Objectives
  • To understand the diagnostic aspects of renal cell cancer (RCC), and the prognostic categories associated with good, intermediate and poor survival of metastatic patients

  • To understand when nephrectomy is indicated; appreciate the curative role of surgery in localised disease and the role of nephron-sparing procedures in RCC as well as the increasing use of laparoscopy

  • To understand that RCC is a metabolic disease and that is not just one cancer, but that there are many different histological categories of RCC often with different genetic associated abnormalities

  • To be aware of the novel systemic therapies, including antiangiogenic therapies, inhibitors of the mammalian target of rapamycin (mTOR) pathway and novel immunotherapy; the expanded role of molecular targeted treatments has dramatically changed the treatment paradigm of RCC

  • To be familiar with the changing landscape of therapies and be familiar with the clinical presentations of RCC as well as possible paraneoplastic aspects of the disease and palliation of advanced disease

Awareness
  • Awareness of how to classify and stage localised disease and metastatic disease

  • Awareness that improved laparoscopic techniques and local techniques are available

  • Awareness that improved survival has been obtained with the approval of several novel targeted agents in the last decade, particularly directed against angiogenesis, the vascular endothelial growth factor (VEGF) and mTOR pathways

  • Appreciation that new studies have shown improved survival with novel checkpoint inhibition immunotherapy and novel targeted agents, which are thus far in the second-line setting

Knowledge
  • Knowledge of the different types of focal therapy in use, including enucleation, partial nephrectomy, cryotherapy and hyperthermia and that laparoscopic surgery plays a large role in the treatment of smaller tumours for localised disease

  • Understanding that radical nephrectomy, as well, is often performed with laparoscopic or robotic techniques

  • Knowledge about the newer staging systems for assessing risk in patients with metastatic disease

  • Knowledge of the studies in first- and second-line therapy for patients with metastatic disease that have led to overall improved survival in patients with metastatic clear cell RCC

  • Knowledge about the new studies with checkpoint inhibition, and ongoing studies with combination therapies and vaccines

  • Knowledge about the studies that have been conducted in patients with non-clear cell RCC

  • Understanding that, in contrast to many other cancers, metastasectomy for oligometastatic disease has an important role, in particular, for clear cell RCC management and should be discussed at the multidisciplinary team meetings

  • Familiarity with results available from the adjuvant studies with targeted therapy

  • Familiarity with the study results that are available and the ongoing studies in the adjuvant setting, and in the setting of targeted therapy in evaluating the role of nephrectomy

Skills
  • Ability to recognise the indications for nephrectomy and partial nephrectomy in patients with localised disease and metastatic disease

  • Ability to recognise the treatment guidelines for first and further lines of therapy for metastatic clear cell RCC

  • Ability to manage the toxicities associated with targeted therapies and immunotherapy