Kidney cancer, the majority of which is renal cell carcinoma (RCC), accounts for about 2% of all cancers worldwide, although the incidence rates vary over three fold with the highest rates in Northern Europe and the lowest rates in Asia. The incidence of RCC has been increasing in many populations, partly due to the increased detection of asymptomatic tumours but the mortality rates have also increased in most Western populations, suggesting that exposure to environmental risk factors associated with an affluent lifestyle are important in the aetiology and pathogenesis of disease. The natural history of untreated disease is to invade locally, infiltrate into the venous circulation and to metastasise to lymph nodes and distant organs, especially the lung. Surgical intervention, employing a variety of techniques, has the potential to improve survival but renal cell cancer is a tumour that rarely responds to chemotherapy or hormone therapy and more recent approaches have focused preferentially on immunotherapy, in particular the use of interferon-alpha and interleukin-2, although patients who are unfit and who have rapidly progressing tumours do not usually benefit. The development of novel approaches to therapy, including selective cytokine inhibitory drugs (SelCIDs) and immunomodulatory drugs (IMiDs) as well as cancer vaccine strategies and allogeneic bone marrow transplantation may come to represent valuable new approaches to the management of the disease.
The current volume has been prepared in the manner of a major, comprehensive and authoritative review of our current knowledge of renal cell carcinoma and its treatment. Part One of the volume is dedicated, through Chapters 1, 2 & 3, to in-depth reviews of the epidemiology of disease, the identification of the individual at risk and the natural history of RCC and Part Two, in Chapters 4 & 5, with histopathology and imaging services. Part Three, in Chapters 6, 7 & 8, is concerned to review the evidence base for surgical intervention in RCC through a review of the use of conventional approaches, nephron-sparing surgery and laparascopic techniques with Part Four, in Chapters 9-12, providing highly detailed documentations of the evidence and opinion base for medical intervention in the management of the disease and the use of prognostic factors in clinical decision making. The management of metastatic disease is considered in particular detail within Chapters 13 & 14 which constitute Part Five of the text and in Part 6, through Chapters 15 & 16, issues of clinical governance are reviewed through a consideration of models for clinical audit and the availability to patients of cancer information resources.