KIDNEY CANCER:EPIDEMIOLOGY AND TREATMENT

After more than two decades of rising rates, in recent years the total kidney cancer incidence worldwide has shown signs of stabilizing,or even decreasing. In adults, kidney cancer consists of renal cell carcinoma (RCC), the predominant form, and renal transitional cell carcinoma (RTCC); these types primarily arise in the renal parenchyma and renal pelvis.The number of new cases of renal cell carcinoma has been steadily increasing since the 1965s, reaching 65,000 and 92,000 annually in the United States and Europe, respectively, in 2017. The current standard of care for early-stage disease is nephron-sparing surgery, which has a demonstrated long-term disease-free survival and an acceptable safety profile.Technical developments (thin, powerful probes and real-time image guidance systems) have allowed image-guided percutaneous ablation to become a viable option for stage I renal cell carcinoma. All 3 ablative modalities (radiofrequency ablation, microwave ablation, and cryoablation) have been extensively applied. The utilization of ablation was initially hampered by the lack of prospective, long-term oncologic data. As a result, ablation was reserved for specific subgroups of patients, for example, patients with solitary kidney, chronic kidney disease; poor surgical candidates; or patients with syndromes that predispose them to renal cell cancer. Recently, however, studies on percutaneous ablation for early-stage renal cancer have yielded prospective, long-term oncologic data, affirming the earlier, lower-level-evidence studies. In conclusion, image-guided percutaneous ablation should be considered a viable, curative option for stage IA renal cell carcinoma