Renal Cell Carcinoma

📋 Key Information Summary

📋

Renal cell carcinoma (RCC) accounts for approximately 90% of all kidney cancers and is the 8th most common cancer diagnosed in Australia, with ~4,600 new cases annually.
Clear cell RCC is the most common subtype (70–80%), followed by papillary (10–15%) and chromophobe (5%) subtypes — subtype classification guides systemic therapy selection.
RCC most commonly presents incidentally on cross-sectional imaging; the classically described triad of haematuria, flank pain, and palpable mass occurs in <10% and indicates advanced disease.
Paraneoplastic syndromes (polycythaemia, hypercalcaemia, Stauffer syndrome) occur in 20–30% of patients and may resolve after nephrectomy.
Contrast-enhanced CT abdomen/pelvis is the primary diagnostic and staging modality; MRI is preferred for renal vein/IVC tumour thrombus assessment.
TNM staging (AJCC 8th edition) determines management: stage I–III disease is treated with curative surgery; stage IV requires systemic therapy.
Partial nephrectomy (nephron-sparing surgery) is the standard for T1a tumours (≤4 cm) and selected T1b tumours to preserve renal function.
Cytoreductive nephrectomy remains appropriate in selected metastatic patients with good performance status, ideally performed before commencing systemic therapy.
First-line systemic therapy for intermediate- and poor-risk metastatic clear cell RCC is combination immune checkpoint inhibitor therapy — nivolumab + ipilimumab or pembrolizumab + axitinib.
Tyrosine kinase inhibitors (TKIs) such as sunitinib and pazopanib remain options for favourable-risk metastatic clear cell RCC and as second-line agents.
Cabozantinib is preferred for papillary RCC (non-clear cell) based on the PAPMET trial and is PBS-listed for this indication.
Aboriginal and Torres Strait Islander peoples have higher rates of kidney cancer with later-stage presentation; culturally safe pathways and access to specialist services must be prioritised.
Renal function monitoring (eGFR, proteinuria) is essential during TKI and immunotherapy to detect nephrotoxicity and immune-related adverse events affecting the kidneys.

Introduction & Australian Epidemiology

Renal cell carcinoma (RCC) is the most common malignant neoplasm of the kidney, arising from the renal tubular epithelium. In Australia, RCC is the 8th most frequently diagnosed cancer, with the Australian Institute of Health and Welfare (AIHW) estimating approximately 4,600 new cases diagnosed annually. Age-standardised incidence has been rising steadily over the past two decades, partly attributable to increased cross-sectional imaging and incidental detection of small renal masses.

The median age at diagnosis is 65 years, with a male-to-female ratio of approximately 1.5:1. Major modifiable risk factors include cigarette smoking (relative risk 1.4–2.3), obesity (particularly in women), and hypertension. Non-modifiable risk factors include acquired cystic kidney disease in end-stage renal failure, and inherited syndromes such as von Hippel–Lindau (VHL) disease, hereditary papillary RCC, and Birt–Hogg–Dubé syndrome.

RCC often presents incidentally on imaging performed for unrelated indications — the so-called "incidentaloma" — which now accounts for >50% of new diagnoses. Earlier detection through incidental imaging has improved 5-year survival, which currently stands at approximately 75% overall in Australia, though outcomes are significantly worse for metastatic disease (5-year survival ~15%).

The treatment landscape for advanced RCC has been transformed in the past decade by immune checkpoint inhibitors (ICIs) and targeted therapies, shifting first-line management from single-agent TKIs to combination immunotherapy-based regimens. This guideline addresses the epidemiology, clinical presentation, staging, and evidence-based management of RCC in the Australian context, including PBS-listed therapeutic options and Australian-specific considerations.

Epidemiology & Subtypes

RCC encompasses a heterogeneous group of malignancies classified by histopathological subtype according to the WHO Classification of Tumours of the Urinary System (5th edition, 2022). Subtype classification is critical because it influences prognosis, genetic counselling, and systemic therapy selection.

Subtype	Frequency	Molecular Features	Prognosis
Clear cell RCC	70–80%	VHL gene inactivation (3p25), HIF pathway upregulation, VEGF-driven angiogenesis	Variable; most responsive to TKIs and ICIs
Papillary RCC (types 1 & 2)	10–15%	Type 1: MET activation (HPRC); Type 2: FH mutation (HPRC type 2), CpG island methylator phenotype	Type 1 — favourable; Type 2 — aggressive
Chromophobe RCC	5%	Birt–Hogg–Dubé syndrome (FLCN); multiple chromosome losses	Generally favourable
Collecting duct carcinoma	<1%	Aggressive; NF-κB pathway involvement	Poor; most present metastatic
Renal medullary carcinoma	<1%	Associated with sickle cell trait; SMARCB1 loss	Very poor; median survival <12 months
Unclassified RCC	3–5%	Heterogeneous molecular profiles	Generally poor

Clear Cell RCC

Clear cell RCC is the dominant subtype and the focus of most clinical trials. It arises from the proximal tubular epithelium and is characterised histologically by cells with optically clear cytoplasm due to glycogen and lipid content. The hallmark molecular event is biallelic inactivation of the VHL tumour suppressor gene on chromosome 3p25, leading to constitutive activation of the hypoxia-inducible factor (HIF) pathway, which drives overexpression of vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF). This biology underpins the efficacy of VEGF-targeted TKIs in clear cell RCC.

Papillary RCC

Papillary RCC is the second most common subtype, subdivided into type 1 and type 2 based on morphological and molecular differences. Type 1 papillary RCC is associated with germline MET proto-oncogene mutations in hereditary papillary RCC (HPRC) and typically has a favourable prognosis. Type 2 papillary RCC is more aggressive and molecularly heterogeneous, with frequent FH (fumarate hydratase) mutations and CpG island methylator phenotype. Papillary RCC is generally less responsive to VEGF-targeted TKIs compared to clear cell RCC; cabozantinib, a multi-kinase inhibitor with MET inhibition, has demonstrated superior efficacy in this subtype.

Australian Incidence Trends

According to Cancer Council Australia data, the age-standardised incidence rate of kidney cancer in Australia has increased from approximately 9 per 100,000 in the early 2000s to 13 per 100,000 in recent years. The increase is largely attributed to incidental detection of small renal masses on CT and ultrasound performed for other indications. Despite rising incidence, mortality rates have plateaued, reflecting stage migration toward earlier-stage disease at diagnosis. Five-year relative survival has improved from ~60% in the 1990s to ~75% currently.

Clinical Features & Paraneoplastic Effects

RCC has historically been termed the "internist's tumour" due to its propensity to produce diverse paraneoplastic manifestations. However, with increased incidental detection, the majority of RCC is now diagnosed when asymptomatic.

Presenting Features

Incidental finding (>50%): Detected on CT, MRI, or ultrasound performed for unrelated reasons (abdominal pain, trauma, haematuria workup).
Localised symptoms (30–40%): Flank pain, palpable abdominal mass, visible or microscopic haematuria.
Classic triad (haematuria + flank pain + palpable mass): Present in <10% of cases; indicates locally advanced or bulky disease.
Constitutional symptoms (15–20%): Unexplained weight loss (>5% body weight in 6 months), night sweats, fatigue — associated with metastatic disease and poorer prognosis.
Metastatic symptoms: Bone pain (skeletal metastases), persistent cough (pulmonary metastases), neurological symptoms (brain metastases), leg oedema (IVC tumour thrombus).

Paraneoplastic Syndromes

Paraneoplastic effects occur in 20–30% of RCC patients and may be the presenting feature. They arise from ectopic hormone production or immune-mediated mechanisms by the tumour.

Paraneoplastic Effect	Mechanism	Frequency	Clinical Significance
Polycythaemia	Ectopic EPO production	3–5%	May resolve post-nephrectomy; associated with thrombotic risk
Hypercalcaemia	PTHrP, osteoclast-activating factors, calcitriol production	10–20%	Associated with bone metastases or direct humoral effect; treat with IV fluids, denosumab or zoledronic acid
Stauffer syndrome	Hepatic dysfunction without liver metastases (elevated ALP, GGT, α₂-globulins)	3–10%	Paraneoplastic hepatic dysfunction; usually resolves post-nephrectomy; non-resolving Stauffer syndrome suggests residual disease
Anaemia	Chronic disease, haematuria, marrow infiltration	20–40%	Normocytic; may coexist with polycythaemia in rare cases
Erythrocyte sedimentation rate (ESR) elevation	Systemic inflammatory response	30–50%	Non-specific; may be used as a marker of disease activity
Fever of unknown origin	IL-6, TNF-α production	5–10%	Often resolves after tumour removal
Amyloidosis (AA)	Chronic inflammatory stimulus	Rare	Nephrotic syndrome; rare complication

⚠️

Clinical pearl: Unexplained Stauffer syndrome or polycythaemia in a middle-aged patient warrants dedicated renal imaging to exclude occult RCC. Post-nephrectomy persistence of paraneoplastic features suggests metastatic disease.

Staging & Investigations

Diagnostic Investigations

Essential

Contrast-enhanced CT abdomen/pelvis

Primary imaging modality. Characterises renal mass (enhancement >15 HU post-contrast = enhancing solid mass), evaluates local extent, lymphadenopathy, renal vein/IVC involvement, and distant metastases. MBS item 56809.

Available

MRI abdomen (with contrast)

Superior for assessing IVC tumour thrombus level (intra- vs extra-hepatic) and renal vein involvement. Preferred when CT contrast is contraindicated (severe CKD, contrast allergy). MBS item 63460.

Available

Chest CT

Essential for staging — lung is the most common site of metastasis (50–60% of metastatic RCC). Can be included in single CT protocol (chest/abdomen/pelvis). MBS item 56809.

Available

Bone scan (Technetium-99m)

Indicated if bone pain, elevated ALP, or high clinical suspicion of skeletal metastases. MBS item 61420.

Specialist

MRI brain

Indicated if neurological symptoms or high-risk disease (sarcomatoid features, multiple metastatic sites). Brain metastases occur in 10–15% of metastatic RCC. MBS item 63073.

Essential

Renal biopsy

Not routine for a resectable renal mass with classic CT appearance. Indications: small renal mass (≤4 cm) in elderly/frail patients where active surveillance is considered; suspected lymphoma, metastasis, or abscess; before systemic therapy for inoperable/metastatic disease. Core biopsy preferred (18-gauge, ≥2 cores). Diagnostic yield ~90%. MBS item 30442.

Essential

Baseline bloods

FBC, LFTs, calcium (corrected), LDH, eGFR, urate, coagulation. These are used for IMDC risk stratification and treatment monitoring.

TNM Staging (AJCC 8th Edition)

Stage	T	N	M	Description
I	T1	N0	M0	Tumour ≤7 cm, confined to kidney
II	T2	N0	M0	Tumour >7 cm, confined to kidney
III	T1–T2	N1	M0	Regional lymph node metastasis
III	T3	N0–N1	M0	Tumour extends into renal vein, perinephric fat, or ipsilateral adrenal
IV	T4	Any N	M0	Tumour invades beyond Gerota's fascia or ipsilateral adrenal
IV	Any T	Any N	M1	Distant metastases present

IMDC (International Metastatic RCC Database Consortium) Risk Criteria

The IMDC criteria (Heng criteria) are the standard prognostic model for metastatic clear cell RCC and guide first-line systemic therapy selection.

Adverse prognostic factors (one point each):

Karnofsky performance status <80%
Time from diagnosis to systemic treatment <1 year
Haemoglobin below lower limit of normal
Corrected calcium above upper limit of normal
Absolute neutrophil count above upper limit of normal
Platelet count above upper limit of normal

Favourable

IMDC 0 factors

Best prognosis; median OS approximately 43 months with modern therapy.

First-line: Pembrolizumab + axitinib or sunitinib

Intermediate

IMDC 1–2 factors

Intermediate prognosis; median OS approximately 22–26 months.

First-line: Nivolumab + ipilimumab or pembrolizumab + axitinib

Poor

IMDC 3–6 factors

Worst prognosis; median OS approximately 10–14 months.

First-line: Nivolumab + ipilimumab preferred; pembrolizumab + axitinib alternative

Management

Surgical Management

Surgery is the cornerstone of curative treatment for localised RCC. The surgical approach depends on tumour size, location, and patient factors.

Procedure	Indication	Key Points
Partial nephrectomy (nephron-sparing)	T1a (≤4 cm) — standard; T1b (4–7 cm) — selected cases	Oncologically equivalent to radical nephrectomy for T1a; preserves renal function; reduces CKD risk. Laparoscopic or robotic-assisted approach preferred. Warm ischaemia time <20 min target.
Radical nephrectomy	T2–T4; T1b not amenable to partial nephrectomy; large central tumours	Includes perinephric fat, Gerota's fascia, ipsilateral adrenal (if tumour involves upper pole or >4 cm and suspicious). Minimally invasive preferred.
Cytoreductive nephrectomy	Metastatic disease with good PS (ECOG 0–1), resectable primary, limited metastatic burden	CARMENA trial showed upfront nephrectomy not superior to sunitinib alone in poor-risk patients. DECIDE trial supports CNI before IO-based combination. Timing is multidisciplinary.
Active surveillance	Small renal masses (≤2 cm) in elderly/frail patients; CKD where surgery would necessitate dialysis	Growth rate ~0.3 cm/year; metastatic progression rate <2% for masses <3 cm. Serial imaging q6 months × 2 years, then annually.

⚠️

Multidisciplinary team (MDT) meeting: All patients with RCC should be discussed at a uro-oncology MDT meeting. The MDT should include urologists, medical oncologists, radiation oncologists, radiologists, and pathologists. This is a requirement of the Optimal Care Pathway for Kidney Cancer (Cancer Council Victoria, 2020).

Adjuvant Therapy

Adjuvant immunotherapy and TKI therapy remain areas of evolving evidence. The KEYNOTE-564 trial demonstrated improved disease-free survival with adjuvant pembrolizumab (200 mg IV q3 weeks for 17 cycles) in patients with intermediate- or high-risk clear cell RCC post-nephrectomy. Pembrolizumab is now TGA-approved for adjuvant treatment and PBS-listed for this indication. The S-TRAC trial showed DFS benefit with adjuvant sunitinib, but OS benefit has not been confirmed, and sunitinib is not routinely recommended in the adjuvant setting in Australia.

Systemic Therapy for Metastatic Clear Cell RCC

The management of metastatic clear cell RCC has been transformed by immune checkpoint inhibitors. First-line therapy is selected based on IMDC risk group and patient fitness.

First-Line Combination Immunotherapy

💊

Nivolumab + Ipilimumab

Opdivo® + Yervoy® · PD-1 + CTLA-4 inhibitor

Adult dose Nivolumab 3 mg/kg + Ipilimumab 1 mg/kg IV q3 weeks × 4 cycles, then nivolumab 480 mg IV q4 weeks maintenance

Paediatric dose Not indicated for paediatric RCC

Route Intravenous

Key AEs Immune-related: colitis, hepatitis, pneumonitis, nephritis, endocrinopathies. Grade 3–4 toxicity ~46%.

PBS status ✔ PBS Authority Required

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Pembrolizumab + Axitinib

Keytruda® + Inlyta® · PD-1 inhibitor + VEGFR-TKI

Adult dose Pembrolizumab 200 mg IV q3 weeks + axitinib 5 mg PO BD (titrate 2–10 mg BD)

Duration Pembrolizumab up to 24 months; axitinib until progression

Key AEs Diarrhoea, hypertension, hepatotoxicity, hypothyroidism. Grade 3–4 toxicity ~63% (KEYNOTE-426).

PBS status ✔ PBS Authority Required

ℹ️

First-line selection guidance: Nivolumab + ipilimumab is preferred for IMDC intermediate- and poor-risk clear cell RCC (CheckMate 214: OS benefit in this subgroup). Pembrolizumab + axitinib is effective across all IMDC risk groups (KEYNOTE-426) and is a reasonable first-line choice for favourable-risk disease. Multidisciplinary discussion should guide selection based on comorbidities, autoimmune history, and patient preference.

Second-Line and Subsequent Therapy

Following progression on first-line immunotherapy-based regimens, TKI monotherapy is the standard second-line approach.

💊

Cabozantinib

Cabometyx® · VEGFR/MET/AXL inhibitor

Adult dose 60 mg PO daily

Renal adjustment No dose adjustment required; monitor eGFR

Key AEs Diarrhoea, fatigue, hypertension, hand–foot syndrome, hepatotoxicity

PBS status ✔ PBS Authority Required

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Sunitinib

Sutent® · VEGFR/PDGFR/KIT inhibitor

Adult dose 50 mg PO daily × 4 weeks on / 2 weeks off (Schedule 4/2) or 37.5 mg PO daily continuous

Renal adjustment Not recommended if eGFR <30 mL/min; Caution eGFR 30–60

Key AEs Fatigue, diarrhoea, mucositis, hand–foot syndrome, hypothyroidism, hypertension

PBS status ✔ PBS Authority Required

💊

Pazopanib

Votrient® · VEGFR/PDGFR/c-KIT inhibitor

Adult dose 800 mg PO daily (reduce to 400–600 mg for hepatic impairment)

Renal adjustment No adjustment required; monitor eGFR and phosphate

Key AEs Hepatotoxicity (monitor LFTs fortnightly × 3 months), diarrhoea, hair colour changes, hypertension, QT prolongation

PBS status ✔ PBS Authority Required

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Nivolumab (monotherapy)

Opdivo® · PD-1 inhibitor

Adult dose 3 mg/kg IV q2 weeks (or 480 mg IV q4 weeks flat dosing)

Indication Second-line after prior TKI therapy (CheckMate 025); being superseded by first-line IO combinations

PBS status ✔ PBS Authority Required

Non-Clear Cell RCC — Systemic Therapy

Non-clear cell RCC subtypes are generally less responsive to standard TKIs and immunotherapy. Evidence is derived from basket trials and subtype-specific studies.

💊

Cabozantinib

Cabometyx® · Preferred for papillary RCC

Adult dose 60 mg PO daily

Evidence PAPMET trial: cabozantinib superior PFS vs sunitinib in papillary RCC (9.0 vs 5.6 months; HR 0.60)

PBS status ✔ PBS Authority Required

💊

Everolimus

Afinitor® · mTOR inhibitor

Adult dose 10 mg PO daily

Indication Chromophobe RCC, TSC-associated RCC; second-line for clear cell after TKI failure

Key AEs Stomatitis, pneumonitis, hyperlipidaemia, hyperglycaemia, myelosuppression

PBS status ✔ PBS Authority Required

Treatment Algorithm Summary

1

Localised Disease (Stage I–III)

Partial nephrectomy (T1a ± T1b) or radical nephrectomy (T2–T3). Adjuvant pembrolizumab for intermediate/high-risk clear cell RCC (KEYNOTE-564).

2

Metastatic — Favourable Risk (IMDC 0)

Pembrolizumab + axitinib (preferred) or sunitinib. Consider cytoreductive nephrectomy if resectable primary and ECOG 0–1.

3

Metastatic — Intermediate/Poor Risk (IMDC 1–6)

Nivolumab + ipilimumab (preferred) or pembrolizumab + axitinib. Cytoreductive nephrectomy per MDT decision (postponed to post-systemic response per CARMENA/DECI

4

Second-Line (Clear Cell)

Cabozantinib 60 mg daily (preferred) or sunitinib/pazopanib if not previously used. Consider clinical trial enrolment.

5

Non-Clear Cell RCC

Cabozantinib for papillary RCC (PAPMET). Pembrolizumab + lenvatinib or nivolumab + ipilimumab per emerging data. Clinical trial enrolment encouraged.

Monitoring During Systemic Therapy

Clinical review: Every 2–3 weeks during initial IO combination therapy; every 4–6 weeks for TKI monotherapy.
Bloods at each visit: FBC, LFTs, UEC (including eGFR), corrected calcium, thyroid function (TSH q6 weeks on IO therapy).
Imaging: CT chest/abdomen/pelvis q8–12 weeks to assess response (RECIST 1.1 criteria). Pseudoprogression may occur with ICIs — confirm true progression before switching.
Immune-related adverse event (irAE) monitoring: Urinalysis for nephritis (proteinuria, haematuria); stool calprotectin for colitis; cortisol and ACTH for adrenal insufficiency (fatigue, hypotension).
Blood pressure: Target <140/90 mmHg on TKIs; ACE inhibitors or ARBs preferred (renoprotective). Amlodipine if additional antihypertensive required.
Proteinuria: Urine ACR q4–6 weeks on TKIs; discontinue if nephrotic-range proteinuria (>3.5 g/day) to assess for TMA or immune nephritis.

Radiation Therapy

RCC is traditionally considered radioresistant. However, stereotactic body radiotherapy (SBRT) has demonstrated efficacy for oligometastatic disease (1–5 metastases), with local control rates >85% for extracranial metastases and >90% for brain metastases. SBRT to oligoprogressive sites while continuing systemic therapy is an increasingly utilised strategy. Palliative radiotherapy is indicated for symptomatic bone metastases, spinal cord compression, and brain metastases.

Special Populations

🫘 Renal Impairment

All TKIs Monitor eGFR closely; no formal dose reduction for mild–moderate CKD. Avoid nephrotoxic combinations. Partial nephrectomy increasingly utilised to preserve renal function in CKD patients.

ICIs (nivolumab, pembrolizumab) Immune-related nephritis (1–2%); monitor urine ACR and eGFR. Withhold IO if creatinine doubles; start prednisolone 1–2 mg/kg/day for irAE nephritis. No dose adjustment for pre-existing CKD.

Dialysis patients RCC management is individualised. Radical nephrectomy may be acceptable if on or imminent for dialysis. TKI dosing on dialysis requires specialist pharmacology input.

👴 Elderly

General Comprehensive geriatric assessment recommended. Age alone is not a contraindication to surgery or systemic therapy, but comorbidity burden affects treatment tolerance. Active surveillance is appropriate for small renal masses in patients with limited life expectancy.

IO combinations Higher irAE rates in elderly; careful monitoring required. Pembrolizumab + axitinib may be easier to manage than nivolumab + ipilimumab (lower severe irAE rate).

🛡️ Immunocompromised

Autoimmune disease IO therapy may exacerbate underlying autoimmune conditions. Multidisciplinary discussion with rheumatology/immunology is essential. TKI monotherapy may be safer in patients with active autoimmune disease.

Organ transplant recipients ICIs are contraindicated due to high graft rejection risk (30–40% in kidney transplant recipients). TKIs are the preferred systemic therapy. Surgical management remains the mainstay for localised disease.

🫁 Hepatic Impairment

Pazopanib Hepatotoxicity is a major concern. Baseline LFTs required; contraindicated if baseline bilirubin >1.5× ULN. Monitor LFTs fortnightly × 3 months then monthly. Discontinue if ALT >8× ULN.

Sunitinib Dose reduce in Child–Pugh B (37.5 mg daily). Avoid in Child–Pugh C.

Stauffer syndrome Paraneoplastic hepatic dysfunction without metastases; usually resolves after nephrectomy. Non-resolution suggests residual disease and warrants restaging.

Aboriginal and Torres Strait Islander Health Considerations

Aboriginal and Torres Strait Islander Health

Epidemiology

Aboriginal and Torres Strait Islander Australians have a 1.3–1.5 times higher incidence of kidney cancer compared to non-Indigenous Australians, with higher rates of presentation at advanced stage. The AIHW reports that 5-year survival for Indigenous Australians with kidney cancer is approximately 60% compared to 75% for non-Indigenous Australians.

Risk factor burden

Higher prevalence of modifiable risk factors including smoking (40% vs 12% in non-Indigenous Australians), obesity, hypertension, and chronic kidney disease — all contribute to increased RCC risk and poorer outcomes.

Geographic barriers

Many Aboriginal and Torres Strait Islander peoples live in rural and remote areas with limited access to urology, medical oncology, and radiology services. Travel for specialist consultation and treatment (often >500 km) is a significant barrier to timely diagnosis and management.

Health system barriers

Racism, cultural insensitivity, and mistrust of health services contribute to delayed presentation and lower rates of guideline-concordant care. Aboriginal Health Workers and Liaison Officers are essential for bridging this gap. Telehealth has expanded access but connectivity remains limited in some remote communities.

Surgical access

Nephrectomy requires transfer to a tertiary centre. Post-operative recovery away from Country and community can be distressing. Support for family travel and accommodation (e.g., via Patient Assisted Travel Schemes — PATS) should be facilitated early.

Systemic therapy access

Intravenous immunotherapy requires regular attendance at infusion centres, which may be impractical for remote patients. Consider oral TKI-based regimens where clinically appropriate and equivalent, facilitated through remote chemotherapy programmes such as those run by the Northern Territory Department of Health and Queensland Health.

Culturally safe care

Care should be delivered in partnership with local Aboriginal Community Controlled Health Organisations (ACCHOs). Respect for cultural practices, gender-sensitive care, yarning as a communication tool, and involving Elders in care decisions improve engagement and outcomes. End-of-life care discussions must be culturally appropriate and may involve extended family networks.

National framework

The Optimal Care Pathway for Aboriginal and Torres Strait Islander People with Cancer (Cancer Council Victoria, 2018) and NHMRC guidelines provide the framework for culturally safe cancer care. Services should be assessed against these standards.

📚 References

1. Australian Institute of Health and Welfare (AIHW). Cancer data in Australia. Canberra: AIHW; 2024. Available from: https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia
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5. Choueiri TK, Tomczak P, Park SH, et al. Adjuvant pembrolizumab after nephrectomy in renal-cell carcinoma. N Engl J Med. 2021;385(8):683–694.
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8. Moch H, Cubilla AL, Humphrey PA, et al. The 2016 WHO classification of tumours of the urinary system and male genital organs — Part A: renal, penile, and testicular tumours. Eur Urol. 2016;70(1):93–105.
9. Choueiri TK, Escudier B, Powles T, et al. Cabozantinib versus everolimus in advanced renal-cell carcinoma. N Engl J Med. 2015;373(19):1814–1823 (METEOR trial).
10. Cancer Council Victoria. Optimal care pathway for people with kidney cancer. 2nd ed. Melbourne: Cancer Council Victoria; 2020.
11. Cancer Council Victoria. Optimal care pathway for Aboriginal and Torres Strait Islander people with cancer. Melbourne: Cancer Council Victoria; 2018.
12. Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander health performance framework 2020 summary report. Canberra: AIHW; 2020.
13. Sternberg CN, Davis ID, Mardiak J, et al. Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. J Clin Oncol. 2010;28(6):1061–1068 (VEG105192 trial).
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15. Siva S, Bressel M, Pryor D, et al. Stereotactic radiotherapy for the treatment of oligometastases in renal cell carcinoma: the TROG RAPPORT trial. ANZ J Surg. 2020;90(7–8):1244–1248.