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Source: Walko CM, La-Beck NM, Walsh
MD. Renal Cell Carcinoma. In: DiPiro, JT, Talbert RL, Yee GC, Matzke
GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach.
8th ed. http://accesspharmacy.com/content.aspx?aid=8011227.
Accessed August 6, 2012.
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- Malignant tumor of kidney
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- Genetic factors contribute to 15% of cases of
renal cell carcinoma (RCC); remaining 85% believed to be
sporadic.
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- Clear cell RCC
- Predominant subtype responsible
for most cases.
- Affects proximal tubule.
- Likely to metastasize.
- Results from inactivation of von Hippel-Lindau (VHL) tumor
suppressor gene on chromosome 3p25.
- Leads to increased
production of growth factors, including:
- Vascular
endothelial growth factor (VEGF)
- Transforming growth factor (TGF)
- Platelet-derived growth factor (PDGF), as well as others responsible
for angiogenesis and cell growth
- Papillary RCC types 1 and 2
- Occur in proximal
tubule.
- Account for 5–10% of RCC cases.
- More favorable prognosis than clear cell.
- Prognosis
with type 1 better than type 2.
- Associated with multiple genetic abnormalities.
- Chromophore and oncocytoma subtypes
- Occur
in intercalated cells of collecting system.
- Account for 5–10% of RCC cases
- Associated with wide variety of chromosomal abnormalities.
- Oncocytomas relatively benign and rarely metastasize.
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- Fifth most common cancer in men; sixth most common in
women.
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- Most cases diagnosed incidentally following computed tomography
(CT) scans done for unrelated reasons.
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- Classic triad symptoms, seen in <10% of patients:
- Flank pain
- Hematuria
- Palpable abdominal mass
- Other presenting symptoms are:
- Fatigue
- Weight loss
- Anemia
- Hypertension
- Fever
- Lower extremity edema
- Metastatic disease symptoms:
- Bone pain
- Adenopathy
- Pulmonary
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Means of Confirmation
and Diagnosis
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- Complete blood count (CBC)
- Metabolic panel
- Lactate dehydrogenase
- Coagulation profile
- Urinalysis
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- CT: contrast and noncontrast of chest, abdomen, and pelvis or
- MRI of chest, abdomen, and pelvis
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- Biopsy of surgical specimen
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- Tumor staging utilizes TNM system.
- Factors associated with prognosis include:
- Positive
surgical margins
- Metastatic spread
- Presence of sarcomatoid architecture
- Tumor subtype, grade, and stage
- Tumor stage
most powerful prognostic indicator.
- Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic
Factors Model was developed for patients with metastatic disease.
- Low risk: No poor prognostic risk factors present.
- Intermediate risk: One or two factors
- High risk: ≥3 factors (Table 1)
- These criteria used by clinicians to determine optimal therapy.
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