Cancer Of The Kidney: Natural History And Staging

Abstract

In the first article of Volume 74 of the British Journal of Surgery, a brief discussion of spontaneous regression of metastatic renal carcinoma is presented in which the author raises several questions about the phenomenon of spontaneous regression of tumours: Do the cases reported in the literature conclusively demonstrate that regression can occur? What is the mechanism for such regression? Could this mechanism be exploited in the treatment of cancer? What bearing does spontaneous regression have on the management of the condition and in particular should its possibility be borne in mind when treating a patient with an advanced renal tumour? What is clear about renal carcinoma is the unpredictability of its behaviour. The author has a patient under his care who is alive and well over two and a half years after the diagnosis of pulmonary metastases from a renal tumour removed six months earlier. Prolonged survival can also occur in patients in whom the primary tumour is not removed. Idiopathic regression perhaps represents one further stage towards this end of the spectrum, a spectrum which unfortunately has at its other end the patient who dies within months of the removal of an apparently localized tumour.