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Kidney cancer is the third most common malignancy of the urinary tract. Otherwise known as renal cell carcinoma (RCC) it occurs mainly in men, with a typical occurrence during the sixth and seventh decade of life and is the most lethal urologic malignancy.

Risk factors
Several potential risk factors have been implicated in the development of renal cell carcinoma.
Smoking has been linked to an increased risk of RCC. The risk decreases after smoking cessation.


In many studies, obesity was also found to be associated with the RCC. The correlation relates only to severe obesity and is more pronounced for women. Additionally, in several studies hypertension has been also associated with RCC. Antihypertensive treatment, especially diuretics, were responsible for the development of kidney cancer. Nutrition is one of the key factors. Fried, sautéed and overly cooked meats have been linked to an increased risk of RCC. Frequent consumption of fruit and vegetables have protective effects.

 

Additionally, protective effects are exhibited by the consumption of vitamins C, E and carotenoids. No correlation has been demonstrated between the consumption of alcohol, coffee, tea and RCC. Occupational exposure to iron, steel, oil, lime and cadmium has been implicated in the development of kidney cancer. Highest incidence of kidney cancer was observed in patients with chronic renal failure undergoing hemodialysis, and especially those with acquired cystic kidney disease. There are conflicting data on the correlation of RCC with kidney stones, urinary tract infections and kidney injuries.

Prevention of RCC should focus on smoking cessation. Being overweight is a risk factor and the maintenance of the ideal BMI is necessary. Data regarding dietary habits is still unclear, so specific dietary recommendations cannot be given.

 

Clinical picture
The majority of renal tumors remain asymptomatic until the disease is at an advanced stage. Signs and symptoms usually occur late and are not specific. The classic triad of symptoms (lumbar pain, haematuria and palpable abdominal mass) occur in less than 10% of patients.

Hematuria is the most common symptom and occurs in 40-60% of patients. Lumbar pain can occur in 40% of patients. Palpable mass occurs in one third of patients.

General symptoms such as fatigue, weakness, weight loss, nausea, fever or night sweats indicate advanced disease. Paraneoplastic syndromes occur in 10-40% of patients.

Laboratory Tests
There are no specific laboratory findings. Hematuria occurs in 40-60% of cancer cases. Increased settling velocity is observed in 55-75% of cases. Also, anemia is exhibited in one third of patients.
He main imaging techniques used are:
• Ultrasound: It offers important information in the early diagnosis of RCC.
• CAT Scan (CT) of the abdomen and the retroperitoneal space: It is the examination of choice for the diagnosis and development of kidney cancer.
• MRI of the abdomen and the retroperitoneal space: It is equivalent to CT in the diagnosis of RCC, but it has an advantage over it because it reveals the development of the disease.

 

Therapy
Radical nephrectomy is considered the treatment of choice for localized kidney cancer, an effective method of eradicating the disease. In recent years there has been increased interest in using conservative surgery (partial nephrectomy) in the treatment of localized renal cancer.

• Radiotherapy. Although it has no therapeutic role in the early stages of renal cancer, it can be applied as a palliative treatment for patients with metastatic disease.
• Chemotherapy. Many studies have demonstrated that adenocarcinoma of the kidney is one of the more resistant tumors to chemotherapy.
• Immunotherapy. In kidney cancer, interferon-alpha (IFNa) and interleukin-2 (IL-2) have been utilized with very low levels of efficiency.The IL-2 and IFNa combination generally leads to better overall response (about 25%, of cases with an 8% of complete recovery).
• Molecular targeted therapy. In recent years substances aimed at the molecular level, at different stages of tumor progression have been used, with encouraging results.

 

Prognosis
The most important prognostic factor in kidney cancer is the stage of the disease at the time of diagnosis. The patients' survival rate is inversely proportional to the pathoanatomical stage of the disease.