An estimated 38 890 individuals will be diagnosed as having renal cell carcinoma (RCC) in the United States in 2006 and approximately 12 840 patients will die from the disease.1 RCC is the most common malignant lesion of the kidney and accounts for 85% of all renal neoplasms and 3% of all adult malignancies.2 The overall incidence of RCC has increased over the past 20 years from 2% to 4% per year.3 While smoking, hypertension, and obesity have all been associated with RCC risk, smoking has emerged as the most significant risk factor. Cigarette smokers have double the risk of RCC than nonsmokers and pipe and cigar smokers also have an increased risk of the disease.3 RCC occurs most often in individuals aged 50 to 70 years and affects men almost twice as often as women.4 Many patients with this cancer are being diagnosed at an earlier stage due to the increased use of diagnostic testing such as computed tomography and magnetic resonance imaging. In fact, approximately half of RCC cases are now detected because a renal mass is incidentally identified during a radiology examination.5 Yet, one fourth of patients present with advanced disease, including locally invasive or metastatic RCC, and one third of patients with resected localized disease will have a recurrence.6
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