By Dr Foo Yoke Ching

Non-specific symptoms in the early stages of renal cell carcinoma (RCC) result in one-third to half of Malaysian patients presenting in the advanced stage, says a consultant oncologist.

Patients who have the classic triad of symptoms for RCC ie, blood in the urine, pain in the flank and lump in the stomach, concurrently only account for about 10 percent of the patient population, said Dr. Foo Yoke Ching, a council member of the Malaysian Oncological Society.

“Some patients may have persistent stomach ache and they consult their doctor when the pain becomes severe and the mass is palpable. By then the cancer is in the advanced stage. The majority of patients may present with blood in their urine,” she said.

In Malaysia, RCC ranks 17^th among men and 20^th among women, and the incidence rises in both genders from 40 years onwards. It is most common among the Chinese, followed by Indians and Malays, she added.

The cause is unknown in the majority of cases, but risk factors for RCC include cigarette smoking, which is the most important risk factor and accounts for one-third of cases, obesity, hypertension, acquired cystic disease of the kidney, occupational hazards (exposure to asbestos and petroleum products) and genetic factors, said Foo.

She added that although RCC is not the most common cancer, it has a negative impact on public health due to the poor survival rate in advanced stages. (Table 1)

For localized disease, surgery is the mainstay of treatment. In advanced disease, it was previously immunotherapy, while in some patients, surgery was advised. “Chemotherapy has little benefit because RCC is a chemo-resistant disease,” said Foo.

Today, oncologists are turning to targeted therapy of faulty genes or proteins that contribute to cancer growth and development without harming normal cells. RCC patients commonly have inactivation of the von Hippel-Lindau (VHL) gene, which leads to over-expression of hypoxia-inducible factor (HIF)-1α. Accumulation of HIF-1α leads to the production of growth factors that stimulate the growth of blood vessels, said Foo.

Targeted agents include bevacizumab, sunitinib, sorafenib, everolimus and temsirolimus. Phase III studies of these targeted agents have shown doubling of time to cancer progression and improvement in treatment response rates, said Foo. She was speaking at a press conference to launch everolimus in Malaysia for the treatment of advanced RCC after failed vascular endothelial growth factor (VEGF)-targeted therapy.

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