Renal cell carcinoma is a type of cancer of the kidneys. VHL mutation is the most common risk factor for renal cell carcinoma. Renal cell carcinoma is divided into four stages depending on whether they have spread to other parts of the body or not. Stage 4 renal cell carcinoma is also called metastatic renal cell carcinoma. The common treatment option for non-metastatic renal cell carcinoma (up to stage 3) is surgery. Some of the medications for metastatic renal cell carcinoma include sunitinib, sorafenib, pazopanib, temsirolimus, everolimus and bevacizumab.
What is renal cell carcinoma?
Renal cell carcinoma is a type of kidney cancer. Kidney cancer is a general term for all types of cancers that arise in the kidney. Of these types, renal carcinoma is the most common, accounting for about 80% of kidney cancer. The remaining 20% is composed of various types such as transitional cell carcinoma, renal sarcoma and Wilm’s tumor.
Kidney cancer or renal cell carcinoma refers to a group of cancers that arise in the kidneys.
What are the major types of renal cell carcinoma?
The most common type of renal cell carcinoma is clear cell renal cell carcinoma. About 70-80% of renal cell carcinomas are clear cell renal cell carcinoma. The second major type of renal cell carcinoma is papillary renal cell carcinoma. About 10-15% of renal cell carcinomas are papillary renal cell carcinomas. The third major type is chromophobe renal cell carcinoma. Approximately 5% of renal cell carcinoma are chromophobe renal cell carcinoma. The fourth type is the collecting duct renal cell carcinoma. When compared with other types of renal cell carcinoma this is a minor type accounting for approximately 1% of renal cell carcinoma.
What are the risk factors for renal cell carcinoma?
There are many risk factors for renal cell carcinoma. These can be generally grouped as genetic and non-genetic risk factors. The most common genetic risk factor for renal cell carcinoma, especially the clear cell renal cell carcinoma, is a non-functional VHL gene (von Hippel-Lindau gene). One of the functions of VHL gene is tumor suppression, which means the VHL gene functions properly it blocks the development of renal cell carcinoma.
When it becomes non-functional for various reasons (some of these ‘reasons’ are technically called mutations, hyper-methylations and loss of heterozygosity) it causes renal cell carcinoma.The non-genetic risk factors for renal cell carcinoma include cigarette smoking, high blood pressure (hypertension), long term dialysis, obesity, certain medications, work-related chemicals (occupational exposure) and male gender. Renal cell carcinoma is about three times higher in males than females.
What are the stages of renal cell carcinoma?
Renal cell carcinoma is classified into four stages depending upon their size, location and whether they have spread to other parts of the body or not. Stage 1 renal cell carcinoma is the early stage. In this, the size of the tumor is up to 2 3/4 inches (7 centimeters), and is restricted to the kidneys. Stage 2 renal cell carcinoma is still considered early stage, and the tumor is still restricted to the kidneys, but the tumor is bigger than stage 1.
Stage 3 renal cell carcinoma is where the tumor starts to spread to the organs surrounding the kidneys. For example the tumor may have spread to organs such as the adrenal gland, one nearby lymph node, veins, fat and fibrous tissue surrounding the kidneys. Stage 4 renal cell carcinoma is really bad. The tumor has already spread to other parts of the body. This is also called metastasis. The most common sites of metastasis of renal cell carcinoma are lungs, bones and lymph nodes.
What are the symptoms of renal cell carcinoma?
There are no symptoms that are specific to renal cell carcinoma. Therefore, people are not aware of it until it is very late. In advanced cases patients may have some symptoms. Talk to your doctor if you experience one or more of the following symptoms: Hematuria – blood in the urine; changes in urine color – dark, rusty or brown; lower back pain for unknown reasons; pain or lump in the belly area or other body parts; constant tiredness; unplanned but rapid weight loss.
How is renal cell carcinoma diagnosed?
If your doctors suspects that you have renal cell carcinoma, you doctor may perform one or more of the following tests. Physical examination for general health, high blood pressure, and any abdominal lumps. Urine tests for the presence of blood, change in color. Blood tests for creatinine and anemia. Intravenous pyelogram or IVP: A dye is injected into the vein, which accumulates in the kidneys. The accumulated dye is detected with X-rays. Computerized tomography scan or CT scan: In this procedure, a scanner scans the body and takes detailed pictures of the kidneys, which are put together by a computer to identify renal cell carcinoma. Ultrasound scan: High-frequency sound waves that humans cannot hear are directed toward the kidneys by specialized machines. The waves hit the kidneys and bounce back like an echo. These echoed waves are put together by a computer to produce images of the kidneys, which is also called a sonogram. Biopsy: A tiny portion of the kidney is removed using a biopsy needle, which is examined by a Pathologist looks for cancerous cells.
What are the treatment options for renal cell carcinoma?
There are many treatment options for renal cell carcinoma, which are mostly determined by the stage of the tumor. These treatment options include surgery, arterial embolization, radiation therapy, biological therapy, chemotherapy and targeted therapy. Some may have a combination of treatments.
Surgery as a treatment option for renal cell carcinoma: Surgery is the treatment of choice if the cancer has not spread to other parts of the body – mostly for stages 1 to 3. It involves the removal of kidneys – technically called nephrectomy. The nephrectomy can be either partial or radical. Partial nephrectomy: In this procedure, only the tumor portion and surrounding tissues of the kidneys are removed. The remaining portion of the kidney is left intact to perform its normal functions. Radical nephrectomy: In this procedure the affected kidney is removed entirely. For stage IV, usually medications are given with or without a combination of surgery.
Arterial embolization as a treatment option for renal cell carcinoma: Arterial embolization is a deliberate attempt to block a specific artery so that the organ that depends on that artery for blood supply and nutrients doesn’t get enough oxygen and nutrients. If it is a tumor, then the tumor shrinks and eventually dies. For renal cell carcinoma the artery that undergoes embolization is the renal artery. A narrow tube (catheter) is inserted into the renal artery, and then a substance (emboli) is inserted into the artery through the catheter which blocks the flow of blood into the kidneys.
Radiation therapy as a treatment option for renal cell carcinoma: If the renal cell carcinoma has spread to other parts of the body, then radiation therapy is performed. Radiation therapy uses high energy radiations to kill cancer cells. There are three types of radiation therapy: external beam, internal beam and stereotactic radiation therapy. External beam radiation therapy is the most common form of radiation treatment. Radiation is given from a machine outside the body. In internal beam radiation therapy or brachytherapy, radiation is given using implants. Usually the implant is directly implanted into the tumor. Stereotactic radiotherapy is a special procedure in which radiation is directly focused to specific areas of the body without affecting the surrounding tissues.
Chemotherapy as a treatment option for renal cell carcinoma: Chemotherapy is the treatment of renal cell carcinoma with chemicals or chemotherapeutics. Chemotherapeutics distributed to the body through the blood stream and reach cancer cells. Chemotherapy for renal cell carcinoma can be given either alone or in combination. Such combinations include gemcitabine (Gemzar) and fluorouracil (5-FU, Adrucil) or capecitabine (Xeloda).Through various mechanisms they kill renal cell carcinoma or cancers in general. kill the cancer cells. Unfortunately, they are also toxic to normal cells.
Immunotherapy as a therapeutic option for renal cell carcinoma: Immunotherapy boosts the body’s immune system to fight cancer. Two effective immunotherapeutic for the treatment of renal cell carcinoma are interleukin-2 and interferon alpha. They provide partial benefit for about 10-20% of patients. Until mid-2000s, immunotherapy used to be the standard of care for the treatment of metastatic renal cell carcinoma. Since then many new compounds have been introduced to treat kidney cancer. These are called targeted therapeutics.
Targeted therapies as medications for metastatic renal cell carcinoma
The targeted therapies for metastatic renal cell carcinoma can be grouped under three major classes: vascular endothelial growth factor (VEGF) inhibitor, tyrosine kinase inhibitors and mTOR inhibitors. The basis for the use of these medications is angiogenesis-inhibition. So, it is appropriate to say these medications are angiogenesis inhibitors. What does this mean? Renal cell carcinoma, and most cancers, needs rich blood supply for them to grow.
To do this, cancer cells can induce changes in its surrounding environment and make new blood vessels grow towards them. This process is called angiogenesis. There are hundreds of molecules that help the process of angiogenesis. Prominent among them are VEGF, tyrosine kinases and mammalian target of rapamycin (mTOR). Together they help renal cell carcinoma to grow.
So, in theory, if we can inhibit angiogenesis, then we can stop the growth of renal cell carcinoma. VEGF inhibiting medication for kidney cancer: Avastin (Bevacizumab) Tyrosine inhibitors for kidney cancer: Sunitinib (Sutent), Pazopanib (Votrient), Sorafenib (Nexavar) and Axitinib (Inlyta). mTOR (mammalian target of rapamycin) inhibitors for kidney cancer: Temsirolimus (Torisel) and Everolimus (Afinitor).
What is renal cell carcinoma?
Renal cell carcinoma is a type of kidney cancer. Kidney cancer is a general term for all types of cancers that arise in the kidney. Of these types, renal carcinoma is the most common, accounting for about 80% of kidney cancer. The remaining 20% is composed of various types such as transitional cell carcinoma, renal sarcoma and Wilm’s tumor.
Kidney cancer or renal cell carcinoma refers to a group of cancers that arise in the kidneys.
What are the major types of renal cell carcinoma?
The most common type of renal cell carcinoma is clear cell renal cell carcinoma. About 70-80% of renal cell carcinomas are clear cell renal cell carcinoma. The second major type of renal cell carcinoma is papillary renal cell carcinoma. About 10-15% of renal cell carcinomas are papillary renal cell carcinomas. The third major type is chromophobe renal cell carcinoma. Approximately 5% of renal cell carcinoma are chromophobe renal cell carcinoma. The fourth type is the collecting duct renal cell carcinoma. When compared with other types of renal cell carcinoma this is a minor type accounting for approximately 1% of renal cell carcinoma.
What are the risk factors for renal cell carcinoma?
There are many risk factors for renal cell carcinoma. These can be generally grouped as genetic and non-genetic risk factors. The most common genetic risk factor for renal cell carcinoma, especially the clear cell renal cell carcinoma, is a non-functional VHL gene (von Hippel-Lindau gene). One of the functions of VHL gene is tumor suppression, which means the VHL gene functions properly it blocks the development of renal cell carcinoma.
When it becomes non-functional for various reasons (some of these ‘reasons’ are technically called mutations, hyper-methylations and loss of heterozygosity) it causes renal cell carcinoma.The non-genetic risk factors for renal cell carcinoma include cigarette smoking, high blood pressure (hypertension), long term dialysis, obesity, certain medications, work-related chemicals (occupational exposure) and male gender. Renal cell carcinoma is about three times higher in males than females.
What are the stages of renal cell carcinoma?
Renal cell carcinoma is classified into four stages depending upon their size, location and whether they have spread to other parts of the body or not. Stage 1 renal cell carcinoma is the early stage. In this, the size of the tumor is up to 2 3/4 inches (7 centimeters), and is restricted to the kidneys. Stage 2 renal cell carcinoma is still considered early stage, and the tumor is still restricted to the kidneys, but the tumor is bigger than stage 1.
Stage 3 renal cell carcinoma is where the tumor starts to spread to the organs surrounding the kidneys. For example the tumor may have spread to organs such as the adrenal gland, one nearby lymph node, veins, fat and fibrous tissue surrounding the kidneys. Stage 4 renal cell carcinoma is really bad. The tumor has already spread to other parts of the body. This is also called metastasis. The most common sites of metastasis of renal cell carcinoma are lungs, bones and lymph nodes.
What are the symptoms of renal cell carcinoma?
There are no symptoms that are specific to renal cell carcinoma. Therefore, people are not aware of it until it is very late. In advanced cases patients may have some symptoms. Talk to your doctor if you experience one or more of the following symptoms: Hematuria – blood in the urine; changes in urine color – dark, rusty or brown; lower back pain for unknown reasons; pain or lump in the belly area or other body parts; constant tiredness; unplanned but rapid weight loss.
How is renal cell carcinoma diagnosed?
If your doctors suspects that you have renal cell carcinoma, you doctor may perform one or more of the following tests. Physical examination for general health, high blood pressure, and any abdominal lumps. Urine tests for the presence of blood, change in color. Blood tests for creatinine and anemia. Intravenous pyelogram or IVP: A dye is injected into the vein, which accumulates in the kidneys. The accumulated dye is detected with X-rays. Computerized tomography scan or CT scan: In this procedure, a scanner scans the body and takes detailed pictures of the kidneys, which are put together by a computer to identify renal cell carcinoma. Ultrasound scan: High-frequency sound waves that humans cannot hear are directed toward the kidneys by specialized machines. The waves hit the kidneys and bounce back like an echo. These echoed waves are put together by a computer to produce images of the kidneys, which is also called a sonogram. Biopsy: A tiny portion of the kidney is removed using a biopsy needle, which is examined by a Pathologist looks for cancerous cells.
What are the treatment options for renal cell carcinoma?
There are many treatment options for renal cell carcinoma, which are mostly determined by the stage of the tumor. These treatment options include surgery, arterial embolization, radiation therapy, biological therapy, chemotherapy and targeted therapy. Some may have a combination of treatments.
Surgery as a treatment option for renal cell carcinoma: Surgery is the treatment of choice if the cancer has not spread to other parts of the body – mostly for stages 1 to 3. It involves the removal of kidneys – technically called nephrectomy. The nephrectomy can be either partial or radical. Partial nephrectomy: In this procedure, only the tumor portion and surrounding tissues of the kidneys are removed. The remaining portion of the kidney is left intact to perform its normal functions. Radical nephrectomy: In this procedure the affected kidney is removed entirely. For stage IV, usually medications are given with or without a combination of surgery.
Arterial embolization as a treatment option for renal cell carcinoma: Arterial embolization is a deliberate attempt to block a specific artery so that the organ that depends on that artery for blood supply and nutrients doesn’t get enough oxygen and nutrients. If it is a tumor, then the tumor shrinks and eventually dies. For renal cell carcinoma the artery that undergoes embolization is the renal artery. A narrow tube (catheter) is inserted into the renal artery, and then a substance (emboli) is inserted into the artery through the catheter which blocks the flow of blood into the kidneys.
Radiation therapy as a treatment option for renal cell carcinoma: If the renal cell carcinoma has spread to other parts of the body, then radiation therapy is performed. Radiation therapy uses high energy radiations to kill cancer cells. There are three types of radiation therapy: external beam, internal beam and stereotactic radiation therapy. External beam radiation therapy is the most common form of radiation treatment. Radiation is given from a machine outside the body. In internal beam radiation therapy or brachytherapy, radiation is given using implants. Usually the implant is directly implanted into the tumor. Stereotactic radiotherapy is a special procedure in which radiation is directly focused to specific areas of the body without affecting the surrounding tissues.
Chemotherapy as a treatment option for renal cell carcinoma: Chemotherapy is the treatment of renal cell carcinoma with chemicals or chemotherapeutics. Chemotherapeutics distributed to the body through the blood stream and reach cancer cells. Chemotherapy for renal cell carcinoma can be given either alone or in combination. Such combinations include gemcitabine (Gemzar) and fluorouracil (5-FU, Adrucil) or capecitabine (Xeloda).Through various mechanisms they kill renal cell carcinoma or cancers in general. kill the cancer cells. Unfortunately, they are also toxic to normal cells.
Immunotherapy as a therapeutic option for renal cell carcinoma: Immunotherapy boosts the body’s immune system to fight cancer. Two effective immunotherapeutic for the treatment of renal cell carcinoma are interleukin-2 and interferon alpha. They provide partial benefit for about 10-20% of patients. Until mid-2000s, immunotherapy used to be the standard of care for the treatment of metastatic renal cell carcinoma. Since then many new compounds have been introduced to treat kidney cancer. These are called targeted therapeutics.
Targeted therapies as medications for metastatic renal cell carcinoma
The targeted therapies for metastatic renal cell carcinoma can be grouped under three major classes: vascular endothelial growth factor (VEGF) inhibitor, tyrosine kinase inhibitors and mTOR inhibitors. The basis for the use of these medications is angiogenesis-inhibition. So, it is appropriate to say these medications are angiogenesis inhibitors. What does this mean? Renal cell carcinoma, and most cancers, needs rich blood supply for them to grow.
To do this, cancer cells can induce changes in its surrounding environment and make new blood vessels grow towards them. This process is called angiogenesis. There are hundreds of molecules that help the process of angiogenesis. Prominent among them are VEGF, tyrosine kinases and mammalian target of rapamycin (mTOR). Together they help renal cell carcinoma to grow.
So, in theory, if we can inhibit angiogenesis, then we can stop the growth of renal cell carcinoma. VEGF inhibiting medication for kidney cancer: Avastin (Bevacizumab) Tyrosine inhibitors for kidney cancer: Sunitinib (Sutent), Pazopanib (Votrient), Sorafenib (Nexavar) and Axitinib (Inlyta). mTOR (mammalian target of rapamycin) inhibitors for kidney cancer: Temsirolimus (Torisel) and Everolimus (Afinitor).
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