The CancerWeb Report, What's New In Cancer: October, 1996
Kidney Cancer

• An update on renal-cell cancer - The September 19, 1996 issue of the New England Journal of Medicine included an overview of renal-cell cancer by Dr. Robert Motzer and colleagues at the Memorial Sloan-Kettering Cancer Center, New York. Renal-cell cancer originates in the outer part (cortex) of the kidney and accounts for 80-85% of kidney cancers. Although there are rare family predispositions to renal-cell cancer, such as Von Hippel-Lindau disease, which carries a 40% incidence of the cancer, there does not generally seem to be any inherited pattern. Small local tumors do not generally produce any symptoms. Therefore, the disease is usually advanced when it is diagnosed by work-up for the common symptoms of blood in the urine, pain in the abdomen, or a mass that can be felt in the abdomen or flank. Other less frequent complaints are night sweats, fever, weight loss, general malaise, and a testicular problem (varicocele). The nature and extent of the tumor are usually defined by CT scans, ultrasonography, intravenous urography, and arteriography (in connection with nephron-sparing surgery). Treatment is by removal of the affected kidney, kidney fat, and nearby lymph nodes and adrenal gland (radical nephrectomy), but when scans show it is feasible, more limited surgery is performed, including nephron-sparing partial nephrectomy. Sometimes the tumor actually invades the vein from the kidney (renal vein) and the main vein returning blood to the heart, the vena cava. When metastases are present the outlook is poor, except for when there is just one solitary metastasis. Chemotherapy and hormonal therapy are ineffective. Since the cancer sometimes regresses spontaneously, and in many patients may be stable for long periods, it is assumed that there is an immunological controlling process at work. This has encouraged the use of immune therapy approaches, including interferons and interleukin-2, which give significant numbers (12-20%) of sometimes dramatic responses. However, most patients do not respond, and the search for effective treatments continues, with emphasis on new combinations involving 5-fluorouracil, interferons, interleukin-2, retinoids, and lymphocytes primed to attack the tumor. (Motzer, NEJ Med 335:865, 1996)