Accounts for approximately 90% of all primary renal neoplasms.
Tumors arise from tubule epithelial cells in the renal cortex; they tend to occur at the renal poles, and can range from 1 cm to several times the size of the kidney.
Renal cell carcinoma is often asymptomatic until it reaches an advanced stage, at which point patients may present with hematuria, abdominal masses and pain, weight loss, and anemia.
Another sign to look for is a non-reducing right-sided varicocele, which is an enlargement of the veins that drain the testis. Varicoceles are caused by right renal vein occlusion, which drains the right testicular venous system.
Paraneoplastic disease, including hypertension, hypercalcemia, and polycythemia, develops in a minority of patients.
We need to look for metastases, particularly in the lung, liver, brain, and bone.
Be aware that renal cell carcinoma can trigger thrombus formation in the renal vein or inferior vena cava and disseminate hematogenously.
Risk factors for renal cell carcinoma include:
Acquired polycystic kidneys (i.e., in dialysis patients), cigarette smoking, hypertension, diabetes, chronic analgesic use, and exposure to various chemicals, particularly trichloroethylene.
Genes associated with renal cell carcinoma include VHL and PBRM-1; both are tumor suppressor genes located on chromosome 3.
Black men in their 60's and 70's are at higher risk of renal cell carcinoma.
Patients with the familial syndrome Von Hippel Lindau have an increased risk of renal cell carcinoma
Von Hippel Lindau is an autosomal dominant disorder characterized by the growth of cysts and tumors in the kidneys, CNS, retina, reproductive organs, pancreas, and adrenal glands.
The most common subtype of renal cell carcinoma is clear-cell renal cell carcinoma, followed by the papillary and chromophobe subtypes.
Clear-cell renal cell carcinoma is characterized by strands of fibrosis weaving among collections of polygonal clear cells filled with lipids and carbohydrates, which give the tumor a yellowish color.
Diagnosis: We can diagnose renal cell carcinoma with contrast CT or MIR;
Treatments include partial or radical nephrectomy with possible chemotherapy.
Research currently focuses on immune-checkpoint therapies, because renal cell cancer cells induce apoptosis of cytotoxic lymphocytes.