Renal cell carcinoma (RCC) is a common and lethal urologic cancer, accounting for 2-3% of all adult malignancies. RCC most often occurs in the sixth and seventh decades of life and is more common in males. While most RCCs are sporadic, 2-3% are familial. Historically, clear cell and papillary RCC were thought to arise from the proximal convoluted tubules, while chromophobe and collecting duct RCC arise from more distal regions. RCCs are often circumscribed by compressed parenchyma rather than a true capsule. Prognostic tools combining multiple factors have improved predictions for patient outcomes. Approximately one-third of RCC patients present with

2. 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

3. 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

12. Most RCCs are round to ovoid and
circumscribed by a pseudocapsule of
compressed parenchyma and fibrous
tissue rather than a true histologic
capsule.
Unlike upper tract transitional cell
carcinomas, most RCCs are not grossly
infiltrative, with the notable exception of
collecting duct RCC and some
sarcomatoid variants

30. Several investigators have now
developed tools that combine various
prognostic factors, and this has greatly
improved our predictive capacity for
patients with RCC

37. IVC involvement

41. Locally invasive RCC
Local recurrence after radical/nephron
sparing surgery
Adjuvant therapy for RCC

47. 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

51. 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).

53. Resection of Metastases

55. Palliative surgery

58. group of proteins with diverse biologic
functions,including immunomodulatory
properties[interferon alpha]
overall response rates of 16% to 26% in
patients treated with interferon-α
durable complete responses with this
agent are relatively rare (<2%)

59.  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

61. experimental

65. Antagonists of the Vascular Endothelial
growth Factor Pathway
• Bevacizumab
 High response and progession free survival in
combination of Interferon[CALGB 90206, AVOREN]

66. Sorafenib
• oral receptor kinase inhibitor with activity
against VEGFR2, PDGF receptor-β, and raf-1

68. 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

70. Pazopanib

73. temsirolimus and everolimus

75.  toxicity

76. No role

77. No role

78. mTOR
Chemotherapy-collecting duct type
Clinical trials

79. Thank you