N. Engl. J. Med., 36, 722–731.Google Scholar
Motzer, R. J., Hutson, T. E., McCann, L., et al. (2014). Overall survival in renal-cell carcinoma with pazopanib versus sunitinib. N. Engl. J. Med., 370, 1769–1770.CrossRefGoogle ScholarPubMed
Murphy, W. M., Beckwith, J. B. and Farrow, G. M. (1994). Tumors of the kidney, bladder, and related urinary structures. In: Atlas of Tumor Pathology, 3rd edn. Bethesda, MD: Armed Force Institute of Pathology.Google Scholar
Negrier, S., Gomez, F., Douillard, J. Y., et al. (2005). Prognostic factors of response or failure of treatment in patients with metastatic renal carcinomas treated by cytokines: a report from the Groupe Français D'Immunothérapie. World J. Urol., 23, 161–165.CrossRefGoogle ScholarPubMed
Negrier, S., Perol, D., Ravaud, A., et al. (2007). Medroxyprogesterone, interferon alfa-2a, interleukin 2, or combination of both cytokines in patients with metastatic renal carcinoma of intermediate prognosis. Cancer, 110, 2468–2477.CrossRefGoogle ScholarPubMed
O'Dea, M. J., Zincke, H., Utz, D. C., et al. (1978). The treatment of renal cell carcinoma with solitary metastasis. J. Urol., 120, 540–542.Google ScholarPubMed
Rini, B.I., Halabi, S., Rosenberg, J. E., et al. (2008). Bevacizumab plus interferon alfa compared with interferon alfa monotherapy in patients with metastatic renal cell carcinoma: CALGB 90206. J. Clin. Oncol., 26, 5422–5428.CrossRefGoogle ScholarPubMed
Sternberg, C. N., Davis, I. D., Mardiak, J., et al. (2010). Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J. Clin. Oncol., 28, 1061–1068.CrossRefGoogle ScholarPubMed
Tada, S., Yamagishi, J., Kobayashi, H., et al. (1983). The incidence of simple renal cyst by computed tomography. Clin. Radiol., 34, 437–439.CrossRefGoogle ScholarPubMed
UICC. (2009). TNM Classification of Malignant Tumours, 7th edn, ed. Sobin, L. H., Gospodarowicz, M. and Wittekind, Ch.. New York: Wiley-Liss, pp. 255–257.
Yagoda, A., Abi-Rached, B., Petrylak, D., et al. (1995). Chemotherapy for advanced renal-cell carcinoma: 1983–1993. Semin. Oncol., 22, 42–60.Google ScholarPubMed

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