KIDNEY CANCER

Renal cell carcinoma (RCC, aka hypernephroma) is the most common form of kidney cancer arising from the proximal renal tubule. It is the most common type of kidney cancer in adults. Initial treatment is most commonly a radical or partial nephrectomy. Where the tumour is confined to the renal parenchyma, the 5-year survival rate is 60-70%, but this is lowered considerably where metastases have spread. It is resistant to radiation therapy and chemotherapy, although some cases respond to immunotherapy. Targeted cancer therapies such as sunitinib, temsirolimus, bevacizumab, interferon-alpha, and possibly sorafenib have improved the outlook for RCC (progression-free survival), although they have not yet demonstrated improved survival.
Symptoms
The classic triad is hematuria (blood in the urine), flank pain and an abdominal mass. This is now known as the 'too late triad' because by the time patients present with symptoms, their disease is often advanced beyond a curative stage. In addition, whilst this triad is highly suggestive of RCC, it only occurs in around 15% of the sufferers. Today, the majority of renal tumors are asymptomatic and are detected incidentally on imaging, usually for an unrelated cause.
Signs may include:
Abnormal urine color (dark, rusty, or brown) due to blood in the urine (found in 60% of cases) Loin pain (found in 40% of cases) Abdominal mass (25% of cases) Malaise, weight loss or anorexia (30% of cases) Polycythemia (5% of cases) Anaemia resulting from depression of erythropoietin (5% of cases)
The presenting symptom may be due to metastatic disease, such as a pathologic fracture of the hip due to a metastasis to the bone Varicocele, the enlargement of one testicle, usually on the left (2% of cases). This is due to blockage of the left testicular vein by tumor invasion of the left renal vein; this typically does not occur on the right as the right gonadal vein drains directly into the inferior vena cava. Vision abnormalities Pallor or plethora Hirsutism - Excessive hair growth (females) Constipation Hypertension (high blood pressure) resulting from secretion of renin by the tumour (30% of cases) Elevated calcium levels (Hypercalcemia) Paraneoplastic disease