Renal cell carcinoma RCC is a kidney cancer that originates in the lining of the proximal convoluted tubule , a part of the very small tubes in the kidney that transport primary urine. RCC most commonly occurs between 6th and 7th decade of life. Initial treatment is most commonly either partial or complete removal of the affected kidney s. The body is remarkably good at hiding the symptoms and as a result people with RCC often have advanced disease by the time it is discovered.
|Published (Last):||10 July 2017|
|PDF File Size:||10.16 Mb|
|ePub File Size:||7.73 Mb|
|Price:||Free* [*Free Regsitration Required]|
Most commonly, it is found in patients older than 40 years of age with a male predominance. One-third of tumors are palpable at the time of diagnosis, and one-third present with abdominal or flank pain. The diagnosis of renal carcinoma may be late, often occurring due to a metastasis or at autopsy.
Patients often present with constitutional symptoms or paraneoplastic syndromes. Common among these are fever, which may be low grade or intermittent. Other symptoms and signs are the development of anorexia, weight loss, feminization or masculinization, Cushing syndrome, and hypertension.
A few patients develop massive leukocytosis, eosinophilia, and hypercalcemia, which may be accompanied by metastases, thrombophlebitis, varicocele, endocrine syndromes, or amyloidosis. Signs of tumor extension are renal vein occlusion of the vena cava, potentially up to the right atrium, or spontaneous rupture of the kidney with retroperitoneal hemorrhage.
Thus, one should perform a urinalysis with microscope to quantify the amount of hematuria and to rule out other diseases, such as infection leukocytes and bacteria or primary renal disease casts. Urine cultures are useful in establishing the presence of infection, as well as ruling it out.
Evaluation of hematuria is the most common laboratory test, and its knowledge of its differential diagnosis is important. Pseudohematuria can be caused by food, such as beets, or food dyes. It may be caused by certain medications, such as phenytoin, rifampin, or pyridium.
Pigments, such as porphyria, myoglobin, or hemoglobin, also appear as hematuria. The latter usually results from intravascular hemolysis. In the renal parenchyma, post-infectious glomerulonephritis, thin basement membrane disease, IgA nephropathy, membranoproliferative glomerulonephritis, focal glomerulosclerosis, and crescentic glomerulonephritis all represent primary glomerular causes of hematuria.
Other causes of hematuria are acute pyelonephritis, nephrolithiasis, renal cyst, renal trauma, other urinary tract neoplasms, such as transitional cell carcinoma of the renal pelvis, ureters, or bladder, low clotting factors, thrombocytopenia, acute interstitial nephritis, analgesic nephropathy, sickle cell trait or disease, medullary sponge kidney, malaria, papillary necrosis, and renal infarction. Lower urinary tract abnormalities cause hematuria, such as cystitis, prostatitis, urethritis, trauma, foreign body, calculi, varices, radiation cystitis, cyclophosphamide, anticoagulants, schistosomiasis, and tuberculosis.
Non-urinary tract causes of hematuria include appendicitis, pelvic inflammatory disease, diverticulitis, and neoplasms of adjacent organs. Interstitial nephritis can be caused by penicillins and cephalosporins, sulfonamides, sulfonamide-containing diuretics, NSAIDs, rifampin, phenytoin, and allopurinol. Proteinuria and protein casts suggest a renal origin. Bacteria in the urine and positive urine cultures suggest infectious causes. Further evaluation includes cytology, upper tract imaging, and cystoscopy.
There is no specific laboratory medicine test that absolutely confirms the diagnosis of renal cell carcinoma. Localization of the tumor relies on imaging studies, and confirmation of the diagnosis depends on histopathological identification of tissue. IL-2R: Serum levels increase with the stage of the tumor; preoperative level remains elevated for at least 3 months.
Only TNF-alpha is also an independent prognostic indicator. A normal plasma TNF-alpha is highly predictive of a good prognosis in patients with untreated renal cell carcinoma. Survival time for patients with serum levels above median level is significantly longer than for patients with lower levels.
E-selectin: High concentrations in patient sera correlate with low incidence of metastasis and, consequently, correlate with good prognosis. Expression of elevated E-selectin facilitates metastasis. However, excessive production of E-selectin in the serum is said to have an inhibitory effect against metastasis. All three are also significantly higher in C-reactive protein CRP -positive patients. Many of the follow-up tests may be affected by other conditions.
Because these tests, such as IL-6, TNF-alpha, and IL2-R, are markers of the inflammation, conditions related to infection or other causes of inflammation may affect the results. All rights reserved. No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. Login Register. We want you to take advantage of everything Cancer Therapy Advisor has to offer. To view unlimited content, log in or register for free.
Register now at no charge to access unlimited clinical news, full-length features, case studies, conference coverage, and more. Powered By Decision Support in Medicine. In addition, what follow-up tests might be useful? In particular, does your patient take any medications - OTC drugs or Herbals - that might affect the lab results?
Popular Emailed Recent Loading Please login or register first to view this content. Open Next post in LabMed Close. Wilms Tumor. Close more info about Renal Cell Carcinoma. Want to view more content from Cancer Therapy Advisor?
Renal Cell Carcinoma
Renal cell carcinoma (Grawitz tumor)
Malignant parenchymal neoplasms are: 4 common or conventional clear cell renal carcinoma , 5 papillary formerly chromophilic or tubulopapillary renal carcinoma , 6 chromophobe renal carcinoma , 7 collecting duct carcinoma, and 8 renal cell carcinoma, unclassified. Clinics and Pathology Note Although common RCC and papillary RCC both are derived from the same part of the renal tubule and have a similar antigenic phenotype, they differ in genetic changes. This might be explained by the fact that common RCC arises from mature renal tubular cells, whereas papillary tumors are from embryonal origin. Embryonic origin In former times it was believed that certain clear cell epithelial renal tumors are derived from ectopic adreno-cortical elements as expressed by Virchow and advocated by Grawitz. This has led to the term hypernephroma or Grawitz tumor. Nowadays, there is evidence that the usual nonembryonic RCC in all its variants derives, in principle, from the mature uriniferous tubule nephron.