Epidemiology, diagnosis, and surgical treatment of renal cell carcinoma

Renal tumors make up about 3-4 % of all malignant tumors of the adults, and approximately 80-90 % of all malignant tumors of the kidney are renal cell carcinomas. Sonography is the leading examination for early detection of kidney tumors. The treatment of renal cell carcinoma has been enriched in recent years by new therapeutic options for localized and metastatic cancer. The classification of renal cell carcinoma is based on TNM and UICC criteria. The current standard medicinal therapy includes the use of tyrosine kinase inhibitors, antiangiogenic substances, such as VEGF receptor antagonists (VEGF: vascular endothelial growth factor) or mTOR inhibitors (mTOR: mammalian target of rapamycin). Improvement in clinical response is to be expected when surgical tumor debulking by nephrectomy or metastasectomy is performed before systemic therapy is started and should be considered especially in patients with a good performance status. In addition, complete resection of solitary or at least a limited number of metastases can potentially be done with curative intent. At the time of diagnosis, 25-30 % of all patients with renal cell carcinoma already present with metastatic disease. Furthermore, 20-30 % of patients with renal cell carcinoma will have progressive disease despite radical nephrectomy with complete tumor resection. Metastatic renal cell carcinoma has a poor prognosis with a median overall survival rate of approximately 2 years.