Renal cell carcinoma (RCC) is one of the most common types of kidney cancer in adults and is a malignant tumor originating from the epithelial cells of the renal tubules. This type of cancer is characterized by features such as relative resistance to chemotherapy and a tendency to metastasize in the late stages of the disease. The anatomical location of the tumor is usually unilateral, and statistically more cases of the disease are observed in men than in women. The main symptoms include hematuria, lumbar pain, weight loss, and general weakness. Treatment of renal cell carcinoma can vary from surgery to immunotherapy or targeted therapy, which is determined by the stage of the disease and individual patient characteristics.
History of the disease and interesting historical facts
Renal cell carcinoma was first described in medical literature in the 19th century, but its diagnosis and treatment have only begun to develop rapidly over the last century. In 1887, German pathologist Ludwig Ferdinand Gebhardt described the first case of renal cell carcinoma, unaware that this disease would become one of the major problems of urology in the future. Interestingly, at the beginning of the 20th century, the tumor was known as “lateral renal cancer” because this disease was common in people working in the cold. In the 1970s, significant advances were made in surgery and oncology, which contributed to improved patient survival; however, progress in the diagnosis and treatment of renal cell carcinoma occurred in the 1990s with the advent of new imaging techniques and drugs aimed at tumor cells.
Epidemiology
According to the data provided by the World Health Organization, renal cell carcinoma accounts for approximately 3% of all cases of malignant neoplasms in adults and is the leading type of kidney cancer. In 2020, approximately 431,000 new cases were reported worldwide, as well as approximately 179,000 deaths, making it a major challenge for health systems. The incidence of RCC varies depending on geographic and ethnic factors, with the highest number of cases observed in North America and Europe, while Asian and African countries show lower rates. The gradual increase in incidence is associated with factors such as population aging and lifestyle changes.
Genetic predisposition to this disease
Research has shown that genetic predisposition is a significant factor in the development of renal cell carcinoma. Research studies confirm that mutations in certain genes, such as VHL (von Hippel-Lindau), PBRM1, and SETD2, play a key role in the pathogenesis of this disease. For example, von Hippel-Lindau syndrome is an inherited disorder associated with mutations in the VHL gene and is characterized by an increased risk of developing RCC. Other mutations found in genes associated with cell cycle regulation and in genes responsible for DNA repair may complete the picture of genetic vulnerability to this type of cancer. Given all of the above, genetic testing and consultation with medical geneticists may be useful for patients from families with a known predisposition to malignant tumors.
Risk factors for the development of this disease
Among the numerous risk factors that contribute to the development of renal cell cancer, the following are distinguished:
- Smoking: Associated with an increased risk of 50% in smokers compared with non-smokers.
- Obesity: Metabolic disorders associated with excess weight are associated with increased risk.
- Chronic kidney diseases: such as glomerulonephritis and diabetes.
- Contact with chemicals: for example, with heavy metals (cadmium, lead).
- Professional factors: work in areas involving chemicals or radiation.
Understanding these risk factors helps in developing preventive measures and improving living conditions for vulnerable populations.
Diagnosis of this disease
Diagnosis of renal cell carcinoma involves several key steps that begin with a clinical examination and history. The main symptoms that doctors look for may include:
- Hematuria (blood in urine).
- Lumbar pain.
- Unintentional weight loss.
- General weakness and fatigue.
Laboratory tests often include a general urine and blood test, a biochemical blood test, which can show changes in the functional state of the kidneys. Radiological studies such as ultrasound, CT and MRI are extremely important for visualizing the tumor and metastases. Contrast MRI is especially informative, allowing for a detailed vascular structure of the tumor. Other types of diagnostics may include a puncture biopsy for histological confirmation of the diagnosis. The differential diagnosis can be made taking into account benign kidney tumors such as angiomyolipoma and fibroma.
Treatment
Treatment for renal cell carcinoma depends on the stage of the disease, the patient's condition, and the presence of metastases. The main treatment methods include:
- Surgical intervention: radical nephrectomy and partial nephrectomy.
- Pharmacological treatment: targeted therapy, immunotherapy.
- Local methods: radiofrequency ablation, cryoablation.
Surgery remains the mainstay of treatment in the early stages, while drug therapy, especially programmed cell therapy and tyrosine kinase inhibitors, has shown high efficacy in later stages. It is important that the comprehensive treatment is tailored to the individual patient and the specifics of the disease.
List of medications used to treat this disease
Some of the most commonly used drugs to treat renal cell carcinoma include:
- Sorrafenib (Nexavar).
- Lenvacin (Lenvima).
- Nivolumab (Opdivo).
- Alemtuzumab (Campath).
- Apartamib (Apatinib).
Each of the listed agents can be used both as monotherapy and in combination with other methods, depending on the clinical picture and stage of the disease.
Disease monitoring
Monitoring the patient’s condition after treatment for renal cell carcinoma involves a number of key steps, such as regular imaging studies (e.g., CT or MRI), blood tests for disease markers (e.g., hemoglobin, renal function parameters), and assessment of the patient’s general condition. The prognosis of the disease largely depends on the time of diagnosis and the stage of the disease at the first visit. Complications may include recurrence of the disease and metastasis to other organs, which requires additional intervention and adjustment of the treatment strategy.
Age-related features of the disease
Renal cell carcinoma mainly develops in people over 50 years of age, but in recent decades there has been an increase in the incidence among the younger population. Patients over 70 years of age have a more aggressive form of the disease, often in combination with concomitant pathologies, which complicates the treatment process. In young people, the disease often develops against the background of a genetic predisposition and has a less aggressive course.
Questions and Answers
- What are the main symptoms of renal cell carcinoma? The main symptoms include hematuria, low back pain, weight loss and general weakness.
- What are the risk factors associated with the development of RCC? Risk factors include smoking, obesity, chronic kidney disease and exposure to harmful chemicals.
- How is renal cell carcinoma diagnosed? Diagnosis includes clinical examination, laboratory tests, radiological studies and biopsy.
- What is the treatment for renal cell cancer? Treatment may include surgery, targeted and immunotherapy, and local methods.
- Can renal cell cancer be cured? The chance of recovery depends on the stage of the disease and how quickly treatment is started; early stages have a more favorable prognosis.
