Kidney cancer. Principles and practice. Second edition. Primo N. Lara, Jr. Eric Jonasch (Editors). Springer International Publishing (2015)

Renal cell carcinoma incidence has continued to increase over several decades among all racial groups. This has been in the context of widespread use of diagnostic imaging and increasing prevalence of risk factors leading to the diagnosis of smaller tumors and localized disease. Cigarette smoking, excess body weight leading to increased BMI, and hypertension are established modifiable risk factors of RCC and have likely contributed to the increasing prevalence of RCC in both sexes. The variation in the prevalence of these factors across subpopulations may explain the racial and geographic variation in RCC incidence observed, not only in the United States but worldwide. These risk factors may contribute to as much as 50% of all RCC cases and are targets for preventative strategies in reducing RCC incidence. The relative contribution of other risk factors such as occupational and environmental exposures, hormonal factors, and dietary considerations are not as clearly elucidated. While only a small proportion of renal cell carcinoma occur within the milieu of familial cancer syndromes, genetic susceptibility and its interplay with environmental exposures play an important role in the etiology and development of sporadic renal cell carcinoma. Genetic polymorphisms may modulate an effect on metabolic activation and detoxification enzymes, which will allow improved analysis and interpretation of exposure associations that are important in the initiation and progression of RCC. The multifactorial nature of RCC requires that further studies are conducted to explain underlying factors that may influence individual risk and to elucidate complex relationships between potential genetic, lifestyle, and environmental elements on cancer development.

Due to the advances in the molecular and genetic biology of renal cell carcinoma, a paradigm shift has occurred in the treatment of patients with advanced renal cell carcinoma. Advances in the molecular genetics of RCC syndromes have allowed earlier genetic testing leading to improvements in detection, surgical interventions, and therapeutic approaches. The development of targeted therapies involving the VEGF and mTOR pathway in renal cell carcinoma has drastically improved the survival and outcomes of patients afflicted with this malignancy.

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