Rcc Anatomy And Physiology Pdf

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Kidney cancer is one of the 10 most common cancers to affect men and women. It is more common in older people. The average age of those diagnosed with kidney cancer is 64 years old.

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Renal cell carcinoma RCC is a kidney cancer that originates in the lining of the proximal convoluted tubule , a part of the very small tubes in the kidney that transport primary urine. RCC most commonly occurs between 6th and 7th decade of life. Initial treatment is most commonly either partial or complete removal of the affected kidney s. The body is remarkably good at hiding the symptoms and as a result people with RCC often have advanced disease by the time it is discovered.

Historically, medical practitioners expected a person to present with three findings. This classic triad [9] is 1: haematuria , which is when there is blood present in the urine, 2: flank pain, which is pain on the side of the body between the hip and ribs, and 3: an abdominal mass, similar to bloating but larger.

Finally, studies have found that women who have had a hysterectomy are at more than double the risk of developing RCC than those who have not. Hereditary factors have a minor impact on individual susceptibility with immediate relatives of people with RCC having a two to fourfold increased risk of developing the condition.

The most significant disease affecting risk however is not genetically linked — patients with acquired cystic disease of the kidney requiring dialysis are 30 times more likely than the general population to develop RCC. The tumour arises from the cells of the proximal renal tubular epithelium. The first steps taken to diagnose this condition are consideration of the signs and symptoms, and a medical history the detailed medical review of past health state to evaluate any risk factors.

Although this disease lacks characterization in the early stages of tumor development, considerations based on diverse clinical manifestations, as well as resistance to radiation and chemotherapy are important. The main diagnostic tools for detecting renal cell carcinoma are ultrasound , computed tomography CT scanning and magnetic resonance imaging MRI of the kidneys.

Renal cell carcinoma RCC is not a single entity, but rather a collection of different types of tumours , each derived from the various parts of the nephron epithelium or renal tubules and possessing distinct genetic characteristics, histological features, and, to some extent, clinical phenotypes.

Array-based karyotyping can be used to identify characteristic chromosomal aberrations in renal tumors with challenging morphology. The World Health Organization WHO classification of genitourinary tumours recognizes over 40 subtypes of renal neoplasms. Since the publication of the latest iteration of the WHO classification in , several novel renal tumour subtypes have been described: [36].

Laboratory tests are generally conducted when the patient presents with signs and symptoms that may be characteristic of kidney impairment. They are not primarily used to diagnose kidney cancer, due to its asymptomatic nature and are generally found incidentally during tests for other illnesses such as gallbladder disease.

Laboratory analysis can provide an assessment on the overall health of the patient and can provide information in determining the staging and degree of metastasis to other parts of the body if a renal lesion has been identified before treatment is given.

The presence of blood in urine is a common presumptive sign of renal cell carcinoma. The haemoglobin of the blood causes the urine to be rusty, brown or red in colour. Alternatively, urinalysis can test for sugar , protein and bacteria which can also serve as indicators for cancer. A complete blood cell count can also provide additional information regarding the severity and spreading of the cancer.

The CBC provides a quantified measure of the different cells in the whole blood sample from the patient. Such cells examined for in this test include red blood cells erythrocytes , white blood cells leukocytes and platelets thrombocytes. A common sign of renal cell carcinoma is anaemia whereby the patient exhibits deficiency in red blood cells.

Blood chemistry tests are conducted if renal cell carcinoma is suspected as cancer has the potential to elevate levels of particular chemicals in blood. For example, liver enzymes such as aspartate aminotransferase AST and alanine aminotransferase ALT are found to be at abnormally high levels. Blood chemistry tests also assess the overall function of the kidneys and can allow the doctor to decide upon further radiological tests.

The characteristic appearance of renal cell carcinoma RCC is a solid renal lesion which disturbs the renal contour. It will frequently have an irregular or lobulated margin and may be seen as a lump on the lower pelvic or abdomen region.

Ten percent of RCC will contain calcifications , and some contain macroscopic fat likely due to invasion and encasement of the perirenal fat. As there are several benign cystic renal lesions simple renal cyst, haemorrhagic renal cyst, multilocular cystic nephroma , polycystic kidney disease , it may occasionally be difficult for the radiologist to differentiate a benign cystic lesion from a malignant one.

The main imaging tests performed in order to identify renal cell carcinoma are pelvic and abdominal CT scans, ultrasound tests of the kidneys ultrasonography , MRI scans, intravenous pyelogram IVP or renal angiography. Contrast-enhanced computed tomography CT scanning is routinely used to determine the stage of the renal cell carcinoma in the abdominal and pelvic regions.

CT scans have the potential to distinguish solid masses from cystic masses and may provide information on the localization, stage or spread of the cancer to other organs of the patient. Key parts of the human body which are examined for metastatic involvement of renal cell carcinoma may include the renal vein , lymph node and the involvement of the inferior vena cava. Ultrasonographic examination can be useful in evaluating questionable asymptomatic kidney tumours and cystic renal lesions if Computed Tomography imaging is inconclusive.

This safe and non-invasive radiologic procedure uses high frequency sound waves to generate an interior image of the body on a computer monitor. The image generated by the ultrasound can help diagnose renal cell carcinoma based on the differences of sound reflections on the surface of organs and the abnormal tissue masses.

Essentially, ultrasound tests can determine whether the composition of the kidney mass is mainly solid or filled with fluid. A Percutaneous biopsy can be performed by a radiologist using ultrasound or computed tomography to guide sampling of the tumour for the purpose of diagnosis by pathology.

However this is not routinely performed because when the typical imaging features of renal cell carcinoma are present, the possibility of an incorrectly negative result together with the risk of a medical complication to the patient may make it unfavourable from a risk-benefit perspective. Magnetic Resonance Imaging MRI scans provide an image of the soft tissues in the body using radio waves and strong magnets.

MRI can be used instead of CT if the patient exhibits an allergy to the contrast media administered for the test. Patients on dialysis or those who have renal insufficiency should avoid this contrasting material as it may induce a rare, yet severe, side effect known as nephrogenic systemic fibrosis. MRI scans should also be considered to evaluate tumour extension which has grown in major blood vessels, including the vena cava , in the abdomen. MRI can be used to observe the possible spread of cancer to the brain or spinal cord should the patient present symptoms that suggest this might be the case.

Intravenous pyelogram IVP is a useful procedure in detecting the presence of abnormal renal mass in the urinary tract. This procedure involves the injection of a contrasting dye into the arm of the patient. The dye travels from the blood stream and into the kidneys which in time, passes into the kidneys and bladder.

Renal angiography uses the same principle as IVP, as this type of X-ray also uses a contrasting dye. This radiologic test is important in diagnosing renal cell carcinoma as an aid for examining blood vessels in the kidneys. This diagnostic test relies on the contrasting agent which is injected in the renal artery to be absorbed by the cancerous cells.

This is imperative for surgeons as it allows the patient's blood vessels to be mapped prior to operation. The staging of renal cell carcinoma is the most important factor in predicting its prognosis. The gross and microscopic appearance of renal cell carcinomas is highly variable. The renal cell carcinoma may present reddened areas where blood vessels have bled, and cysts containing watery fluids.

Gross examination often shows a yellowish, multilobulated tumor in the renal cortex , which frequently contains zones of necrosis , haemorrhage and scarring. Sarcomatoid changes morphology and patterns of IHC that mimic sarcoma, spindle cells can be observed within any RCC subtype and are associated with more aggressive clinical course and worse prognosis.

Under light microscopy, these tumour cells can exhibit papillae , tubules or nests, and are quite large, atypical, and polygonal.

Recent studies have brought attention to the close association of the type of cancerous cells to the aggressiveness of the condition. Some studies suggest that these cancerous cells accumulate glycogen and lipids, their cytoplasm appear "clear", the nuclei remain in the middle of the cells, and the cellular membrane is evident.

The stroma is reduced, but well vascularised. The tumour compresses the surrounding parenchyma , producing a pseudocapsule. The most common cell type exhibited by renal cell carcinoma is the clear cell , which is named by the dissolving of the cells' high lipid content in the cytoplasm.

The clear cells are thought to be the least likely to spread and usually respond more favourably to treatment. However, most of the tumours contain a mixture of cells. The most aggressive stage of renal cancer is believed to be the one in which the tumour is mixed, containing both clear and granular cells. This system categorises renal cell carcinoma with grades 1, 2, 3, 4 based on nuclear characteristics.

The details of the Fuhrman grading system for RCC are shown below: [62]. Nuclear grade is believed to be one of the most imperative prognostic factors in patients with renal cell carcinoma. The risk of renal cell carcinoma can be reduced by maintaining a normal body weight. If it has spread outside of the kidneys, often into the lymph nodes , the lungs or the main vein of the kidney, then multiple therapies are used including surgery and medications.

RCC is resistant to chemotherapy and radiotherapy in most cases but does respond well to immunotherapy with interleukin-2 or interferon-alpha, biologic, or targeted therapy. In early-stage cases, cryotherapy and surgery are the preferred options. Active surveillance or "watchful waiting" is becoming more common as small renal masses or tumours are being detected and also within the older generation when surgery is not always suitable.

The recommended treatment for renal cell cancer may be nephrectomy or partial nephrectomy , surgical removal of all or part of the kidney.

This allows for more renal preservation as compared to the radical nephrectomy, and this can have positive long term health benefits. Surgical nephrectomy may be "radical" if the procedure removes the entire affected kidney including Gerota's fascia , the adrenal gland which is on the same side as the affected kidney, and the regional retroperitoneal lymph nodes, all at the same time.

But it is not always appropriate, as it is a major surgery that contains the risk of complication both during and after the surgery and can have a longer recovery time. In cases where the tumor has spread into the renal vein, inferior vena cava, and possibly the right atrium, this portion of the tumor can be surgically removed, as well.

When the tumor involved the inferior vena cava, it is important to classify which parts of the vena cava are involved and to plan accordingly, as sometimes complete resection will involve an incision into the chest with increased morbidity.

For this reason, Dr. Gaetano Ciancio , adapted liver mobilization techniques from liver transplant to address retrohepatic or even suprahepatic inferior vena caval thrombus associated with renal tumors. Kidneys are sometimes embolized prior to surgery to minimize blood loss. Surgery is increasingly performed via laparoscopic techniques. Commonly referred to as key hole surgery, this surgery does not have the large incisions seen in a classically performed radical or partial nephrectomy, but still successfully removes either all or part of the kidney.

Laparoscopic surgery is associated with shorter stays in the hospital and quicker recovery time but there are still risks associated with the surgical procedure. These have the advantage of being less of a burden for the patient and the disease-free survival is comparable to that of open surgery.

This may involve temporarily stopping blood flow to the kidney while the mass is removed as well as renal cooling with an ice slush. Mannitol can also be administered to help limit damage to the kidney. This is usually done through an open incision although smaller lesions can be done laparoscopically with or without robotic assistance.

Laparoscopic cryotherapy can also be done on smaller lesions. Typically a biopsy is taken at the time of treatment. Intraoperative ultrasound may be used to help guide placement of the freezing probes. As the tumor is not removed followup is more complicated see below and overall disease-free rates are not as good as those obtained with surgical removal. Surgery for metastatic disease: If metastatic disease is present surgical treatment may still a viable option.

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Renal call carcinoma RCC is the most common malignancy of the kidney in adults. Heredity appears to play a role within the etiology of RCC. Recent evidence indicates that deletions and translocations involving the short arm of chromosome 3 are important for the oncogenesis and tumor progression of RCC. Overt symptoms accompanying RCC are often associated with advanced local or distant disease. There is an increased number of patients in whom the diagnosis of RCC is made incidentally in cases when the tumor is confined to the kidney. This finding is responsible for the fact that the prognosis is better in this group of patients. Surgical extirpation is the cornerstone of therapy of localized RCC.

Students who need tutorial services in other subject areas are encouraged to contact The Learning Center in Room The Math Clinic at Roxbury Community College is committed to drop-in accessibility as it supports students to succeed in all levels of mathematics by providing a safe environment to ask questions, study for tests, and complete homework assignments. Students who struggle with math are equally welcome as those for whom math is a major concentration. We are located in room of the Academic Building. Paid Internships: Below please find examples of recent "paid" internships for Roxbury Community College students. RCC Technology Club.

Renal cell carcinoma

Renal cell carcinoma RCC is a kidney cancer that originates in the lining of the proximal convoluted tubule , a part of the very small tubes in the kidney that transport primary urine. RCC most commonly occurs between 6th and 7th decade of life. Initial treatment is most commonly either partial or complete removal of the affected kidney s. The body is remarkably good at hiding the symptoms and as a result people with RCC often have advanced disease by the time it is discovered. Historically, medical practitioners expected a person to present with three findings.

Hons , M. CUHK , Dr. BioHuman Ph. HKU Scholars Hub. Research Gate.

Renal cell carcinoma: physiology, diagnosis, and therapy

Associations between imaging features and genomic landscape of RCC have been recently investigated in order to characterize better tumor diagnosting more precisely, staging and establishing more accurate prognosis comparing to classic histopathologic approach. In our previous work we have already described usefulness of expression of mi-Ra measured in urine during RCC diagnostics. Moreover, high miRa expression values have been significantly associated with poor survival rates in patients with RCC.

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