RENAL CELL CARCINOMA(RCC)

RENAL CELL CARCINOMA(RCC). Gina Chavarria Russell Sage College BIO 560.

Incidence. RCC is the most common cancer of the kidneys, it accounts for 80 to 90 % of all kidney tumors . Worldwide (RCC) represents the sixth most frequently diagnosed cancer in men and the 10th in women. More frequently diagnosed males African American.

Risk Factors. Etiology is unclear Obesity Hypertension Smoking Cystic kidney disease associated with chronic renal insufficiency Genetic predisposition.

Clinical Manifestations. Silent disorder Hematuria Flank pain Palpable flank mass.

Diagnosis. Ultrasonography CT scan MRI Presence of hematuria and a renal mass.

Stages of RCC (American Cancer Society, 2021). A picture containing table Description automatically generated.

Treatment. Radical nephrectomy or partial nephrectomy Targeted drug therapy ( such as sunitinib) Chemotherapy.

Sunitinib ( Sutent ). Blocks angiogenesis and growth-stimulating proteins (tyrosine kinases). This drug is taken as a pill daily, typically for 4 weeks on and 2 weeks off. Sunitinib can be used in people with advanced kidney cancer, as well as in people with a high risk of recurrence ..

Pembrolizumab- Axitinib. As of April 2020, one of the first treatment options for metastatic RCC are pembrolizumab + axitinib . Axitinib is a drug that inhibits several tyrosine kinases involved in the formation of new blood vessels. Pembrolizumab is an immune check inhibitor that targets PD-1, a protein on T cells ( Chau & Bilusic , 2020). These medication boost the immune response against kidney cancer cells. Research has shown that the combination of these two medication improves both progression-free survival and overall survival compared to sunitinib.

Case Study 33. Mr. M.B. is a 58 yo male who developed end-stage renal disease six years ago from postinfectious glomerulonephritis. He received hemodialysis for two years. Then, four years ago, he successfully accepted a kidney transplant from a deceased donor. His health has been fair-to-good since receiving the kidney, although immunosuppressant medications have occasionally caused serious side effects, including hyperglycemia and infections ( Bruyere, 2009).

Chief Complain. “ I’ve been having some dull, aching pain in my left lower back. It’s been going on now for 3 days. I think that what’s remaining of my own kidney is going bad now”..

PMH. H/O ESRD due to post-streptococcal glomerulonephritis that was diagnosed 10 years ago 4 years S/P cadaveric renal transplantation, right side OA of left knee (had several skiing accidents as an adolescent) Mild arthritis involving hands, elbows, and shoulders DVT, acute episode 1 year ago PUD, diagnosed 4 weeks ago Mild recurrent bouts of depression that have not been treated pharmacologically.

SH. Divorced and lives alone He cares for himself but is unable to carry on normal activities Disability benefits Retired farmer from the Midwest 1 ppd cigarette smoker for 25 years Vietnam War veteran Hobbies include woodworking and gardening Denies non-compliance with his medications H/O IVDA in his twenties; none since.

List a minimum of ten distinct clinical manifestations in this case study that are consistent with a diagnosis of renal cell carcinoma ..

What are this patient’s two major risk factors for renal cell carcinoma?.

List any other potential risk factors that may have contributed to renal cell carcinoma in this case..

To which clinical stage of renal cell carcinoma has the disease advanced?.

What is the probability that this patient will survive 5 years?.

References. American Cancer Society. (2021). Kidney cancer stages: Renal cell carcinoma staging . https://www.cancer.org/cancer/kidney-cancer/detection-diagnosis-staging/staging.html. Bruyere, H. J. (2009). 100 Case studies in pathophysiology . LWW. Cairns P. (2010). Renal cell carcinoma. Cancer biomarkers : section A of Disease markers , 9 (1-6), 461–473. https://doi.org/10.3233/CBM-2011-0176 Chau, V., & Bilusic , M. (2020). Pembrolizumab in Combination with Axitinib as First-Line Treatment for Patients with Renal Cell Carcinoma (RCC): Evidence to Date. Cancer management and research , 12 , 7321–7330. https://doi.org/10.2147/CMAR.S216605 Ficarra, V. , Purdue, M. P., Signoretti, S., Swanton, C., Albiges , L., Schmidinger , M., Heng, D. Y., Larkin, J., & Hsieh, J. J. (2017). Renal cell carcinoma. Nature reviews. Disease primers , 3 , 17009. https://doi.org/10.1038/nrdp.2017.9.