world cancer report - iarc
world cancer report - iarc
world cancer report - iarc
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KIDNEY CANCER<br />
SUMMARY<br />
> Cancer of the kidney is the 15 th most<br />
common <strong>cancer</strong> in the <strong>world</strong> and most<br />
prevalent in developed countries. Close<br />
to 190,000 cases are diagnosed each<br />
year <strong>world</strong>wide and men are generally<br />
affected more frequently than women.<br />
> Tobacco smoking is an established<br />
cause. Excess body weight (obesity) has<br />
also been identified as a risk factor, particularly<br />
in women.<br />
> Patients with late stage diagnosis face a<br />
poor prognosis. Recent advances in<br />
imaging allow the early detection of<br />
asymptomatic tumours. The five-year<br />
survival rate is approximately 50%.<br />
Definition<br />
In adults, 85-90% of cases of kidney <strong>cancer</strong><br />
are renal cell carcinomas, a very heterogeneous<br />
group of tumours (mainly<br />
adenocarcinomas) which arise from cells<br />
of the proximal convoluted renal tubule.<br />
Transitional cell carcinoma is a less<br />
common tumour type that arises from<br />
the transitional cell epithelium in the<br />
renal pelvis, ureter and urethra. Wilms<br />
tumour (nephroblastoma) is an embryonal<br />
malignancy that afflicts 1 in 10,000<br />
children.<br />
Epidemiology<br />
The incidence of kidney <strong>cancer</strong> is considerably<br />
higher in developed countries<br />
than in less developed countries (Fig.<br />
5.142) and appears to be increasing over<br />
the past decade [1,2]. More than<br />
189,000 new cases are diagnosed <strong>world</strong>wide<br />
each year. In Western Europe, for<br />
example, kidney <strong>cancer</strong> is the sixth most<br />
frequently occurring <strong>cancer</strong>, incidence<br />
being particularly high in the Bas-Rhin<br />
region of France [3]. Incidence is also<br />
exceptionally high in the Czech Republic<br />
< 1.3<br />
< 2.1<br />
Fig. 5.142 Global burden of kidney <strong>cancer</strong> in men, showing a generally higher incidence in more developed<br />
countries.<br />
and among Scandinavian populations.<br />
Kidney <strong>cancer</strong> is relatively less common<br />
among Asian and African peoples,<br />
although renal cell carcinoma appears to<br />
be increasing in black American men [4].<br />
Men are affected by kidney <strong>cancer</strong> more<br />
than women, the sex ratio being 1.6-<br />
2.0:1 [5]. Most cases occur between<br />
ages 50-70, but kidney <strong>cancer</strong> may be<br />
diagnosed over a broad age range<br />
including young adults [1]. Wilms tumour<br />
is responsible for 5-15% of childhood<br />
<strong>cancer</strong>s, affecting females slightly more<br />
than males. This tumour occurs with<br />
highest frequency in the black population<br />
of USA and Africa, and with lowest<br />
in Eastern Asia [1]. Kidney <strong>cancer</strong> causes<br />
the deaths of more than 91,000 people<br />
each year.<br />
Etiology<br />
Kidney <strong>cancer</strong> has consistently been<br />
found to be more common in cigarette<br />
smokers than in non-smokers. The association<br />
was first established as causative for<br />
transitional cell carcinoma of the bladder<br />
< 3.6<br />
< 8.3<br />
Age-standardized incidence/100,000 population<br />
< 22.2<br />
and has now been extended to renal cell<br />
carcinomas, the risk increasing two-fold<br />
for heavy smokers [6]. An increased risk<br />
of renal cell carcinoma has been linked to<br />
obesity, particularly in women, as has<br />
diuretic therapy, again especially in<br />
women [7]. Leather tanners, shoe workers<br />
and dry cleaning employees have an<br />
increased risk as <strong>report</strong>ed in some studies,<br />
as do workers exposed to asbestos<br />
and trichloroethylene. The influence of<br />
beverages, in particular coffee and alcohol,<br />
has not been clearly determined<br />
despite many studies. Phenacetin is carcinogenic:<br />
patients with kidney damage<br />
secondary to phenacetin-containing analgesic<br />
abuse have an increased risk of transitional<br />
cell carcinoma (Medicinal drugs,<br />
p48). Patients with multicystic kidney disease<br />
consequent on long-term dialysis,<br />
adult polycystic kidney disease and tuberous<br />
sclerosis also have an increased<br />
propensity to develop renal cell carcinoma<br />
and von Hippel-Lindau disease, an autosomal<br />
dominant condition, is a predisposing<br />
factor.<br />
Kidney <strong>cancer</strong><br />
261