RENALCELL CARCINOMA

Dr H.Niroomand M.D.Aja University Of Medical

Sience

Epidemiology & Etiology

accounts for 2% to 3% of all adult malignant neoplasms

most lethal of the common urologic cancers

30% to 40% of patients with RCC have died of theirCancer

Epidemiology

12 new cases are diagnosed per100,000 population

per year

male-to-female predominance of 3 : 2

(6,7th decades)primarily a disease of the elderly

Epidemiology

The majority of cases are sporadic

only 2% to 3% are familial

Epidemiology

The incidence of RCC has increased since the 1970s:

3% per year for whitesFor African-Americans 4% per year

largely related to the more prevalent

use of ultrasonography and CT

Epidemiology

RCC in childhood:

- is uncommon (2.3-6.6) - Mean age is 8 to 9 years

- RCC is as common as Wilms tumor during the 2th decade of life .

Stage for stage, children and young adults may respond better to surgical therapy

Epidemiology

traditionally thought to arise primarily fromthe proximal convoluted tubules(clear cell and papillary)

chromophobe and collecting duct RCC, arederived from the more distal components of the nephron

Etiology

accepted environmental risk factor:

1 - Tobacco exposure: . Relative risks:1.4 to 2.5

. All forms of tobacco use implicated . risk increases with cumulative dose

. accounts for 20% to 30% of cases of RCC in men and 10% to 20% in women

Etiology

2 -Obesity:

- increased relative risk of 1.07 for each unit of rising body mass index

> - 40% of cases of RCC in the US may be causally linked to obesity

- increased insulin-like growthfactor-1, increased circulating estrogen , increased arterionephrosclerosis

& local inflammation

Etiology

3 - Hypertension:

- Diuretics and other antihypertensive medications implicated

- hypertension, rather than the treatment, that increases the risk

- The proposed mechanisms: hypertension-induced renal injury and inflammation, metabolic or functional changes in the renal tubules

Etiology

Although a number of other potential etiologic factors

have been identified in animal models, including : viruses,lead compounds, and more than 100 chemicals such as aromatic hydrocarbons

no specific agent has been definitively

established as causative in human RCC

Etiology

family history of RCC may also be a factor ;

one study showed a relative risk of 2.9 for individuals with a first- or second-degree

relative with RCC

Etiology

Familial Renal Cell Carcinoma (RCC) Syndromes:

1-von Hippel-Lindau Disease

(Clear cell RCC, Hemangioblastomas of the CNS

Retinal angiomas,Pheochromocytoma) 2 -Familial Papillary Renal Cell Carcinoma

3-Hereditary Leiomyomatos and RCC( Type 2 papillary RCC,

Cutaneous leiomyomas Uterine leiomyomas )

4-Birt-Hogg-Dubé Syndrome

Etiology

Thank you