2% to 3% of all adult malignant neoplasms

Most lethal of the common urologic

cancers.

12 new cases per 100000 population

male-to-female predominance of 3 : 2

sixth and seventh decades of life

Majority sporadic- 2%to 3 % familial

traditionally thought to arise primarily

from the proximal convoluted tubules,

and this is probably true for the clear

cell and papillary variants.

chromophobe and collecting duct RCC,

are derived from the more distal

components of the nephron

Most RCCs are round to ovoid and circumscribed by a pseudocapsule of compressed parenchyma and fibrous tissue rather than a true histologiccapsule.

Unlike upper tract transitional cell carcinomas, most RCCs are not grossly infiltrative, with the notable exception of collecting duct RCC and some sarcomatoid variants

Several investigators have now

developed tools that combine various

prognostic factors, and this has greatly

improved our predictive capacity for

patients with RCC

IVC involvement

Locally invasive RCC

Local recurrence after radical/nephron

sparing surgery

Adjuvant therapy for RCC

Approximately one third of all newly

diagnosed RCC patients present with

synchronous metastatic disease

20% to 40% of patients with clinically

localized disease at diagnosis will

eventually develop metastases

Debulking or Cytoreductive

Nephrectomy in Patients with

Metastatic RCC• two randomized phase III studies conducted

by the Southwest Oncology Group (SWOG)

and the European Organization for Research

and Treatment of Cancer (EORTC).

Resection of Metastases

Palliative surgery

group of proteins with diverse biologic

functions,including immunomodulatory

properties[interferon alpha]

overall response rates of 16% to 26% in

patients treated with interferon-αdurable complete responses with this

agent are relatively rare (<2%)

response rates in the range of 15% to 20%7% to 9% of patients receiving high-dose

IL-2 are reported to have achieved complete regression of all metastatic tumor

combination of IL-2 and interferon resulted in a higher response rate (18.6%) and 1-year event-free survival (EFS 20%)

No survival benefit

experimental

Antagonists of the Vascular Endothelial

growth Factor Pathway• Bevacizumab

High response and progession free survival in

combination of Interferon[CALGB 90206, AVOREN]

Sorafenib• oral receptor kinase inhibitor with activity

against VEGFR2, PDGF receptor-β, and raf-1

Sunitinib• Tyrosine kinase inhibitor

• potent inhibitor of VEGFR2, PDGFR-β, c-KIT,

and fms-like tyrosine kinase-3.

• most widely used oral VEGFR kinase inhibitor

in the initial treatment of metastatic clear cell

RCC

Pazopanib

temsirolimus and everolimus

toxicity

No role

No role

mTOR

Chemotherapy-collecting duct type

Clinical trials

Thank you