Renal cell carcinoma

Abstract

The global incidence of cases of kidney cancer has increased rapidly, and a relatively high incidence of kidney cancer has been reported in developed countries such as Northern and Eastern Europe. Various factors can affect the incidence and mortality of kidney cancer, including demographic risk factors, lifestyle factors, iatrogenic risk factors, nutritional factors and diet, occupation, and genetic factors. Renal cell carcinoma (RCC) refers to a tumor group with heterogeneity derived from renal tubular cells, which form almost all kidney cancer types. Clear cell RCC (ccRCC) is the most frequent renal tumor subtype, accounting for 75% of renal cancer, followed by papillar RCC(pRCC) making up approximately 10% of RCC. Hematoxylin-eosin staining shows a clear, eosinophilic cytoplasm in ccRCC cells. Epithelial cells forming the papillae and tubules have pRCC histological characteristics. Traditionally, genetic mutations of VHL and MET are the genetic features in ccRCC and pRCC, respectively. Recently, a new concept supports the contribution of mutations in some chromatin-modifier genes, including polybromo 1 (PBRM1), SET domain containing 2 (SETD2), BRCA1-associated protein-1 (BAP1), and lysine (K)-specific demethylase 5C (KDM5C). The metabolic disease concept in renal cancer is noted by researchers worldwide. The PD-1 pathway has been valued by researchers of kidney cancer in recent years, and new agents, such as anti-PD-1 monoclonal antibodies (nivolumab and pembrolizumab) and CTLA4 inhibitors (Ipilimumab), have been approved to treat advanced RCC. Partial nephrectomy (PN) and radical nephrectomy (RN) remain the standard management option for local RCC with a stage of T1 and T2, respectively. PN can also be selected for T2 stage RCC in suitable cases. Even though targeted therapy consisting of mainly the anti-VEGF and anti-mTOR pathways is recommended as the first-line and second-line treatment for RCC, the effectiveness and side effect of these therapies should be improved in future research.