Cancerul renalCplna Marius

Copyright, 2004 Debi Foli

Debi Foli - Bio 316Biology of Cancer

Anatomiefiecare rinichi este de dimensiunea unui pumnn partea superioar a rinichiului se afl glanda suprarenalrinichiul i glanda suprarenal sunt nconjurate de o mas de esut grsos i de o fascie fibroas (fascia Gerota)

Epidemiologieal 7-lea cancer ca frecven i al 10-lea ca mortalitate la brbatde obicei diagnosticat ntre 50 i 70 ani, poate aprea la orice vrstmajoritatea pacienilor cu cancer renal sunt trecui de 40 anide 2 ori mai frecvent la brbai dect la femeiexist anumii factori genetici predispozaniacetia apar doar n 5% din cazuri2 celule maligne apar mai frecvent n cancerul renalcelula clar, cauzat de o mutaie a genei VHLcelula papilar, cauzat de o serie de mutaii genetice

Factori de riscFumatulfumtorii au risc dublu de cancer renal

Obezitatea

Hipertensiunea arterial

Abuzul cu anumite medicamente

Dializa de lung durat

Sindromul von Hippel-Lindau

Ocupaiamuncitoriide la cuptoarele din industria fierului i oeluluimuncitorii expui la azbest sau cadmiu

Sexulbrbaii au risc dublu

PatologieAdenocarcinoame (>85%) cea mai frecvent form de cancer renal, denumit i hipernefromtumor Grawitzcu cteva suptipuricu celule clare (75-85%), avnd originea n tubul proximalpapilarchromofoboncocitic (rar) de obicei nu e agresiv

Carcinoame tranziionalecu origine n celulele uroteliale din pelvisul renal

Tumora Wilmsneoplasm embrional 8% din cancerele pediatrice, cea mai frecvent tumor abdominal n copilrieapare cu frecven maxim la 3-4 anirata de vindecare este de aproape 90%

SimptomeGeneraleinapetenscdere ponderal inexplicabilfatigabilitatefebr recurent (fr legtur cu infecii)HTAanemieHematurieDurere n regiunea lombar persistent Presiune / mas / tumor n flanc / regiunea lombarEdem de membru inferiorSimptome de boal avansatinvazie local (ficat, pancreas, colon)boal metastatic (pulmonar, limfatic, osos, hepatic, cerebral, suprarenal, rinichi contralateral)

Diagnosticexamen clinic

laboratorteste sangvine (hemogram, teste funcionale renale i hepatice)teste de urin

imagisticecografieCT / RMNextensia boliiinvazia limfatic / vascularmetastazeurografie cu substan de contrastscintigrafie osoas

biopsie

Stadializare< 7 cm50 60% supravieuire la 5 anitumor limitat la un rinichi, nu invadeaz ganglionii limfatici / organe la distan> 7 cm30 60% supravieuire la 5 ani

Stadializare0 20% supravieuire la 5 ani

tumora depete esutul perirenal, cu rspndire la distan20 50% supravieuire la 5 ani

tumor de orice mrime care invadeaz - ganglionii limfatici regionali- venele mari / esutul perirenal

Tratamenttratamentul depinde de stadiul boliiadesea se utilizeaz abordri multimodale

chirurgia este tratamentul standard n cancerul renal localizat

radioterapia i chimioterapia nu sunt foarte eficiente n cancerul renal

terapiile biologice (intite / imunoterapia) sunt tot mai mult utilizate

Prognosticcancer limitat renal 40% din pacientitratat exclusiv chirurgical curativ n 90% din cazuri

cancer extins 60% din pacientin general nu este vindecabil exclusiv chirurgicalprognostic mai rezervat

79% din pacienii cu nefrectomie parial nu fac recidiv, comparativ cu 77% din pacienii cu nefrectomie radicalincidena insuficienei renale este de 11% n nefrectomia parial, comparativ cu 22% n nefrectomia radical nefrectomia parial este la fel de eficient ca i nefrectomia radical, dar cu morbiditate mai redus

**Smoking: Cigarette smoking is a major risk factor. Cigarette smokers are twice as likely as nonsmokers to develop kidney cancer. Cigar smoking also may increase the risk of this disease. Obesity: People who are obese have an increased risk of kidney cancer. High blood pressure: High blood pressure increases the risk of kidney cancer. Long-term dialysis: Dialysis is a treatment for people whose kidneys do not work well. It removes wastes from the blood. Being on dialysis for many years is a risk factor for kidney cancer. Von Hippel-Lindau (VHL) syndrome: VHL is a rare disease that runs in some families. It is caused by changes in the VHL gene. An abnormal VHL gene increases the risk of kidney cancer. It also can cause cysts or tumors in the eyes, brain, and other parts of the body. Family members of those with this syndrome can have a test to check for the abnormal VHL gene. For people with the abnormal VHL gene, doctors may suggest ways to improve the detection of kidney cancer and other diseases before symptoms develop. Occupation: Some people have a higher risk of getting kidney cancer because they come in contact with certain chemicals or substances in their workplace. Coke oven workers in the iron and steel industry are at risk. Workers exposed to asbestos or cadmium also may be at risk. Gender: Males are more likely than females to be diagnosed with kidney cancer. Each year in the United States, about 20,000 men and 12,000 women learn they have kidney cancer.

*Symptoms: Many kidney tumors go undetected due to the lack of symptoms and are incidentally detected during the medical evaluation of an unrelated problem. Kidney tumors can cause symptoms by compressing, stretching or invading structures near or within the kidney. Symptoms caused by these processes include pain (in the flank, abdomen or back) and blood in the urine (small amounts may not be visible). If cancer spreads beyond the kidney, symptoms depend upon which organ is involved. Shortness of breath or coughing up blood may occur when cancer is in the lungs; bone pain or fracture may occur when cancer in the bone; and neurologic symptoms may occur when cancer is in the brain. In some cases, the cancer causes associated clinical or laboratory abnormalities called paraneoplastic syndromes. These syndromes are observed in approximately 30% of patients with kidney cancer and can occur in any stage. Clinical symptoms include weight loss, loss of appetite, fever, sweats and high blood pressure. Laboratory findings include elevated erythrocyte sedimentation rate, low red blood cell count (anemia), high calcium level in the blood, abnormal liver function tests, elevated alkaline phosphatase in the blood, and high white blood cell count. In many cases, the paraneoplastic syndrome resolves after the cancer is removed.CancerConsultant.com**