There is a growing recognition of the complex interplay between renal cell cancer (RCC), kidney function and mechanical reduction of nephron mass and systemic agents targeting the cancer. Earlier detection of RCC and rising life expectancy of cancer survivors places a greater emphasis on preservation of renal function after cancer resection and during systemic therapy. Unique adverse effects associated with RCC drugs not only help reveal cancer pathophysiology but also expand our knowledge of normal cell signaling and metabolism. In this review, we outline our current understanding of RCC biology and treatment, their bidirectional relationship with kidney function, and unmet research needs in this field.

Renal Cell Carcinoma (RCC) is the most common malignancy originating in the kidney and the most lethal genitourinary cancer. It has been classically characterized by an asymptomatic disease course, with a late and highly variable presentation portending a poor survival prognosis. Although its management in the past involved primarily urologists and oncologists, more recently, changing trends in RCC epidemiology, new therapeutic options, and overall improvement in patients’ life expectancy has drawn in nephrologists in a multidisciplinary approach to this disease and generated interest in the emerging field of once-nephrology.

Kidney cancer is cancer that begins in the kidneys. Your kidneys are two bean-shaped organs, each about the size of your fist. They're located behind your abdominal organs, with one kidney on each side of your spine. In adults, renal cell carcinoma is the most common type of kidney cancer. Other less common types of kidney cancer can occur. Young children are more likely to develop a kind of kidney cancer called Wilms' tumor.

The incidence of kidney cancer seems to be increasing. One reason for this may be the fact that imaging techniques such as computerized tomography (CT) scans are being used more often. These tests may lead to the accidental discovery of more kidney cancers. Kidney cancer is often discovered at an early stage, when the cancer is small and confined to the kidney.

Kidney cancer is one of the 10 most common cancers in the United States with 90% being attributed to renal cell carcinoma. Men, especially black men, are more likely to be affected than women. Renal masses, either cystic or solid, are best detected with contrast-enhanced, triple-phase computed tomography. Renal tumors are often detected incidentally during a computed tomography scan of the abdomen or chest that was ordered for unrelated symptoms. Hematuria serves as a warning sign that necessitates further evaluation and imaging leading to a diagnosis and treatment plan.

Significant stage migration of RCC at presentation due to earlier detection of smaller renal masses and greater life expectancy with novel treatment strategies associated with unique adverse effects offer fertile ground for research aimed at improving patient survival and understanding the molecular biology of RCC. Increased levels of markers of programmed cell death or altered angiogenesis such as cytokeratin’s or (PHD3) antibodies, respectively, have been detected in the serum of RCC patients.

 Journal of Nephrology and Urology is an Open Access peer-reviewed publication that discusses current research and advancements in diagnosis and management of kidney disorders as well as related epidemiology, pathophysiology and molecular genetics.

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Regards
Mercy Eleanor
Editorial Assistant
Journal of Nephrology and Urology