Carsinoma Doctor

Archive for the ‘Renal Cell Cancer’ Category

Renal cell carcinoma originates in the proximal renal tubular epithelium. Kidney cancer occurs in a hereditary and nonhereditary (most frequently the latter), and both forms are associated with structural alterations of the short arm of chromosome 3 (3p).

Is associated with genes, tumor suppressor genes (VHL, TSC) or oncogenes (MET).

There are at least 4 hereditary syndromes associated with renal cell carcinoma:
1) The von Hippel-Lindau (VHL), which is a familial syndrome associated with various cancers, among which we quote:

* Renal cell carcinoma with clear cell histology
* Pheochromocytoma
* Pancreatic cysts and tumors of islet cell
* Retinal angiomas
* The central nervous system hemangioblastomas
* Endolymphatic sac tumors
* Epididymal cystadenomas

Renal cell carcinoma develops in nearly 40% of patients with von Hippel-Lindau and is a major cause of death among these patients.

2) hereditary papillary renal carcinoma (HPRC) is an inherited disorder with an autosomal dominant pattern, affected individuals develop a severe form of bilateral papillary renal carcinoma and multifocal (ie develops MABOS kidney disease and in different parts of each kidney at a time).

3) familial renal oncocytoma (FRO) associated with Birt-Hogg Dube (BHDS), this syndrome also develops multifocal or bilateral forms. Patients with this syndrome have an inherited predisposition to develop benign tumors of hair follicle (ie fibrofolliculomas), predominantly in the face, neck and upper trunk, and are at risk of developing renal tumors, colon tumors or polyps and lung cysts.

4) hereditary renal carcinoma (HRC).

Incidence of renal cancer
We have no statistical Peru. In the United States of America estimated 60 000 new cases with 13 deaths during 2009.

Macroscopically tumor is a variegated appearance with yellowish areas, other white, necrotic, others red or hemorrhagic cystic areas and other hyaline or involution. The tumor compresses and infiltrates the renal tissue, the excretory system of the urinary tract, and often invades the veins, lymphatics, capsule and renal cell.

Microscopically the tumor is solid forms, tubular, or papillary cordonal and consists of large polygonal cells, limits net central core of cytoplasm relatively small and light (for the extraction of lipids and glycogen to make up). Cells and their arrangement are similar to those of a plant tissue. There are other less common cell types, such as chromophobe cells and cells fusadas, the latter can simulate a sarcoma. To establish the prognosis is necessary to evaluate the histologic grade: group 1 are better differentiated and less atypia, those in group 3, the worst differentiated, the latter are highly pleomorphic or sarcomatoid forms.

Metastases occur most frequently in skin, bone, lungs, central nervous system, liver and lymph nodes. At the time of nephrectomy prognostic value Robson classification into 4 stages.

Robson stages:

1: tumor confined to the kidney, no invasion of capsule, vein or pelvicalyceal apparatus;

2: invasion of the perirenal cell;

3: invasion of the renal vein, vena cava or regional lymph node metastases;

4: distant metastasis or invasion of adjacent organs (adrenal glands, spine).

Benign tumors of the kidney are relatively common, especially in atrophic kidneys of adults and the elderly. They are usually very small, a few millimeters in diameter and are usually as autopsy findings, as they have no clinical manifestations. These include fibroids of the marrow and renal cortex, found in 10 to 35% of autopsies, and cortical adenomas, which are observed in 20% of the autopsies.

Adenomas are benign tumors of renal cell can be tubular or papillary. When they are larger than 3 cm in diameter, are difficult to distinguish from renal cell carcinomas and in this case are considered tumors of uncertain biological behavior.

Benign tumors of the kidney are very characteristic: the reninoma, oncocytoma and angiomyolipoma

Reninoma

Is a tumor of the juxtaglomerular apparatus consisting of renin-producing cells. This substance can be identified by immunohistochemistry and electron microscopy. Usually not a large tumor and clinically manifests with hypertension.

Oncocytoma

Is a tumor composed of oncocytic renal cell (cells rich in mitochondria). This tumor can be large and resemble a renal cell carcinoma.

Angiomyolipoma

This tumor belongs to the group of hamartomas. It consists of mature adipose tissue, blood vessels without elastic fibers and smooth muscle fiber bundles. Its size is variable, can reach 20 cm in diameter. In 80% of cases are associated with cerebral tuberous sclerosis (Bourneville disease). It is observed more frequently in women between 40 and 50 years of age. Clinically manifested by pain, fever, hematuria and hypertension.

We recommend surgical removal of the whole kidney or part of it ( nephrectomy ). This process may include removal of the bladder, surrounding tissue or lymph nodes.

Radiation therapy is usually not effective in the treatment of renal cell carcinoma and for that reason, not often used. In some cases, hormone treatments can reduce tumor growth.

Medications such as alpha interferon and interleukin, have been effective in reducing the growth of some renal cell carcinomas, including some that have spread. In December 2005, the Food and Drug Administration of the United States approved a new type of drug, called Nexavar for adults with advanced renal cell carcinoma. The drug works by restricting the blood supply to the tumor.

In some cases, you can resort to the chemotherapy , but you may not achieve a complete cure, unless you can completely remove the cancer with surgery.

Renal cell carcinoma is a type of kidney cancer. Cancer cells are found in the lining of very small tubes (tubules) in the kidney. It is the most common type of kidney cancer in adults.

Alternative Names

Adenocarcinoma of renal cell kidney cancer, hypernephroma, renal cancer

Causes and Risk Factors

Renal cell carcinoma affects about 3 in 10,000 people, which means about 32,000 new cases per year in the U.S.. Each year, about 12,000 people in the U.S. die from renal cell carcinoma. It is more common in people between 50 and 70 years of age and usually affects men.

There is no known exact cause.

Among the risk factors include:

• Smoking
• Genetic factors
• Family history of disease
• Dialysis

The von Hippel-Lindau disease, an inherited disease that affects the capillaries of the brain.
The first symptom is usually the presence of blood in the urine. Sometimes both kidneys are affected. The cancer spreads easily, most often to the lungs and other organs. About a third of patients have disease spread ( metastases ) at diagnosis.

Symptoms

• Blood in urine
• Abnormal urine color (dark, rusty, or brown)
• Flank pain
• Back pain
• Abdominal pain
• Involuntary weight loss , more than 5% of body weight
• Emaciated, thin, malnourished
• Enlargement of a testicle
• Swelling or enlargement of the abdomen

You can use the following tests and procedures:

Physical exam and history: An exam of the body to check general health and identify any signs of disease, such as lumps or anything else that seems unusual. Also recorded data on patient health habits and past illnesses and treatments.

Studies of blood chemistry : A procedure which checks a blood sample to measure the amounts of certain substances released into it by the organs and tissues of the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.

Urinalysis : A test to determine the color of urine and its contents, such as sugar, protein, red blood cells and white blood cells .

Liver function test : A procedure which checks a blood sample to measure the amount of enzymes released into the blood by the liver . A number abnormal of an enzyme may be a sign that the cancer has spread to the liver. Certain diseases that are not cancer may also increase concentrations of liver enzymes.

Intravenous pyelogram (IVP): A series of radiographs of the kidneys, ureters and bladder to determine if cancer is found in these organs. It injects a dye into the vein. As of this dye moves through the kidneys, ureters and bladder, x-rays to see if there is any obstruction.

Ultrasound : A procedure which bounce high-energy sound waves (ultrasound) off internal tissues or organs and make echoes. The echoes form a picture of body tissues on a screen.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body from different angles. The images are created by a computer linked to an x-ray machine Dye is injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography or CT scan.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves and a computer to create a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Biopsy : The removal of cells or tissues so that a pathologist viewed under a microscope for signs of cancer. To perform a biopsy of renal cell cancer, a thin needle is inserted into the tumor and removes a tissue sample.