Renal cell cancer

Renal cell carcinoma (RCC) is the malignancy seen most commonly in the clinical practice of nephrology. The most common subtype by far, clear cell RCC (ccRCC), is one of the relatively few malignancies that is increasing in incidence, and RCC is one of the cancers which is characterized by metabolic reprogramming, hence it is known as a metabolic disease. RCC is often asymptomatic at presentation and is commonly detected by nephrologists in the process of working up other diseases, such as acute kidney injury or obstruction, often by the observation of paraneoplastic phenomena. In addition, RCC is frequently discovered in an advanced form, such that many patients have metastases at the time of diagnosis, a finding which is associated with a markedly poor prognosis. Thus the practicing nephrologist needs at least a rudimentary understanding of this disease. In this chapter, we consider surgical, as well as medical treatment, with an emphasis on the very recent and evolving approaches from a medical, as well as surgical standpoint, including novel treatments related to immune modulation, which may soon change the landscape of treatment of this disease.