Harrison's Internal Medicine Chapter 90. Bladder and Renal Cell Carcinomas
A transitional cell epithelium lines the urinary tract from the renal pelvis to the ureter, urinary bladder, and the proximal two-thirds of the urethra. Cancers can occur at any point: 90% of malignancies develop in the bladder, 8% in the renal pelvis, and the remaining 2% in the ureter or urethra. Bladder cancer is the fourth most common cancer in men and the thirteenth in women, with an estimated 67,160 new cases and 13,750 deaths in the United States predicted for the year 2007.
Renal Cell Carcinoma
Renal cell carcinomas account for 90–95% of malignant neoplasms arising from the kidney. Notable features include resistance to cytotoxic agents, infrequent responses to biologic response modifiers such as interleukin (IL) 2, and a variable clinical course for patients with metastatic disease, including anecdotal reports of spontaneous regression.
The incidence of renal cell carcinoma continues to rise and is now nearly 51,000 cases annually in the United States, resulting in 13,000 deaths. The male to female ratio is 2:1.
The presenting signs and symptoms include hematuria, abdominal pain, and a flank or abdominal mass. This classic triad occurs in 10–20% of patients. Other symptoms are fever, weight loss, anemia, and a varicocele (Table 90-4). The tumor can also be found incidentally on a radiograph. Widespread use of radiologic cross-sectional imaging procedures (CT, ultrasound, MRI) contributes to earlier detection, including incidental renal masses detected during evaluation for other medical conditions.
Renal Cell Carcinoma: Treatment
Localized Tumors The standard management for stage I or II tumors and selected cases of stage III disease is radical nephrectomy. This procedure involves en bloc removal of Gerota's fascia and its contents, including the kidney, the ipsilateral adrenal gland, and adjacent hilar lymph nodes. The role of a regional lymphadenectomy is controversial. Extension into the renal vein or inferior vena cava (stage III disease) does not preclude resection even if cardiopulmonary bypass is required.
The primary goal of treatment for metastatic disease is to achieve complete remission with chemotherapy alone or with a combined-modality approach of chemotherapy followed by surgical resection of residual disease, as is done routinely for the treatment of germ cell tumors. One can define a goal in terms of cure or palliation on the basis of the probability of achieving a complete response to chemotherapy using prognostic factors, such as Karnofsky Performance Status (KPS) (...
Despite the aberrant expression of cholinesterases in tumours, the question of
their possible contribution to tumorigenesis remains unsolved. The identifica-tion in kidney of a cholinergic system has paved the way to functional studies,
but details on renal cholinesterases are still lacking. To fill the gap and to
determine whether cholinesterases are abnormally expressed in renal
tumours, paired pieces of normal kidney and renal cell carcinomas (RCCs)
were compared for cholinesterase activity and mRNA levels....
Angiogenic switch in renal cell carcinoma (RCC) is attributed to the
inactivation of the von Hippel–Lindau tumor suppressor, stabilization of
hypoxia inducible factor-1 transcription factor and increased vascular
endothelial growth factor.
Ung thư tế bào vảy thường gặp thứ hai trong ung thư da sau ung thư tế bào đáy. Dịch tễ học Tần số: tỷ lệ mắc bệnh SCC rất khác nhau giữa các nước. Australia là một trong những nước có tỷ lệ mắc bệnh cao nhất 1.332 ca/100.000 dân đối với nam và 755 ca/100.000 dân đối với nữ; vì đây là nước có nhiều người da trắng và phơi nhiễm với ánh nắng mặt trời mạnh. Ở Mỹ khoảng 107 ca/100.000 dân. Chủng tộc: SCC đứng thứ hai trong ung thư da của người da trắng....
Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành hóa học dành cho các bạn yêu hóa học tham khảo đề tài:
Prognostic significance of Oct4 and Sox2 expression in hypopharyngeal squamous cell carcinoma
Until recently, surgical resection was considered the only option for treatment of kidney
cancer, especially renal cell carcinoma. The disease is relatively resistant to both radiotherapy
and chemotherapy, and although alternative systemic therapies such as interleukin-
2 immunotherapy and interferon have shown promise, objective response rates are
still quite low. Minimally invasive therapies have piqued the interest of researchers by
showing significant improvements in treatment and management of kidney cancer.
Summarizing a decade of scientific advance and therapeutic innovation, Renal Tumor offers all physicians treating kidney cancer, as well as researchers, updated information concerning the epidemiology, biology, and treatment of renal cell carcinoma. Contributors to this book are from all over the world and are experts in their individual fields.
The multicentric nature of the disease and high rate of recurrence has led to the hypothesis of a field defect in the urothelium that results in a predisposition to cancer. Molecular genetic analyses suggest that the superficial and invasive lesions develop along distinct molecular pathways in which primary tumorigenic aberrations precede secondary changes associated with progression to a more advanced stage.
Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Radiation Oncology cung cấp cho các bạn kiến thức về ngành y đề tài: Stereotactic body radiation therapy for melanoma and renal cell carcinoma: impact of single fraction equivalent dose on local control...
Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Primary osteosarcoma of the urinary bladder treated with external radiotherapy in a patient with a history of transitional cell carcinoma: a case report
Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Human papillomavirus-mediated carcinogenesis and HPV-associated oral and oropharyngeal squamous cell carcinoma. Part 1: Human papillomavirus-mediated carcinogenesis