Cancer of the Kidney

Renal cell carcinoma (RCC) accounts for approximately 4% of adult malignancies, including approximately 90% of primary renal tumors. RCC exists in sporadic and hereditary forms and is a clinically and pathologically heterogeneous disease. The WHO classification for renal neoplasms recognizes several different histologic subtypes of RCC, which are characterized by distinct genetic abnormalities and molecular signatures reflecting the differences in the cell type, biology, and underlying molecular mechanisms. Of these, clear cell and papillary RCC are most common. The clinical presentation of RCC has been described with the classic triad of symptoms of hematuria, flank pain, and fever. However, with the increased general use of imaging techniques, the vast majority of kidney tumors are now being detected incidentally. Improved surgical techniques for treatment of localized disease and recently developed novel systemic therapies for metastatic renal cell carcinoma (mRCC) have changed the management of this condition. This chapter describes the epidemiology, pathology, genetics, and biologic characteristics, clinical presentation, diagnosis, staging, and management of localized and advanced RCC.