NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA)

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1 NEOPLASMS OF KIDNEY (RENAL CELL CARCINOMA) And RENAL PELVIS (TRANSITIONAL CELL CARCINOMA) Merat Esfahani, MD Medical Oncologist, Hematologist Cancer Liaison Physician SwedishAmerican Regional Cancer Center

2 INTRODUCTION / EPIDEMIOLOGY: Kidney cancer is a type of cancer that starts in the cells in the kidney. The two most common types of kidney cancer are renal cell carcinoma (RCC) and transitional cell carcinoma (TCC) of the renal pelvis. These names reflect the types of cell from which the cancer developed. Globally, the incidence of RCC varies widely from region to region with the highest rates observed in the Czech Republic and North America. In the United States, there are approximately 64,000 new cases and almost 14,000 deaths from RCC each year. The different types of kidney cancer (such as RCC and TCC) develop in different ways, meaning that the diseases have different long-term outcomes, and need to be staged and treated in different ways. RCC is responsible for approximately 80 percent of primary renal cancers, and TCC accounts the majority of the remainder. The median age at diagnosis is around 64 years of age, according to 2003 to 2007 NCI s Surveillance, Epidemiology and End Results (SEER) Cancer Statistics Reviews. The incidence of kidney and renal pelvis cancer has increased 2.3 percent annually among patient with age less than 65 years old from the years 2002 to The correlated number among patients aged 65 years and older is 1.6 percent.

3 Between 2000 and 2011 a total of 297 cases of RCC and TCC were diagnosed at the SwedishAmerican Regional Cancer Center. Most of the kidney cancer patients traveled locally to receive their care. A total of 19 percent of the patients with RCC or TCC traveled less than five miles, 39 percent traveled 6-10 miles, 22 percent traveled miles, 14 percent traveled miles and 6 percent traveled more than 50 miles in order to be treated at SwedishAmerican Cancer Center.

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5 RISK FACTORS: Smoking Misusing certain pain medicines, including over-the-counter pain medicines, for a long time Having certain genetic conditions, such as Von Hippel-Lindau disease or hereditary papillary renal cell carcinoma CLINICAL MANIFESTATION: There may be no signs or symptoms in the early stages. Signs and symptoms may appear as the tumor grows. Blood in the urine A lump in the abdomen A pain in the side that doesn t go away Loss of appetite Weight loss for no known reason Anemia

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8 PATHOLOGICAL SUBTYPES: The major pathological subtypes include clear cell carcinoma, which was 23 percent of all RCC and TCC at the SwedishAmerican Regional Cancer Center. Other subtypes include papillary abdomen NOS (8%), papillary transitional cell carcinoma (7%), transitional cell carcinoma (5%), and renal cell carcinoma otherwise unspecified (44%).

9 TREATMENT: Treatment for kidney cancer depends on the type and stage of disease. Surgery typically is the mainstay of treatment. It usually doesn t involve chemotherapy and radiotherapy, because kidney cancers often do not respond to these treatments. If the cancer has not spread, it usually will be removed by surgery. Sometimes this involves nephrectomy, but most tumors are amenable to partial nephrectomy. Unfortunately, surgery is not always feasible due to comorbid conditions or metastatic disease. There currently is no evidence that adjuvant therapy helps to improve survival in kidney cancer. At the SwedishAmerican Regional Cancer Center, between the years 2000 and 2011, 188 patients underwent surgical treatment only. Three patients underwent surgery and chemotherapy, 33 patients underwent targeted therapy and seven patients did not receive any type of treatment. The first course of the treatment based on the pathological subtypes has been demonstrated as follows.

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