Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

Renal cell carcinoma
J.N. Eble
K. Togashi
P. Pisani
Definition
Renal cell carcinoma is a group of malignancies
arising from the epithelium of the
renal tubules.
Epidemiology of renal cell cancer
Renal cell cancer (RCC) represents on
average over 90% of all malignancies of
the kidney that occur in adults in both
sexes. Overall it is the 12th most common
site in men and 17th in women. In
males living in industrialized areas
including Japan, it is as common as non-
Hodgkin lymphoma ranking 6th, while in
less developed areas it ranks 16th, in the
same order of magnitude as carcinoma
of the nasopharynx. In women it ranks
12th and 17th in developed and developing
countries respectively {749}. The
incidence is low in the African and Asian
continents but not in Latin America where
around 1995 Uruguay recorded one of
the highest rates in the world. The highest
rates in both men and women were
observed in the Czech Republic with 20
and 10 annual new cases per 100,000
population respectively, age standardized
{2016}. The lowest rates recorded
were less that 1 new case per 100,000
showing a 10-fold variation in the risk of
the disease. The latest systematic analyses
of time trends of the incidence of kidney
cancer indicate a general increase in
both sexes in all monitored regions, up
until the mid-80s {481}. These trends
were paralleled by mortality, which thereafter
began to slow down or even fall in
some high risk countries {2843}. After the
low peak in children due to nephroblastoma,
the incidence of renal cell cancer
increases steadily after age 40 years as
most epithelial tumours but the risk levels
off or even declines from age 75 in both
sexes. It is two to three times more common
in men than in women in both high
and low risk countries {2016}.
Etiology
Tobacco smoking is a major cause of kidney
cancer and accounts for at least
39% of all cases in males {2015}.
Exposure to carcinogenic arsenic compounds
in industrial processes or
through drinking water increases the risk
of renal cancer by 30% {1150}. Several
other environmental chemicals have
been addressed as possible carcinogens
for the kidney but definitive evidence
has not been established. These
include asbestos, cadmium, some
organic solvents, pesticides and fungal
toxins. Some steroidal estrogens and the
nonsteroidal diethylstilboestrol induce
tumours in hamster {1150,1154}, but to
date an excess has not been reported in
exposed humans. Estrogens could be
Males
involved in the mechanism that induces
RCC in overweight and obese individuals.
Several epidemiological studies both
prospective and retrospective, conducted
in many different populations have
established that the risk of kidney cancer
increases steadily with increasing body
mass index (BMI), the most common
measure of overweight {1156}. The incidence
of RCC in obese people (BMI>29
kg/m 2 ) is double that of normal individuals
and about 50% increased if overweight
(BMI 25-30 kg/m 2 ) {221}. The
same authors estimated that in Europe
Females
Fig. 1.01 Estimates of the age-standardized incidence rates of kidney cancer, adjusted to the world standard
age distribution (ASR). From Globocan 2000 {749}.
12 Tumours of the kidney