Renal Cell Carcinoma
What is Renal Cell Carcinoma?
Renal cell cancer (RCC) is the most common malignancy of the kidney and accounts for approximately 3% of adult malignancies. It is estimated that the world wide incidence of renal cell carcinoma is increasing at an annual rate of approximately 2%. RCC is curable only in patients presenting with resectable, early-stage disease. Although a rare disease, the world wide mortality from RCC is expected to exceed 100,000 in the year 2000.
RCC arises from the proximal renal tubular epithelium. The stimulus for neoplastic transformation has not been identified, however many associations with etiologic factors have been evaluated. Cigarette smoking has been identified as a risk factor for the development of RCC. Studies also indicate that the incidence of RCC is significantly increased in endstage renal patients who develop acquired cystic kidney disease.
The most common presentation of renal cell cancer is a solitary renal mass that may cause symptoms of pain and hematuria. Although the tumors typically arise in the renal cortex, they may invade the renal vein and even extend into the inferior vena cava. Paraneoplastic syndromes such as hypercalcemia and hepatic dysfunction in the absence of liver metastases have been reported. The Robson staging classification divides stages into: confinement to the renal parenchyma (stage I), tumor extension into the perirenal fat (stage II), tumor involvement of the renal vein or inferior vena cava (stage IIIa), or tumor involvement of local hilar lymph node or other vascular structures (stage IIIb). Stage IV classifies tumors involving adjacent organs or distant metastasis. Approximately one-third of patients will have metastatic disease at presentation, and 40% of individuals undergoing surgical resection will eventually develop metastasis. Among individuals with metastatic disease approximately 75% exhibit lung metastasis, 36% have lymph node and/or soft tissue involvement, 20% have bone involvement, and 18% have liver involvement.
Renal Cell Carcinoma Diagnosis/Prognosis
Survival appears to be dependent mainly upon the extent to which the tumor has invaded and spread locally, and upon the presence or absence of distant metastasis. Once metastases develop, survival depends primarily on the extent of the disease, performance status, and the interval between nephrectomy and the appearance of metastasis. The outcome varies depending on the amount of metastasis. The 5-year survival, rate is around 60 to 75% if the tumor is in the early stages. If it has spread to the lymph nodes, 5-year survival is around 5 to 15%. If it has spread to other organs The probable outcome is poor, with 5-year survival at less than 5%. Despite the continued development of new chemotherapeutic agents and increased understanding of the biology, RCC remains fatal in nearly 80% of patients.
Surgical removal of all or part of the kidney is recommended. This may include removal of the bladder or surrounding tissues or lymph nodes.
Radiation therapy may be used to reduce the cancerís spread (metastasis), but a renal cell carcinoma is often resistant to radiation. It may be attempted before surgery to reduce the size of the tumor. Hormonal therapy may reduce the growth of the tumor in some cases.
Medications such as alpha-interferon and interleukin have been successful in reducing the growth of some renal cell carcinomas, including some with metastasis. Chemotherapy may be used in some cases, and it's results vary.
The stress of illness can often be helped by joining a support group where members share common experiences and problems.
American Cancer Society: National
General information on cancer research/statistics, treatments and living with cancer.
Eastern Cooperative Oncology Group
One of the largest clinical cancer research organizations in the United States, and conducts clinical trials in all types of adult cancers.
National Cancer Institute
A wide range of cancer information based on the latest research for patients, health professionals and basic researchers.
National Kidney Foundation
General information on kidney disease, donations and support groups.
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