Kidney Cancer: Epidemiology and Pathogenesis: Difference between revisions
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== Epidemiology == | == Epidemiology == | ||
=== Incidence & Mortality === | |||
* Many databases include upper tract urothelial carcinoma with kidney cancer and therefore independent incidence of kidney cancer cannot be assessed | |||
** [https://pubmed.ncbi.nlm.nih.gov/33538338/ 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[https://pubmed.ncbi.nlm.nih.gov/33433946/]) | |||
** Includes renal pelvis cancers | |||
** Estimated mortality 13,780 | |||
** Estimated incidence 76,080 | |||
* Canada (2020[https://pubmed.ncbi.nlm.nih.gov/32122974/]) | |||
** 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[https://pubmed.ncbi.nlm.nih.gov/33433946/]: | |||
** Localized: 93% | |||
** Regional: 70% | |||
** Distant: 13% | |||
** All stages: 75% | |||
* Most lethal of all GU malignancies | |||
** 5-year relative survival all stages for[https://pubmed.ncbi.nlm.nih.gov/33433946/]: | |||
*** Prostate cancer: 98% | |||
*** Bladder: 77% | |||
* Survival has been increasing (≈1% year since 2004) | |||
=== '''<span style="color:#ff0000">Gender</span>''' === | |||
* '''<span style="color:#ff0000">M:F 3:2</span>''' | |||
** 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 == | == Pathogenesis == |
Revision as of 10:11, 5 April 2022
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[1])
- Includes renal pelvis cancers
- Estimated mortality 13,780
- Estimated incidence 76,080
- Canada (2020[2])
- 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
- Increased use of diagnostic imaging
Survival
- 5-year relative survival (survival relative to population without disease) based on disease stage at diagnosis[3]:
- Localized: 93%
- Regional: 70%
- Distant: 13%
- All stages: 75%
- Most lethal of all GU malignancies
- 5-year relative survival all stages for[4]:
- Prostate cancer: 98%
- Bladder: 77%
- 5-year relative survival all stages for[4]:
- 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
- RCC in children and young adults is more likely to be symptomatic, locally advanced, high grade, and of unfavorable histologic subtypes.
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[5]
- 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.
- Controversial; however, patients on maintenance dialysis also are reported to have an increased risk
- Obesity
- 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.