Kidney cancer is a relatively rare cancer, growing from kidney cells.
Kidney cancer accounts for 2 to 3% of all cancers. In 2000, there were more than 8 000 new cases of kidney cancer.
The average age of onset is 62 years and over 80% of patients over 50 years at diagnosis.
Kidney cancer is twice as common in men than in women. (sex ratio 2.1 / 1)
The incidence of kidney cancer in 2003 to 5.7 / 100,000 in women and 12.2 / 100,000 in men. It is steadily increasing in industrialized countries, due to improved diagnostic techniques, but probably also because of changes in lifestyle (increase in obesity, hypertension for both criteria best rated).
The main risk factors of kidney cancer are tobacco and hypertension. Other factors are known:
* Exposure to petroleum, heavy metals and asbestos
* Work in the steel industry
* Von Hippel-Lindau
* Many kidney cancers are now diagnosed on incidental renal imaging (45%).
* Other diagnoses are carried on loco-regional signs (blood in urine or hematuria, lumbar pain or mass) (45%) or general (fever) (10%).
* When a suspected kidney cancer, we must perform further tests and staging. (see diagnosis tree in progress
* Headache, hypertension
* Sign for a paraneoplastic syndrome, especially hypercalcemia
* Unexplained fever
* Deterioration of general condition: the condition of the patient will be evaluated by a standardized scale (ECOG, WHO, Karnofsky).
* Macroscopic hematuria, total, spontaneous, painless and intermittent
* Back pain due to tumor or renal colic by migration of clot
* Lumbar mass that appears late
The classic triad involving hematuria, flank pain and lumbar mass is found in only 10% of cases.
Surgical treatment of kidney cancer
The cure for kidney cancer is based on surgery, which is to ensure the removal of the tumor. This gesture is called: nephrectomy. Nephrectomy can be performed through open surgical or laparoscopic. Nephrectomy may be radical and total or partial to retain part of the normal renal parenchyma. Initially restricted to cancers of the kidney solitary kidney partial nephrectomy for its indications expanded gradually.
Medical treatment of kidney cancer
If the metastatic treatment has long been limited to immunotherapy with interferon alpha and / or interleukin 2. More recently (2005-2006), the anti-angiogenic, in the development of neo-angiogenesis, have revolutionized the care of patients.
Treatment of metastatic renal cell carcinoma
In the absence of possibility of cure, the treatment of metastatic renal cell carcinoma based on medical treatment. first line:
* Bevacizumab (I.V.) + interferon (subcutaneous)
* Sunitinib (oral)
* Temsirolimus (IV), particularly for patients with poor prognosis (see Motzer criteria)
second line after failure of interferon:
* Sorafenib (Oral)
second line treatment after failure of targeted therapy:
* Everolimus (oral - currently ATU)
When metastases are found at diagnosis (synchronous metastases), it is justified to perform the nephrectomy, if this surgery is not too decaying. Several studies have demonstrated the value of the removal of the tumor in this context. There are rare observation of spontaneous regression of lung metastases in some patients. However, the benefit of nephrectomy in patients with metastatic never been compared to antiangiogenic treatment. Thus, a European trial will soon open two comparing sunitinib sunitinib alone vs + nephrectomy for patients with clear cell carcinoma.
Always discuss a surgical resection of metastases in a patient in good general condition, with a slowly progressive disease and metastatic sites accessible to surgery.
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