About Renal Cell Carcinoma

Transcription

1 Renal Cell Carcinoma Incidence and Prevalence Kidney Cancer Prevalence Worldwide ESTIMATED 2012 CASES Less than 50,000 ASIA 123,402 AFRICA 10,033 SOUTH AMERICA 15,661 Renal cell carcinoma, or RCC, is the most common type of kidney cancer, accounting for about nine out of 10 kidney cancers in the United States. 100,001150,000 EUROPE 115,252 NORTH AMERICA 63,822 CENTRAL AMERICA 4,492 50,000100,000 OCEANIA 4,168 Kidney cancer is the 13th most common cancer worldwide with approximately 338,000 in Incidence rates vary substantially worldwide with generally high ratesin Europe, North America and Western Pacific regions. Five-year survival rate for kidney cancer that has spread beyond the kidney (Stage IV) is only eight percent in the United States and 10 percent in the UK. In the United States, there are approximately 62,000 new and about 4,000 deaths from RCC estimated in Europe: Europe: 115,252 in Asia: 123,402 in Figure 1: Renal Cell Carcinoma Adapted from Medscape.com ONCUS /15

2 Typically, RCC forms as a single tumor in the kidney, but more than one tumor may grow in one or both kidneys. There are several subtypes of RCC including: Clear cell renal cell carcinoma (Figure 2) the most common type of RCC, accounting for about 7 out of 10 patients; when viewed under a microscope, the cancer cells appear clear. Papillary renal cell carcinoma (Figure 3) approximately 10 percent of people with RCC have this type of disease; when viewed under a microscope, the cancer cells appear pink and finger-like. Chromophobe renal cell carcinoma (Figure 4) fewer people with RCC have this type of the disease (about 5 in 100 patients); when viewed under a microscope, the cancer cells look like clear cell RCC but larger. The remaining subtypes are very rare, each making up less than 1% of RCCs: Collecting duct RCC Multilocular cystic RCC Medullary carcinoma Mucinous tubular and spindle cell carcinoma Neuroblastoma-associated RCC Though unlikely, the disease can also be labeled as unclassified renal cell carcinoma if the characteristics of the cancer cells do not fit within the above descriptions. Symptoms The most common signs of RCC are: X Blood in the urine (hematuria) X Low back pain on one side (not caused by injury) X A mass or lump on the side or lower back X Fatigue X Weight loss and loss of appetite (not caused by dieting) X Fever that is not caused by an infection and that doesn t go away X Anemia Figure 2: Clear Cell Renal Cell Carcinoma Figure 3: Papillary Renal Cell Carcinoma Figure 4: Chromophobe Renal Cell Carcinoma

3 If a patient has signs or symptoms that suggest they might have RCC, their doctor will want to take a complete medical history to check for risk factors and symptoms. Additional tests may be used to determine if kidney cancer is present in the body, including: Ultrasound or ultrasonography utilizes sound waves to create images of internal organs, like the kidney, and can be used to determine if a mass is solid or filled with fluid. Computed tomography (CT or CAT) scan this x-ray scan produces detailed images of the body and can be used to find and look at a tumor inside the kidney. It can even provide information about the size, shape and position of a tumor. Magnetic resonance imaging (MRI) an MRI can provide a detailed image of parts of the body by using radio waves and strong magnets. Generally, these are used less often than CT scans to diagnose kidney cancer. Positron emission tomography (PET) scan a PET scan can help doctors identify cancer cells and may also be useful in determining if cancer has spread from the kidney to other parts of the body. Being aware of the subtype of RCC can be a large factor in deciding treatment and can also help your doctor determine if your cancer might be due to an inherited genetic syndrome. When it comes to staging for RCC, the TNM system (Tumor, Node, Metastasis) is one of the most widely used systems. The system is based on the size and/or extent (reach) of the primary tumor (T), the amount of spread to nearby lymph nodes (N), and the presence of metastasis (M). A number is added to each letter to indicate the severity of the disease. Risk Factors There are a number of factors that may increase a person s likelihood of developing RCC, such as: X Smoking increased risk appears to be related to how much a person smokes X Obesity obesity may cause changes in certain hormones that can lead to RCC X Exposure to certain substances such as asbestos, the metal cadmium and some herbicides X Family history of kidney cancer; certain genetic conditions X High blood pressure X Gender Men are twice as likely to develop RCC as women X Advanced Kidney Diseaseespecially patients needing dialysis X Race African Americans and American Indians/ Alaska natives are at a higher risk than whites

4 Stage grouping Once the T, N, and M categories have been assigned, this information is combined to assign an overall stage of I, II, III, or IV. The stages identify cancers that have a similar prognosis and are treated in a similar way. Patients with lower stage numbers tend to have a better prognosis. Stage I: T1, N0, M0 The tumor is 7 cm across or smaller and is only in the kidney (T1). There is no spread to lymph nodes (N0) or distant organs (M0). Stage II: T2, N0, M0 The tumor is larger than 7 cm across but is still only in the kidney (T2). There is no spread to lymph nodes (N0) or distant organs (M0). Stage III: Either of the following: T3, N0, M0: The tumor is growing into a major vein (like the renal vein or the vena cava) or into tissue around the kidney, but it is not growing into the adrenal gland or beyond Gerota s fascia (T3). There is no spread to lymph nodes (N0) or distant organs (M0). T1 to T3, N1, M0: The main tumor can be any size and may be outside the kidney, but it has not spread beyond Gerota s fascia. The cancer has spread to nearby lymph nodes (N1) but has not spread to distant lymph nodes or other organs (M0). Stage IV: Either of the following: T4, any N, M0: The main tumor is growing beyond Gerota s fascia and may be growing into the adrenal gland on top of the kidney (T4). It may or may not have spread to nearby lymph nodes (any N). It has not spread to distant lymph nodes or other organs (M0). Any T, Any N, M1: The main tumor can be any size and may have grown outside the kidney (any T). Figure 5: Stages of RCC Adapted from Urologist.com Stage I: T1, N0, M0 Stage II: T2, N0, M0 It may or may not have spread to nearby lymph nodes (any N). It has spread to distant lymph nodes and/or other organs (M1). Life expectancy following diagnosis of advanced RCC is less than one year. Stages of RCC Stage T N M I T1 NO MO II T2 NO MO T1-3 N1 MO III T3 NO-1 MO T4 Any N MO IV Any T Any N M1 Stage III: T3, N0, M0 or T1 to T3, N1, M0 Stage IV: T4, any N, M0

5 Current Treatment Landscape Though new types of treatment are being tested in clinical trials, there are currently five types of standard treatment used. Targeted therapy This type of treatment uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Radiation therapy Uses radiation or x-rays to kill cancer cells or stunt their growth. Chemotherapy Uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Biologic therapy Uses the immune system to fight cancer; substances made by the body or made in a laboratory are used to boost, direct, or restore the body s natural defenses against cancer. Surgery There are multiple surgical options for RCC treatment including: Partial nephrectomy: Removes the cancer within the kidney and some of the tissue around it. Simple nephrectomy: Removes the kidney only. Radical nephrectomy: Removes the kidney, the adrenal gland, surrounding tissue, and, usually, nearby lymph nodes. Economic Burden The impact of renal cell carcinoma on a patient s life can be costly. In select countries worldwide, the estimated economic burden of RCC is $446 million $1.6 billion.

6 Resources to learn more about Renal Cell Carcinoma Cancer Care International Kidney Cancer Coalition Cancer Support Community International Society of Nurses Cancer Care Stupid Cancer Cancer Research Institute Union for International Cancer Control