Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Large cell non-Hodgkin’s lymphoma masquerading as renal carcinoma with inferior vena cava thrombosis: 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: Adhesions due to peritoneal carcinomatosis caused by a renal carcinoma leading to mechanical gastric outlet obstruction: 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: Renal carcinoma infiltrating inferior vena cava and combined valvular heart disease - one-stage uro-cardiological procedure: a case report
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.
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.
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.
In 1999 it was estimated that renal cell carcinoma (RCC) would account for
29,990 new cancer cases diagnosed in the United States (61% in men and 39%
in women), and lead to 11,600 deaths. RCC accounts for 2–3% of all malignancies
in adults and causes 2.3% of all cancer deaths in the United States
annually (1). Approx 4% of all RCC cases are bilateral at some point in the life
of the patient. Data from over 10,000 cases of renal cancer entered in the
Connecticut Tumor Registry suggests an increase in the incidence of renal
cancer from 1935–1989; in women the incidence increased from 0.
I have been involved in the treatment of chronic renal insuffi ciency for 40 years,
beginning with peritoneal dialysis immediately after graduation from medical school
in 1965, then with hemodialysis in 1967 after I fi rst experienced it in Kanazawa, and
with renal transplantation since 1972, when I was studying in the United States.
During this period, the number of dialysis patients has continued to increase rapidly
to the present fi gure of 257 765 (at the end of 2005), and with surprising increases in
the survival rate.
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.
In the past 15 years, molecular biologists and geneticists have uncovered
some of the most basic mechanisms by means of which normal stem cells
in a certain organ or tissue develop into cancerous tumors. This biological
knowledge serves as a basis for various models of carcinogenesis.
While most autosomal dominant inherited cancer syndromes are due to mutations in tumor-suppressor genes (Table 79-1), there are a few interesting exceptions. Multiple endocrine neoplasia type II, a dominant disorder characterized by pituitary adenomas, medullary carcinoma of the thyroid, and (in some pedigrees) pheochromocytoma, is due to gain-of-function mutations in the protooncogene RET on chromosome 10. Similarly, gain-of-function mutations in the tyrosine kinase domain of the MET oncogene lead to hereditary papillary renal carcinoma.
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...
The treatment of a tumor that has invaded muscle can be separated into control of the primary tumor and, depending on the pathologic findings at surgery, systemic chemotherapy. Radical cystectomy is the standard, although in selected cases a bladder-sparing approach is used; this approach includes complete endoscopic resection; partial cystectomy; or a combination of resection, systemic chemotherapy, and external beam radiation therapy. In some countries, external beam radiation therapy is considered standard.