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Researchers find they can predict which kidney cancers will be aggressive

Researchers have found they can predict which kidney cancers will become aggressive, as well as finding that elements of kidney cancer can be present in children.

Three Cancer Research UK-funded studies, published in Cell, found three distinct sets of evolutionary paths kidney cancer can take, with some of the earliest triggers occurring in adolescence or childhood. These early events can occur up to 50 years before the tumour is diagnosed.

The TRACERx Renal team, based at the Francis Crick Institute, UCL, The Royal Marsden NHS Foundation Trust, and Guy's and St Thomas' NHS Foundation Trust and supported by the BRC, analysed samples from patients and identified three distinct types of kidney cancer evolution. The first type follows a slow path and never acquires the ability to become aggressive. The second type forms the most aggressive of tumours, with changes to large sections of the genome occurring early on in tumour progression. The early changes often mean that the cancer is able to spread throughout the body before it is diagnosed. The third tumour type acquires the ability to spread through the body due to a gradual accumulation of genetic damage. The changes in the third type often occur over a longer period of time.

Dr Samra Turajlic, co-lead author, said: “The outcomes of patients diagnosed with kidney cancer vary a great deal – we show for the first time that these differences are rooted in the distinct way that their cancers evolve.”

Knowing how these cancers evolve will allow for tailor-made treatment to be offered to patients, giving them the best clinical care. This would mean that patients with the least aggressive tumours would be able to avoid surgery, while those with aggressive tumours could have the initial tumour removed before it spreads.

Professor Charles Swanton, co-lead author of all three papers, said: “Understanding how cancers develop and evolve over time is likely to be critical in helping us piece together the information that will point the way to new treatment approaches and predicting outcomes. In this study we show that large changes in the genome appear to be a particularly high risk factor for early progression and death following surgery. We hope that in the future this work will help tailor surgical and medical intervention to the right patients at the right time.”

Understanding the early events in childhood/adolescence will present an opportunity for early intervention and monitoring in individuals that have a high genetic risk of developing kidney cancer.