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Encyclopedia > Renal cell carcinoma
Renal cell carcinoma
Classification & external resources
Histopathologic image of clear cell carcinoma of the kidney. Nephrectomy specimen. Hematoxylin-eosin stain.
ICD-10 C64.
ICD-9 189.0
ICD-O: M8312/3
DiseasesDB 11245
MedlinePlus 000516
eMedicine med/2002 

Renal cell carcinoma is the most common form of kidney cancer arising from the renal tubule. It is the most common type of kidney cancer in adults. Initial treatment is surgery. It is notoriously resistant to radiation therapy and chemotherapy, although some cases respond to immunotherapy. The advent of targeted cancer therapies such as sunitinib has vastly improved the outlook for treatment of RCC. Image File history File linksMetadata Download high-resolution version (2040x1536, 499 KB) Histopathologic image of clear cell carcinoma of the kidney. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // C00-D48 - Neoplasms (C00-C14) Malignant neoplasms, lip, oral cavity and pharynx (C00) Malignant neoplasm of lip (C01) Malignant neoplasm of base of tongue (C02) Malignant neoplasm of other and unspecified parts of tongue (C03) Malignant neoplasm of gum (C04) Malignant neoplasm of floor of mouth (C05) Malignant neoplasm of... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The International Classification of Diseases for Oncology (ICD-O) is a domain specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. ... The International Classification of Diseases for Oncology (ICD-O) is a domain specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Nephron of the kidney A nephron is the basic structural and functional unit of the kidney. ... The kidneys are organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... Cancer is a class of diseases or disorders characterized by uncontrolled division of cells and the ability of these to spread, either by direct growth into adjacent tissue through invasion, or by implantation into distant sites by metastasis (where cancer cells are transported through the bloodstream or lymphatic system). ... “Surgeon” redirects here. ... Clinac 2100 C100 accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... Chemotherapy is the use of chemical substances to treat disease. ... Immunotherapy is a form of medical treatment based upon the concept of modulating the immune system to achieve a therapeutic goal. ... Sunitinib (marketed as Sutent, previously known as SU11248) is a small molecule receptor tyrosine kinase inhibitor that is used in the treatment of gastrointestinal stromal tumor (GIST) as well as renal cell carcinoma (RCC). ...

Contents

Signs and symptoms

The classic triad is hematuria (blood in the urine), flank pain and an abdominal mass. This "classic triad" is infrequently present when the patient first presents for medical attention. In medicine, hematuria (or haematuria) is the presence of blood in the urine. ...


Other signs may include:

  • Abnormal urine color (dark, rusty, or brown) due to blood in the urine
  • Weight loss, malnourished appearance
  • The presenting symptom may be due to metastatic disease, such as a pathologic fracture of the hip due to a metastasis to the bone
  • Enlargement of one testicle (usually the left, due to blockage of the left gonadal vein by tumor invasion of the left renal vein -- the right gonadal vein drains directly into the inferior vena cava)
  • Vision abnormalities
  • Pallor or plethora
  • Hirsutism|Excessive hair growth (females)
  • Constipation
  • High blood pressure
  • Elevated calcium levels (Hypercalcemia)

In medicine, hematuria (or haematuria) is the presence of blood in the urine. ... Varicocele is an abnormal enlargment of the veins draining the testicles in the scrotum. ... In medicine, gonadal vein refers to the blood vessel that carrying blood away from the gonad (testis, ovary) toward the heart. ... The renal veins are veins that drain the kidney. ... This article may be too technical for most readers to understand. ... Hypercalcaemia is an elevated calcium level in the blood. ...

Causes

Renal cell carcinoma affects about three in 10,000 people, resulting in about 31,000 new cases in the US per year. Every year, about 12,000 people in the US die from renal cell carcinoma. It is more common in men than women, usually affecting men older than 55. In medicine, carcinoma apanting dog named rufis It is malignant by definition: carcinomas invade surrounding tissues and organs, and may spread to lymph nodes and distal sites (metastasis). ... Motto: (Out Of Many, One) (traditional) In God We Trust (1956 to date) Anthem: The Star-Spangled Banner Capital Washington D.C. Largest city New York City None at federal level (English de facto) Government Federal constitutional republic  - President George Walker Bush (R)  - Vice President Dick Cheney (R) Independence from...


Why the cells become cancerous is not known. A history of smoking greatly increases the risk for developing renal cell carcinoma. Some people may also have inherited an increased risk to develop renal cell carcinoma, and a family history of kidney cancer increases the risk.


People with von Hippel-Lindau disease, a hereditary disease that also affects the capillaries of the brain, commonly also develop renal cell carcinoma. Kidney disorders that require dialysis for treatment also increase the risk for developing renal cell carcinoma. Von Hippel-Lindau disease (VHL) is a rare inherited genetic condition involving the abnormal growth of tumors in parts of the body which are particularly rich in blood supply. ... In animals, the brain or encephalon (Greek for in the head), is the control center of the central nervous system, responsible for behaviour. ... In medicine, dialysis is a type of renal replacement therapy which is used to provide an artificial replacement for lost kidney function due to renal failure. ...


Pathology

Renal cell carcinoma

Gross examination shows a hypervascular lesion in the renal cortex, which is frequently multilobulated, yellow (because of the lipid accumulation) and calcified. Image File history File links Download high resolution version (467x650, 89 KB) Summary Taken from http://web2. ... Image File history File links Download high resolution version (467x650, 89 KB) Summary Taken from http://web2. ...


Light microscopy shows tumor cells forming cords, papillae, tubules or nests, and are atypical, polygonal and large. Because these cells accumulate glycogen and lipids, their cytoplasm appear "clear", lipid-laden, the nuclei remain in the middle of the cells, and the cellular membrane is evident. Some cells may be smaller, with eosinophilic cytoplasm, resembling normal tubular cells. The stroma is reduced, but well vascularized. The tumor grows in large front, compressing the surrounding parenchyma, producing a pseudocapsule.[1] This article does not cite any references or sources. ... A polyunsaturated triglyceride. ...


Secretion of vasoactive substances (e.g. renin) may cause arterial hypertension, and release of erythropoietin may cause polycythemia (increased production of red blood cells). Renin, also known as angiotensinogenase, is a circulating enzyme (EC 3. ... Arterial hypertension, or high blood pressure is a medical condition where the blood pressure is chronically elevated. ... Erythropoietin (IPA pronunciation: , alternative pronunciations: ) or EPO is a glycoprotein hormone that is a cytokine for erythrocyte (red blood cell) precursors in the bone marrow. ... Polycythemia is a condition in which there is a net increase in the total number of red blood cells in the body. ... Human red blood cells Red blood cells are the most common type of blood cell and the vertebrate bodys principal means of delivering oxygen from the lungs or gills to body tissues via the blood. ...


Radiology

A CT scan showing bilateral renal cell carcinomas

The characteristic appearance of renal cell carcinoma (RCC) is a solid renal lesion which disturbs the renal contour. It will frequently have an irregular or lobulated margin. 85% of solid renal masses will be RCC. 10% of RCC will contain calcifications, and some contain macroscopic fat (likely due to invasion and encasement of the perirenal fat). Following intravenous contrast administration (computed tomography or magnetic resonance imaging), enhancement will be noted, and will increase the conspicuity of the tumor relative to normal renal parenchyma. Wikipedia does not have an article with this exact name. ... CT apparatus in a hospital Computed axial tomography (CAT), computer-assisted tomography, computed tomography, CT, or body section roentgenography is the process of using digital processing to generate a three-dimensional image of the internals of an object from a large series of two-dimensional X-ray images taken around... It has been suggested that Synchrotron X-ray tomographic microscopy, X-ray tomography be merged into this article or section. ... Magnetic Resonance Image showing a median sagittal cross section through a human head. ...


A list of solid renal lesions includes:

  • renal cell carcinoma
  • metastasis from an extra-renal primary neoplasm
  • renal lymphoma
  • squamous cell carcinoma
  • juxtaglomerular tumor (reninoma)
  • transitional cell carcinoma
  • angiomyolipoma
  • oncocytoma
  • Wilm's tumor

In particular, reliably distinguishing renal cell carcinoma from an oncocytoma (a benign lesion) is not possible using current medical imaging or percutaneous biopsy.


Renal cell carcinoma may also be cystic. As there are several benign cystic renal lesions (simple renal cyst, hemorrhagic renal cyst, multilocular cystic nephroma, polycystic kidney disease), it may occasionally be difficult for the radiologist to differentiate a benign cystic lesion from a malignant one. A famous radiologist named Dr. Morton Bosniak developed a classification system for cystic renal lesions that classifies them based specific imaging features into groups that are benign and those that need surgical resection[2]. At diagnosis, 30% of renal cell carcinoma has spread to that kidney's renal vein, and 5-10% has continued on into the inferior vena cava[3]. Radiology is the branch of medical science dealing with the medical use of x-ray machines or other such radiation devices. ...


Percutaneous biopsy can be performed by a radiologist using ultrasound or computed tomography to guide sampling of the tumor for the purpose of diagnosis. However this is not routinely performed because when the typical imaging features of renal cell carcinoma are present, the possibility of an incorrectly negative result together with the risk of a medical complication to the patient make it unfavorable from a risk-benefit perspective.This is not completely accurate, there are new experimental treatments. Radiology is the branch of medical science dealing with the medical use of x-ray machines or other such radiation devices. ... Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize muscles and internal organs, their size, structures and possible pathologies or lesions. ... It has been suggested that Synchrotron X-ray tomographic microscopy, X-ray tomography be merged into this article or section. ...


Treatment

If it is only in the kidneys, which is about 40% of cases, it can be cured roughly 90% of the time with surgery. If it has spread outside of the kidneys, often into the lymph nodes or the main vein of the kidney, then it must be treated with chemotherapy and other treatments. “Surgeon” redirects here. ... Lymph nodes are components of the lymphatic system. ... Chemotherapy is the use of chemical substances to treat disease. ...


Surgery

Surgical removal of all or part of the kidney (nephrectomy) is recommended. This may include removal of the adrenal gland, retroperitoneal lymph nodes, and possibly tissues involved by direct extension (invasion) of the tumor into the surrounding tissues. In cases where the tumor has spread into the renal vein, inferior vena cava, and possibly the right atrium (angioinvasion), this portion of the tumor can be surgically removed, as well. In case of metastases surgical resection of the kidney ("cytoreductive nephrectomy") may improve survival[4], as well as resection of a solitary metastatic lesion. Nephrectomy is the surgical removal of a kidney. ...


Percutaneous therapies

Percutaneous, image-guided therapies, usually managed by radiologists, are being offered to patients with localized tumor, but who are not good candidates for a surgical procedure. This sort of procedure involves placing a probe through the skin and into the tumor using real-time imaging of both the probe tip and the tumor by computed tomography, ultrasound, or even magnetic resonance imaging guidance, and then destroying the tumor with heat (radiofrequency ablation) or cold (cryotherapy). These modalities are at a disadvantage compared to traditional surgery in that pathologic confirmation of complete tumor destruction is not possible. In surgery, percutaneous pertains to any medical procedure where access to inner organs or other tissue is done via needle-puncture of the skin, rather than by using an open approach where inner organs or tissue are exposed (typically with the use of a scalpel). ... Radiology is the branch of medical science dealing with the medical use of x-ray machines or other such radiation devices for the purpose of obtaining visual information as part of medical imaging. ... It has been suggested that Synchrotron X-ray tomographic microscopy, X-ray tomography be merged into this article or section. ... Ultrasound is a form of cyclic sound pressure with a frequency greater than the upper limit of human hearing, this limit being approximately 20 kilohertz (20,000 hertz). ... Magnetic Resonance Image showing a median sagittal cross section through a human head. ... Radiofrequency ablation (RFA) uses radiofrequency energy to destroy abnormal electrical pathways in heart tissue. ... Cryotherapy is used to define several techniques and procedures in the medical community. ...


Radiation therapy

Radiation therapy is not commonly used for treatment of renal cell carcinoma because it is usually not successful. Radiation therapy may be used to palliate the symptoms of skeletal metastases. Clinac 2100 C100 accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ...


Medications

Medications such as alpha-interferon and interleukin-2 (IL-2) have been successful in reducing the growth of some renal cell carcinomas, including some with metastasis. Studies have demonstrated that IL-2 offers the possibility of a complete and long-lasting remission in these diseases. In addition, the anti-VEGF monoclonal antibody gurnistologyisics has been shown to be promising in advanced disease. Interferons (IFNs) are natural proteins produced by the cells of the immune systems of most animals in response to a challenge by a foreign agents such as viruses, bacteria, parasites and tumour cells. ... Interleukin-2 (IL2) is an interleukin, a type of biological response modifier that can improve the bodys natural response to disease. ... Vascular endothelial growth factor or VEGF is an important signal protein involved in angiogenesis. ... Monoclonal antibodies (mAb) are antibodies that are identical because they were produced by one type of immune cell, all clones of a single parent cell. ...


Sorafenib (Nexavar) was FDA approved in December 2005 for treatment of advanced renal cell cancer, the first receptor tyrosine kinase (RTK) inhibitor indicated for this use. Sorafenib (rINN), marketed as Nexavar by Bayer, is a drug approved for the treatment of advanced renal cell carcinoma (primary kidney cancer). ... In biochemistry, a kinase is a type of enzyme that transfers phosphate groups from high-energy donor molecules, such as ATP, to specific target molecules (substrates); the process is termed phosphorylation. ...


A month later, Sunitinib (Sutent) was approved as well. Sunitinib—an oral, small-molecule, multi-targeted (RTK) inhibitor—and sorafenib both interfere with tumor growth by inhibiting angiogenesis as well as tumor cell proliferation. Sunitinib appears to offer greater potency against advanced RCC, perhaps because it inhibits more receptors than sorafenib. However, these agents have not been directly compared against one another in a single trial. [1][2] Sunitinib (marketed as Sutent, previously known as SU11248) is a small molecule receptor tyrosine kinase inhibitor that is used in the treatment of gastrointestinal stromal tumor (GIST) as well as renal cell carcinoma (RCC). ... Angiogenesis is the physiological process involving the growth of new blood vessels from pre-existing vessels. ...


Recently the first Phase III study comparing an RTK with cytokine therapy was published in the New England Journal of Medicine. This study proved that Sunitinib offers superior efficacy compared with interferon-α. Progression-free survival (primary endpoint) was more than doubled. The benefit for sunitinib was significant across all major patient subgroups, including those with a poor prognosis at baseline. 28% of sunitinib patients had significant tumor shrinkage compared with only 5% of patients who received interferon-α. Although overall survival data are not yet mature, there is a clear trend toward improved survival with sunitinib. Patients receiving sunitinib also reported a significantly better quality of life than those treated with IFNa. [5] Based on these results, lead investigator Dr. Robert Motzer announced at ASCO 2006 that “Sunitinib is the new reference standard for the first-line treatment of mRCC.” [6] The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ... Sunitinib (marketed as Sutent, previously known as SU11248) is a small molecule receptor tyrosine kinase inhibitor that is used in the treatment of gastrointestinal stromal tumor (GIST) as well as renal cell carcinoma (RCC). ...


Temsirolimus (CCI-779) is an inhibitor of mTOR kinase (mamallian target of rapamycin) that was shown to prolong overall survival vs. interferon-α in patients with previously untreated metastatic renal cell carcinoma with three or more poor prognostic features. The results of this Phase III randomized study were presented at the 2006 annual meeting of the American Society of Clinical Oncology (www.ASCO.org).


Chemotherapy

Chemotherapy may be used in some cases, but cure is unlikely unless all the cancer can be removed with surgery. Chemotherapy is the use of chemical substances to treat disease. ...


Vaccine

In November 2006, it was announced that a vaccine had been developed and tested with very promising results.(See [3]) The new vaccine, called TroVax, works in a totally different way to existing treatments by harnessing the patient's own immune system to fight the disease. Experts say this suggests that gene therapy vaccines could prove an effective treatment for a whole range of cancers. Oxford BioMedica[4] is the company behind the vaccine; it's a British company established as a spin-out from Oxford University and specialises in the development of gene-based treatments. Further vaccine trials are underway. Look up November in Wiktionary, the free dictionary. ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ... A vaccine is an antigenic preparation used to establish immunity to a disease. ... TroVax is a cancer immunotherapy product produced by Oxford BioMedica. ... Gene therapy is the insertion of genes into an individuals cells and tissues to treat a disease, and hereditary diseases in which a defective mutant allele is replaced with a functional one. ... The University of Oxford, located in the city of Oxford in England, is the oldest university in the English-speaking world. ...


Prognosis

The outcome varies depending on the size of the tumor, whether it is confined to the kidney or not, and the presence or absence of metastatic spread. The Furhman grading, which measures the aggressiveness of the tumor, may also affect survival, though the data is not as strong to support this.


The five year survival rate is around 90-95% for tumors less than 4 cm. For larger tumors confined to the kidney without venous invasion, survival is still relatively good at 80-85%. For tumors that extend through the renal capsule and out of the local fascial investments, the survivability reduces to near 60%. If it has metastasized to the lymph nodes, the 5-year survival is around 5 % to 15 %. If it has spread metastatically to other organs, the 5-year survival rate is less than 5 %. Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ... Fascia, pronounced , is specialized connective tissue layer which surrounds muscles, bones, and joints, providing support, protection and giving structure to the body. ...


For those that have tumor recurrence after surgery, the prognosis is generally poor. Renal cell carcinoma does not generally respond to chemotherapy or radiation. Immunotherapy, which attempts to induce the body to attack the remaining cancer cells, has shown promise. Recent trials are testing newer agents, though the current complete remission rate with these approaches are still low, around 12-20% in most series.


See also

  • Stauffer syndrome

Stauffer syndrome is a constellation of signs and symptoms of liver dysfunction that arise due to presence of renal cell carcinoma[1] but are not due to tumour inflitration into the liver and/or intrinsic liver disease; it is a paraneoplastic syndrome. ...

External links

  • Photo at: Atlas of Pathology
  • www.411cancer.com - General Cancer Information
  • Vaccine for kidney cancer
  • [5] - Popular blog from long-term paient (ARCC)

References

  1. ^ http://www.pathologyatlas.ro/Renal%20Clear%20Cell%20Carcinoma.html
  2. ^ Israel GM, Bosniak MA. How I do it: evaluating renal masses. Radiology. 2005 Aug;236(2):441-50. PMID 16040900.
  3. ^ Oto A, Herts BR, Remer EM, Novick AC. Inferior vena cava tumor thrombus in renal cell carcinoma: staging by MR imaging and impact on surgical treatment. AJR Am J Roentgenol. 1998 Dec;171(6):1619-24. PMID 9843299.
  4. ^ Flanigan RC, Mickisch G, Sylvester R, Tangen C, Van Poppel H, Crawford ED. Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis. J Urol. 2004 Mar;171(3):1071-6. PMID 14767273.
  5. ^ Motzer RJ et al. (2007). "Sunitinib versus interferon alfa in metastatic renal-cell carcinoma". N Engl J Med 356 (2): 115–124. PMID 17215529. 
  6. ^ Motzer RJ et al.. "Phase 3 Randomized Trial of Sunitinib malate (SU11248) versus Interferon-alfa as First-line Systemic Therapy for Patients with Metastatic Renal Cell Carcinoma". Presented at ASCO 2006. Available at: http://www.asco.org/portal/site/ASCO/menuitem.34d60f5624ba07fd506fe310ee37a01d/?vgnextoid=76f8201eb61a7010VgnVCM100000ed730ad1RCRD&vmview=abst_detail_view&confID=40&index=y&abstractID=30512. 

  Results from FactBites:
 
Kidney Cancer: Renal Cell Carcinoma (RCC) (1198 words)
The cause of renal cell carcinoma is unknown, although tobacco and industrial carcinogens have been implicated.
Green: Symptoms/signs of RCC are generally caused by either invasion of the tumor beyond the confines of the kidney causing pain, hematuria (blood in the urine), or a flank mass.
RCC with hepatosplenomegaly, elevated alkaline phosphatase and serum haptoglobin, and prolonged prothrombin (bleeding) time is referred to as Staufer's Syndrome.
Renal Cell Carcinoma (11968 words)
Renal cell carcinoma is an adenocarcinoma of the kidney.
Cytology of morcellated renal specimens: significance in diagnosis and dissemination.
Of 952 consecutively histologically subtyped renal cell carcinomas, the incidence of sarcomatoid differentiation was 8% in conventional (clear cell) renal carcinoma, 3% in papillary renal carcinoma, 9% in chromophobe renal carcinoma, 29% in collecting duct carcinoma, and 11% in unclassified renal cell carcinoma.
  More results at FactBites »

 
 

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