Renal carcinoma
From Medical-Wiki
Renal cell carcinoma accounts for 3% of adult tumors and is the most common tumor arising from the kidney. The tumor is derived from proximal renal tubular epithelium. It occurs in a sporadic—nonhereditary—form and a familial form. Both forms are associated with an alteration in chromosome 3. There are at least 4 hereditary syndromes associated with renal cell carcinoma. One of them, von Hippel-Lindau (VHL) syndrome, is also associated with pheochromocytoma, pancreatic cysts and islet cell tumors, retinal angiomas, central nervous system hemangioblastomas, endolymphatic sac tumors, and epididymal cystadenomas. The tumor is also called clear cell carcinoma (CCC) and hypernephroma.
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Demographics
It has a higher incidence in smokers. Diagnosis is uncommon before age 40.
Clinical presentation
CCC may present as a diffuse pain in the back, side, or abdomen or as a case of hematuria. It may also present as fever and/or weight loss. However, half of the tumors are discovered accidentally.
Once CCC has spread, it may take a slow, benign course or a rapid aggressive one. The rapidly growing tumors may cause decompensation within weeks of their discovery. [1]
Diagnosis
The preferred means of imaging patients with CCC patients is dedicated renal computed tomography (CT). Many other forms of imaging are sometimes used along the road to its identification, but “this single examination can be used to detect and stage RCC and to provide information for surgical planning without additional imaging.” [2]
Treatment
If the tumor is fortuitously discovered when it is small and confined within the capsule of the kidney, a complete surgical cure is possible. If the tumor has invaded local veins or lymph nodes, it may return months or years after the surgical excision. This return may take the form of local reoccurrence or metastasis to lung, bone, liver, or brain.
In addition to traditional methods of surgical excision, cryogenic ablation has recently been used in select populations that are high risk, averse to surgery, or with bilateral lesions. Radiofrequency ablation is also being used in cases of local reoccurrence. Both techniques show promise. [3]
At present, surgery is the mainstay of treatment. In January of 2006, however, a new medication was released by the FDA for use in advanced CCC. The medication, sunitinib, is a tyrosine kinase inhibitor that works “through multiple targets” to deprive the tumor cells of the blood and nutrients needed to grow. [4]
