Renal cell carcinoma accounts for about 2.5% of adult cancers. It usually occurs in the fifth to sixth decades of life and has a male: female ratio of 2: 1. The frequency is higher in blacks than in Hispanics and Orientals. Every year 30,000 new cases are reported in the US and it is associated with 12,000 deaths. The frequency increases in more urbanized cities.
Two variants of hereditary kidney cancer have been shown. One is Von Hippel-Lindau disease is a familial cancer syndrome in which affected individuals have a predisposition to develop tumors in various organs.
Cerebellar hemangioblastoma, retinal angiomas and clear bilateral RCC. The other variant is hereditary papillary renal carcinoma. It is characterized by a predisposition to develop multiple bilateral renal tumors with papillary histological appearance.
The cause of renal cell carcinoma is not known. It is associated with some risk factors:
- Dialysis treatment
- Family history of the disease
Von Hippel-Lindau disease
The associated symptoms can be local and general, these can be diverse or simply do not give symptoms until advanced stages, the most frequent symptoms are:
- Abdominal pain
- Abnormal urine color (dark, brown, or rusty)
- Back pain
- Blood in the urine or change in urine color. 60% of patients.
- Appearance haggard, thin, and malnourished
- Enlargement of a testicle
- Side pain 40% of patients.
- Swelling or enlargement of the abdomen
- Weight loss of more than 5% of body weight.
- The triad of symptoms is: blood in urine, flank pain, and a palpable mass. This is common in only 10 to 15% of patients.
Symptoms in advanced or metastatic stages are:
Shortness of breath and cough, seizures, headache, bone pain. This by metastasis or seeding in: lung, brain, bones. These signs constitute the diagnosis in 30%.
Paraneoplastic syndromes are manifestations of symptoms and signs secondary to the renal tumor. These are:
Erythrocytosis 3-10%, Hypercalcemia 20%, hypertension 40%, staufer syndrome 3-20% this is liver dysfunction in the absence of metastasis.
Other symptoms that can occur with this disease:
- Cold intolerance
- Excessive hair growth in women
- Vision abnormalities
Signs and tests
Palpation of the abdomen may show a mass at the level of the kidney or an enlarged organ, especially the kidney or liver. Men can develop a varicocele on the testicles. (A varicocele that is only on the right side is especially suspicious.)
The exams cover:
- Complete blood count (CBC)
- Intravenous pyelography
- X-ray of the kidneys
- Liver function tests
- Renal arteriography
- Serum calcium
- Serum glutamate pyruvate transaminase (also called ALT) and alkaline phosphatase
- Ultrasound of the abdomen and kidneys
- Urinary cytology
- Urine test
The following tests should be done to find out if the cancer has spread:
- CT scan of the abdomen
- Magnetic resonance imaging (MRI) of the abdomen
- Bone scintigraphy
- Chest x-ray
The ideal treatment is total or partial nephrectomy in very select cases. For some types of kidney cancer whose neoplastic origin comes from the renal pelvis, treatment will include the ureter and the insertion site of the ureter in the bladder. As well as the resection of lymph nodes in surrounding tissues.
Radiation therapy and chemotherapy are not effective in kidney cancer. Currently the use of new drugs such as Sorafenib, sunitinib, temsirolimus, bevacizumab have encouraging effects in advanced prostate cancer.
Immunotherapy with interferons and interleukins has a response of 12% on average, which is why it is part of the treatment in these patients.
The curability will be determined by the complete resection of the tumor and the follow-up.