1. Pathophysiologic etiology
1.1. Genetic considerations
1.1.1. Von Hippel-Lindau (VHL)
1.1.1.1. Genetic syndrome that may cause mutation in genes.
1.1.1.2. 25% to 40% of affected persons
1.2. Stages of cancer
1.2.1. TUMOR, NODES, METASTASIS
1.2.1.1. STAGE I/II
1.2.1.1.1. RCC that invades the urinary collecting system
1.2.1.2. STAGE III
1.2.1.2.1. involvement of the renal vein or inferior vena cava
1.2.1.3. STAGE IV
1.2.1.3.1. Karnofsky Performance Status (KPS) <80
1.2.1.3.2. Time from original diagnosis to initiation of targeted therapy <1 year
1.2.1.3.3. Hemoglobin less than the lower limit of normal
1.2.1.3.4. Serum calcium greater than the upper limit of normal
1.2.1.3.5. Neutrophil count greater than the upper limit of normal
1.2.1.3.6. Platelet count greater than the upper limit of normal
1.3. Mutation in genes
1.3.1. These include the Ras family genes and the p53 tumor suppressor gene
1.3.2. overexpression of p53 protein is detected in approximately one-half of tumors
1.4. Originates in small renal tubule of kidney
1.5. Small renal masses (SRMs; <4 cm) suspicious for clinical stage T1a (MOST COMMON)
2. risk factors
2.1. Smoking
2.2. Insufficient physical activity
2.2.1. activity recommendation of 150 minutes a week of moderate intensity or 75 minutes a week of vigorous intensity
2.3. Insufficient vegetable/fruit intake
2.3.1. <5 portions/day recommended by the Word Health Organization
2.4. Non-ideal body mass index
2.5. Alcohol consumption
2.6. Age factor
2.7. Hereditary factor
2.8. Twice as frequently in men than in women
2.9. more common in North Americans with European ancestry as compared to people with African or Asian ancestors.
3. Diagnostic tests
3.1. Laboratory Values
3.1.1. Trace proteinuria
3.1.2. Abnormal uric level: <416 or ≥476 μmol/L
3.1.3. Abnormal glomerular filtration rate: <60 or ≥90 mL/ min/1.73 m2
3.1.4. creatinine
3.2. Kidney sonogram (ultrasound)
3.2.1. ABNORMAL: Usually a unilateral tumor in one kidney
3.2.2. NORMAL: Bilateral kidneys are properly located and of normal size with smooth outer contours
3.3. Abdominal computed tomography (CT) scan; helical or spiral CT
3.3.1. ABNORMAL: Usually a unilateral tumor in one kidney
3.3.2. NORMAL:Bilateral kidneys are properly located and of normal size with smooth outer contours
3.4. Magnetic resonance imaging
3.5. FOR METASTASIS STAGING
3.5.1. bone scan
3.5.2. chest x-ray
3.5.3. positron emission tomography scan.
4. Intervention/Treatments (TUMOR SPECIFIC)
4.1. Surgical Intervention
4.1.1. Radical Nephrectomy
4.1.2. Lymph node removal
4.1.3. partial nephrectomy
4.1.3.1. Small renal cell tumor
4.2. Fluid management
4.3. Ablative techniques
4.3.1. alternative to partial nephrectomy for patients who do not want or are not able to tolerate definitive surgery and who have an SRM <3 cm
4.3.2. freezing (cryoablation)
4.3.3. heating (radiofrequency ablation).
4.4. Active surveillance
4.4.1. <2 cm, and is generally recommended for those with lesions that are <1 cm.
5. Clinical manifestations
5.1. Weight loss
5.2. Fever
5.3. Lower back pain
5.4. Blood in urine
5.5. On occasion, palpable mass
5.6. many patients are asymptomatic until the disease is advanced
6. References (click the subtopics to view articles)
6.1. - Shadman, A., & Bastani, B. (2017). Kidney calculi: Pathophysiology and as a systemic disorder. Iranian Journal of Kidney Diseases, 11(3), 180-191. Retrieved from Log In - ProQuest
6.2. Tu, H., Wen, C. P., Tsai, S. P., Chow, W., Wen, C., Ye, Y., . . . Wu, X. (2018). Cancer risk associated with chronic diseases and disease markers: Prospective cohort study. BMJ : British Medical Journal (Online), 360 doi:http://dx.doi.org/10.1136/bmj.k134
6.3. Kidney Cancer. Nursing Central. Diseases and Disorders. https://www.unboundmedicine.com/medline/view/Diseases-and-Disorders/73643/all/Kidney_Cancer.
7. TYPES OF KIDNEY CANCER
7.1. Renal cell carcinoma
7.1.1. originates in the lining of the proximal convoluted tubule
7.1.2. clear cell
7.1.3. pupillary
7.1.4. chromophobe
7.1.5. collecting duct