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Wednesday, October 15, 2008

Renal cell carcinoma

Renal cell carcinoma (RCC) 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 but 90% of the time it is unsuccessful. It is resistant to radiation therapy and chemotherapy, although some cases respond to immunotherapy. Targeted cancer therapies such as sunitinib have improved the outlook for RCC, although they have not yet demonstrated improved survivalThe classic triad is hematuria (blood in the urine), flank pain and an abdominal mass. This is now known as the 'too late triad' because by the time patients present with symptoms, their disease is often advanced beyond a curative stage. In addition, whilst this triad is highly suggestive of RCC, it only occurs in around 15% of the sufferers. Today, the majority of renal tumors are asymptomatic and are detected incidentally on imaging, usually for an unrelated cause.
Signs may include:
Abnormal urine color (dark, rusty, or brown) due to blood in the urine (found in 60% of cases) Loin pain (found in 40% of cases) Abdominal mass (25% of cases) 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 known as varicocele (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)

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