RENAL CANCER

Amy Karla Morales

RENAL CANCER
2-3% of all
cancers
5.8 incidence
1.4 mortality
/100,000

EPIDEMIOLOGY
incidence:
25 and 79
and the
peak 60 and
70

Age
30
25
20
15
10
5
0

Age

EPIDEMIOLOGY
30
25

Ratio-

1.5:1.0 men
over women
Race: African
Americans, American
Indian, Alaska Native
populations

20
15
10
5
0

Male
Female

EPIDEMIOLOGY

THE AMERICAN CANCER SOCIETY

2015:
61,560

new cases of kidney cancer (38,270 in

men and 23,290 in women)
About 14,080 people (9,070 men and 5,010
women) will die from this disease

ANATOMY OF THE KIDNEY

PHYSIOLOGY
Kidneys vital function:
Filtration
Blood Pressure Control
Red Blood Cell Synthesis
Bone Metabolism
Acid- Base Balance

ETIOLOGY

Lifestyle-related and job-related risk factors

- Dietary Intake
- Smoking
- Obesity
-Medical Conditions
- Medicines
- Workplace exposures

ETIOLOGY

Genetic

and hereditary risk factors

-Von Hippel-Lindau disease- VHL gene
- Hereditary papillary RCC- aMET proto oncogene
- Hereditary leiomyoma RCC- fumarate hydratase
- Birt-Hogg-Dube (BHD) syndrome- folliculin
- Tuberous Sclerosis- TSC1, TSC2
- Familial renal cancer
- Hereditary renal oncocytoma

STAGING

PROGNOSTIC FACTORS
1. Stage
2. Fuhrman system
3. Histological Type- Clear cell RCC
4. Tumor Size.
5. Microvascular Invasion
6. Patient Presentation
7. C-Reactive Protein and Erythrocyte
Sedimentation Rate

PATHOPHYSIOLOGY

1. Renal Cell Carcinoma 80-90%

2. Transitional cell carcinoma 5-10%
3. Wilms tumor (nephroblastoma) 5-6%
4. Renal sarcoma <1%

PATHOPHYSIOLOGY
Malignant renal cell tumors (adenocarcinoma)
About 9 out of 10 kidney cancers
1. Clear cell RCC. most common form; higher
stage and grade
2. Papillary RCC. little finger-like projections
a. Type 1
b. Type 2
3. Chromophobe RCC. huge pale cells

PATHOPHYSIOLOGY
4. Collecting duct RCC
5. Multilocular cystic RCC (MCRCC)
6. Medullary carcinoma
7. Renal carcinoma associated with Xp11.2
translocations/TFE3 gene fusions
8. RCC associated with neuroblastoma
9. Mucinous tubular and spindle cell carcinoma

SIGNS/SYMPTOMS
Diagnostic triad: gross hematuria, costovertebral pain,
flank mass
Pareneoplastic syndrome:
-Stauffers Syndrome
-Budd Chiari Syndrome
Hypercalcemia Anorexia
Fever/night sweats Hypertension
Cachexia Polyneuromyopathy
Amyloidosis Erythrocytosis
Thrombocytosis Anemia

CASE STUDY
Pt.-

36 y.o./female
CC: 6mos. Anorexia, weight loss
fatigue
Hx: Hyperthyroidism (enlarged)
Lab: serum enzymes, alkaline phosphatase
y-glutamyltransferase

DIAGNOSIS
Laboratory Test:
Urinalysis- hematuria
Complete Blood Count- anemia, polycythemia
Blood chemistry- liver enzymes, calcium

DIAGNOSIS

Imaging Test:
KUB
Intravenous Pyelogram

DIAGNOSIS
Renal Ultrasound
Computed tomography
MRI

PREVENTION
- Lifestyle Modification
- Screening

TREATMENTS

1. Targeted Therapy: inhibit or interfere with

specific molecular pathways in cancer cell
growth.
2. Biologic therapy (Immunotherapy): boost the
body's natural defenses to fight cancer.

TREATMENTS
3. Surgery:
- Radical nephrectomy
-Partial nephrectomy(nephron-sparing) video
-Radical Nephroureterectomy
- Regional lymphadenectomy
- Adrenalectomy
Surveillance:
Stage 1: yearly monitoring, P.E, blood studies
Stage 2: yearly, P.E., blood studies, xray and Ctscan
(every 2 years)
Stage 3: 6 mos, blood studies, xray, ctscan
Stage 4: 2-3mos,

TREATMENTS

4. Cryotherapy (cryoablation) video

5. Radiofrequency ablation (RFA)
6. Arterial embolization
7. Active surveillance
8. Radiation therapy
9. Chemotherapy

THANK YOU....

VON HIPPEL-LINDAU DISEASE