Author:
Burgess Earle F.,Riggs Stephen B.,Rini Brian I.,Raghavan Derek
Abstract
OverviewRenal cell carcinoma occurs in 64,000 new patients each year in the United States and results in about 14,000 deaths. For localized disease, cure is achieved by nephrectomy. Meticulous surgical staging is crucial. With improved imaging techniques, active surveillance has become an option for small, asymptomatic renal masses. Modifications in surgical technique, including laparoscopic and robotic approaches, have contributed to reduced morbidity. In more advanced disease, with locoregional or metastatic spread, immune response is a governor of outcome and survival, and immune modulation via interleukin‐2 or PDL‐1 inhibition results in sustained responses. Cytotoxic chemotherapy has negligible activity, but targeted therapies, such as tyrosine kinase and mammalian target of rapamycin inhibitors, often cause dramatic regressions. Uncommon cancers of the kidney represent about 10% of incident cases, and a general approach to their management is reviewed in this chapter.