Renal cell carcinoma

Renal cell carcinoma 

Updated: 05/05/2021

© Jun Wang, MD, PhD

General features
  • Most common type of kidney cancer in adults
  • Usually > 60 years old, but younger if in familial clusters
  • More common in male
  • Rarely bilateral
  • More common in people of Northern European ancestry (Scandinavians) and North Americans
  • In the US, slightly more common in blacks
Risk factors
  • Tobacco: Most significant risk factor
  • Obesity, especially in women
  • Hypertension
  • Longer usage of NSAID
  • Long term renal dialysis, probably associated with acquired cystic disease
  • Kidney transplantation
  • Genetic disorders:  von Hippel-Lindau syndrome, hereditary papillary renal carcinoma, Birt-Hogg-Dube syndrome, and hereditary leiomyomatosis and renal cell cancer syndrome
Clinical features
  • Various, most asymptomatic until advanced stage
  • Flank pain
  • Hematuria
  • Abdominal mass
  • Vascular manifestations: scrotal varicocele, inferior vena cava involvements (edema, ascites, abnormal liver functions, etc)
  • Paraneoplastic symptoms: Anemia, weight loss, hypertension, hepatic dysfunctions, fever, erythrocytosis, etc
  • Metastasis: common, most commonly in lung, bones, may occur long time after treatment (anytime, anywhere)
Classification
Markers
  • Positive: PAX8
  • Negative: Uroplakin (positive for urothelial carcinoma)
Diagnosis
  • Image studies
  • Biopsy
Treatment
  • Localized tumor: Surgery, cryotherapy, radiofrequency ablation, adjuvant therapy (immunotherapy, antiangiogenic therapy)
  • Advance tumor: Immunotherapy, molecular targeted therapy (VEGF inhibitor, mTOR inhibitor)


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