Guidelines on Renal Cell Cancer

Objectives: On behalf of the European Association of Urology (EAU), Guidelines for Diagnosis, Therapy and Follow–Up of Renal Cell Carcinoma Patients were established. Criteria for recommendations were evidence based and included aspects of cost–effectiveness and clinical feasibility. Method: A systematic literature research using Medline Services was conducted. References were weighted by a panel of experts on renal cell carcinoma (RCC). Results: RCC is characterised by a constant rise in incidence over the last 50 years, with a predominance of men over women and an incidence peak in the 6th and 7th decade. There is no risk factor established and the current TNM system (UICC, 1997) is endorsed for staging purposes. Clinical signs and symptoms of RCC are becoming less frequent, incidental discovery constitutes already a majority of cases. Diagnosis is established by ultrasound and abdominal CT, extension assessment in routine cases is done by chest X–ray. Additional examinations may be required in select cases. The therapy of choice in organ–confined RCC is surgery. Radical tumour nephrectomy is considered as a standard. Efficacy and side–effects of organ–sparing surgery, lymphadenectomy and inclusion/omission of ipsilateral adrenalectomy in selected cases is a matter of ongoing clinical research. In metastatic cases, tumour nephrectomy should only be considered in the context of modern systemic immunotherapy. A follow–up at regular intervals is recommended because certain cases of recurrences may be candidates for surgery and/or immunomodulating therapy. Conclusion: A rise in incidence, improved diagnostic procedures, and evolving multimodality therapeutic concepts justify the need for rational guidelines on this most challenging urologic malignancy.