Editing Kidney Cancer: Epidemiology and Pathogenesis

== Epidemiology ==

* Incidence & Mortality
** Many databases include upper tract urothelial carcinoma with kidney cancer and therefore independent incidence of kidney cancer cannot be assessed
*** GLOBOCAN includes ICD-9 C65 - "Malignant neoplasm of renal pelvis" with kidney cancer
** Incidence rates are higher in developed countries
*** Likely due to increased use of diagnostic imaging
** USA (2021)
*** Includes renal pelvis cancers
*** Estimated mortality 13,780
*** Estimated incidence 76,080
** Canada (2020)
*** Includes renal pelvis cancers
*** Estimated incidence 7,500
**** 10th most commonly diagnosed cancer in Canada
** Incidence has been increasing due to (2):
**# Increased use of diagnostic imaging
**#* Greatest increase has been in small, clinically localized renal amsses which now represent > 40% of incident tumours.
**# Increased prevalence of risk factors (e.g. obesity), see below
* Survival
** 5-year relative survival (survival relative to population without disease) based on disease stage at diagnosis§:
*** Localized: 93%
*** Regional: 70%
*** Distant: 13%
*** All stages: 75%
** Most lethal of all GU malignancies
*** 5-year relative survival all stages for§:
**** Prostate cancer: 98%
**** Bladder: 77%
** Survival has been increasing (≈1% year since 2004)
* '''Gender'''
** '''M:F 3:2'''
*** Overall mortality worse in males
* Age
** Typical presentation between age 50-70; median age at diagnosis: 64
*** '''RCC in children and young adults is more likely to be symptomatic, locally advanced, high grade, and of unfavorable histologic subtypes.'''
**** Children and young adults may respond better to surgical therapy and aggressive approach and formal lymphadenectomy has been recommended at the time of radical nephrectomy
* Race
** More common in African Americans, American Indian, and Alaska Native populations than Caucasians

== Pathogenesis ==

* '''Majority of cases are believed to be sporadic'''
* '''Established risk factors (5):'''
*# '''Obesity'''
*#* Accounts for ≈30% of incident cases
*#* Obese patients are more likely to develop RCC but these tumours are more likely to be low-grade, early stage tumours
*# '''Smoking'''
*#* Accounts for ≈20% of incident cases
*# '''Hypertension'''
*# '''Familial syndromes'''
*#* '''Accounts for ≈4-6% of incident cases§'''
*# '''Chronic renal failure'''
*** '''Controversial;''' however, patients on maintenance dialysis also are reported to have an increased risk
**** It has been suggested to delay screening for kidney cancer in patients on dialysis and without other major comorbidities until the 3rd year on dialysis.
* '''Other risk factors (5):'''
*# '''Family history of renal malignancy (without familial syndrome)'''
*# '''Exposure to chlorinated solvents'''
*# '''Retroperitoneal radiation'''
*# '''Diet'''
*#* '''Moderate alcohol intake, consumption of fruits and (cruciferous) vegetables, and a diet rich in fatty fish are believed to reduce the risk of RCC'''
*# '''Acquired cystic renal disease'''
* '''No increased risk of RCC in patients with autosomal dominant polycystic kidney disease'''

== Questions ==

# What proportion of RCCs are familial?
# What are the risk factors for RCC?

== Answers ==

# What proportion of RCCs are familial?
#* ≈4-6%
# What are the established risk factors for RCC?

## Obesity
## Hypertension
## Smoking
## Acquired cystic disease
## Familial syndrome

== Next Chapter: Pathology and Familial Syndromes ==

== References ==

* Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds): CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier, 2015, chap 57
* Campbell, Steven C., et al. "Renal Mass and Localized Renal Cancer: Evaluation, Management, and Follow-Up: AUA Guideline Part I." ''The Journal of urology'' (2021): 10-1097.