Renal cell carcinoma: current status and future prospects.

The incidence of renal cell carcinoma (RCC) is increasing. Despite improvements in the management of localized RCC, most patients are diagnosed with advanced RCC, which is often refractory and associated with a poor prognosis. Although surgery is the only curative treatment for localized RCC, improved diagnostic methods facilitating early detection and characterization of renal tumors have enabled more effective use of less invasive treatments. Adrenal-sparing radical total nephrectomy, and laparoscopic radical and total nephrectomy are increasingly being performed in preference to radical nephrectomy. However, standard treatments for advanced RCC are largely unsuccessful. Radiotherapy is often used to control symptoms associated with RCC in patients unsuitable for surgery. Immunotherapy with cytokines is the standard systemic treatment for advanced RCC, and is associated with prolonged survival in a subset of patients, but is generally poorly tolerated. An increased knowledge of the underlying pathophysiology of RCC has resulted in the identification of molecular pathways involved in tumor growth. Promising new agents designed to target these pathways are in development.