Symptoms Of Renal Cell Carcinoma Research Articles

Protocol for a mixed-method study to assess chronic cough in patients with renal cell carcinoma: the prevalence, impact on quality of life, trigger and potential clinical application of chronic cough as an early screening tool in patients with kidney cancer

IntroductionCough as a symptom of renal cell carcinoma (RCC) was first described by Creevy in 1935, and despite one (unpublished) study suggesting it may affect 31% of these patients, as...

Cytokines in Renal Cell Carcinoma: A Step Towards Earlier Detection and Targeted Therapy.

Symptoms of renal cell carcinoma (RCC) have typically late onset and correlate with its advanced stage. No biomarkers of RCC are currently available. The present study analyzed the immuno-biochemical profile of RCC by measuring the levels of cytokines engaged in RCC pathophysiology. Cytokines were examined by capture sandwich immunoassays in tumor tissue and urine. Specimens of cancer and nearby healthy kidney tissues were obtained during nephrectomy from 60 RCC patients. The urine was obtained from both patients and healthy subjects. The findings in RCC tumor tissue compared to healthy renal tissues were following: (i) increases in interleukin-15 (IL-15), vascular endothelial growth factor (VEGF), interferon gamma-induced protein-10 (IP-10), macrophage inflammatory protein-1β (MIP-1β), monocyte chemoattractant protein-1 (MCP-1), and eotaxin, with VEGF, IP-10, and MIP-1β significantly associated with the histologic tumor nuclear grading (NG); (ii) increases in platelet-derived growth factor (PDGF), IL-15, MIP-1ß, eotaxin, and MCP-1 in urine, with significant associations noticed between cytokines and disease stages for eotaxin and MCP-1; and (iii) decreases in PDGF, IL-15, MCP-1, VEGF, MIP-1β, and eotaxin in urine from six patients on the third day after nephrectomy. We conclude that cytokines may play a critical role in the local pathogenesis of RCC, which opens the way for potential targeting of these molecules in novel therapies and their use as biomarkers for early noninvasive detection of RCC.

Cough as Presenting Symptom of Renal Cell Carcinoma

Cough as Presenting Symptom of Renal Cell Carcinoma

Cutaneous Metastasis to the Left Cheek as the First Symptom of RCC

Abstract Renal Cell Carcinoma (RCC) is the third most common genitourinary malignancy with an estimated one third of cases with metastatic disease at the time of diagnosis. RCC metastasizes most commonly to the lung parenchyma, bone, liver, and brain and less commonly to the thyroid, pancreas, muscle, soft tissue and skin. The incidence of cutaneous metastasis from all urologic malignancies has been reported to be 0.73-1.3%. Though rare, cutaneous metastasis from RCC is more frequent than any other genitourinary malignancy. Unfortunately, the prognosis of metastatic Renal Cell Carcinoma (RCC) with skin metastasis is in most cases unfavourable. We report an unusual case of cutaneous metastasis to the left cheek, in a 56-year-old man, as the first symptom of renal cell carcinoma. Keywords Cutaneous metastasis; Renal cell carcinoma; Surgical treatment

Persistent cough as the first presenting symptom of renal cell carcinoma

Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults. It accounts for approximately 3% of adult malignancies and 90­95% of neoplasms arising from the kidney. RCC may remain clinically occult for most of its course and the classic triad of flank pain, hematuria and flank mass is uncommon. RCC is a challenging tumor because of the frequent occurrence of paraneoplastic syndromes. Fourty-six years old male suffered from persistent coughing for approximately 1 year. He had no history of taking angiotensin converting enzyme inhibitors. Physical examination was insignificant. Blood tests revealed an elevated sedimentation rate (ESR 92 mm/1.h), leucocytosis and sideropenic anaema (hemoglobin 103 g/L, iron level 4.3 μmol/l). The chest radiograph and spirometry results were normal. Fecal occult blood test was negative and the tumor markers' levels were within normal ranges. Abdominal ultrasound revealed a mass on the right kidney. Computed tomography (CT) scan of the abdomen demonstrated a 93x72 mm mass arising from the right kidney with no evidence of invasion into surrounding organs. The patient underwent open right radical nephrectomy for renal cell carcinoma. Postoperative recovery was uneventful and the persistent cough disappeared 2 days postoperatively with rapid improvement of anemia and normalization of ESR. Three months after the surgery the patient remained asymptomatic without any evidence of a recurring tumor. It is important to remember the wide variety of guises under which renal cell carcinoma may present.

Persistent cough as the first presenting symptom of renal cell carcinoma

Introduction: Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults. It accounts for approximately 3% of adult malignancies and 90-95% of neoplasms arising from the kidney. RCC may remain clinically occult for most of its course and the classic triad of flank pain, hematuria and flank mass is uncommon. RCC is a challenging tumour because of the frequent occurrence of paraneoplastic syndromes. Case report: Fourty-six year old male suffered from persistent coughing for approximately 1 year. He had no history of taking angiotensin converting enzyme inhibitors. Physical examination was insignificant. Blood tests revealed an elevated sedimentation rate (ESR 92 mm/1.h), leucocytosis and sideropenic anaema (hemoglobin 103 g/L, iron level 4.3 μmol/l). The chest radiograph and spirometry results were normal. Fecal occult blood test was negative and the tumour markers' levels were within normal ranges. Abdominal ultrasound revealed a mass on the right kidney. Computed tomography (CT) scan of the abdomen demonstrated a 93x72 mm mass arising from the right kidney with no evidence of invasion into the surrounding organs. The patient underwent open right radical nephrectomy for renal cell carcinoma. Postoperative recovery was uneventful and the persistent cough disappeared 2 days postoperatively with rapid improvement of anaemia and normalization of ESR. Three months after the surgery the patient remained asymptomatic with no evidence of a recurring tumour. Conclusion: It is important to remember the wide variety of guises under which renal cell carcinoma may be presented.

Changes in symptoms of renal cell carcinoma over four decades

To determine whether there has been a change in typical symptoms of renal cell carcinoma (RCC), by evaluating the symptoms of patients diagnosed during four decades, as although the increasing incidence of a diagnosis of incidental RCC has been widely reported, the change in other symptoms has not. The study included RCC cases diagnosed in the Pirkanmaa Hospital District between 1964 and 1997. The original medical records of 970 patients with 982 RCC tumours were analysed. Primary symptoms were recorded and changes were analysed in three groups, i.e. diagnoses made before 1980, in the 1980s and in the 1990s. Symptoms were also analysed according to stage, tumour class, gender and age. The incidence of haematuria (P < 0.01) and an increased erythrocyte sedimentation rate (P < 0.001) decreased, but there was no change in other symptoms. Incidental diagnoses increased from 12% to 19% (P < 0.01). Less chronic or systemic symptoms were noted more recently. Stage and tumour class were highly correlated with symptoms: systemic symptoms increased (24% in stage I to 72% in stage IV, a highly statistically significant increase) and asymptomatic tumours became rarer (27% in stage I to 8% in stage IV, again a highly significant increase) with increasing stage. Haematuria was more common in male patients, anaemia and flank pain in women. Elderly patients were more often asymptomatic than younger patients, with 70-79-year-olds being the least symptomatic. Incidental cases of RCC have recently become more common. Haematuria, hypersedimentation, chronic and systemic symptoms have decreased. Stage, tumour class, gender and age are correlated with symptoms.

両側耳下腺腫瘤を契機に多発転移が明らかになった腎細胞癌例

Parotid gland metastasis from renal cell carcinoma is extremely rare and this case is, to our knowledge, the first presenting such bilateral parotid gland metastasis. A 70-year-old man who had undergone left radical nephrectomy one year before reported painless swelling in the bilateral parotid glands, found in computed tomography, magnetic resonance imaging, and 99mTc pertechnetate scintigraphy to be a vascular tumor of the superficial gland lobe. Superficial parotidectomy preserving the facial nerve were conducted bilaterally under general anesthesia. The histopathological diagnosis was metastatic renal cell carcinoma. Subsequent examination showed multiple metastases to the right kidney, lung, and pancreas, necessitating molecular target drug (Sunitinib) treatment. Parotid gland metastasis is found as an initial symptom of renal cell carcinoma or may be found during renal cell carcinoma treatment. Renal cell carcinoma metastasis must thus be considered in the case of a parotid mass.

P21 is a Prognostic Marker for Renal Cell Carcinoma: Implications for Novel Therapeutic Approaches

Kidney cancer, although relatively rare compared to other malignancies, is the most lethal of the common urological malignancies. Current treatments are inadequate as evidenced by a poor 5-year survival of patients with metastatic disease. Since there exists a significant disparity in the survival of patients with localized vs metastatic disease, efforts are under way to identify molecular markers of progression as well as targets for novel therapeutic approaches. The apoptosis and cell cycle regulatory protein, p21(waf1/cip1), has been investigated as a possible target in other cancers since it is involved in the repair and apoptotic response of normal and malignant cells to DNA damage. We performed immunohistochemical analysis of a tissue array of 366 patients for which we have data on grade, stage and survival. We found that nuclear p21 is most highly expressed in collecting duct carcinoma and lowest in oncocytoma. Cytosolic p21 staining was highest in oncocytoma. In clear cell renal cell carcinoma p21 has prognostic value, which is a function of whether patients have localized or metastatic disease at diagnosis, suggesting the existence of 2 discrete classes of this disease. In localized disease higher levels of nuclear p21 were associated with a better prognosis, but in patients with metastatic disease at diagnosis higher levels of nuclear and cytosolic p21 were associated with worse survival. Based on our findings p21 may be useful in prognostication, and it may have a role in the differing biological behaviors of localized and metastatic renal cell carcinoma.

A brief symptom index for advanced renal cell carcinoma

BackgroundOur objective was to test a brief, symptom index for advanced renal cell carcinoma, a disease affecting over 38,000 Americans each year and often diagnosed in late stages.MethodsWe conducted secondary data analyses on patient-reported outcomes of 209 metastatic renal cell carcinoma patients participating in a Phase III clinical trial. Patient-reported outcomes, obtained from the FACT-Biological Response Modifier (FACT-BRM) scale, were available at baseline, 2, and 8 weeks. We analyzed data from eight FACT-BRM items previously identified by clinical experts to represent the most important symptoms of advanced renal cell carcinoma. Items comprising this index assess nausea, pain, appetite, perceived sickness, fatigue and weakness, with higher scores indicating fewer symptoms. We determined reliability and validity of the index and estimated a minimally important difference.ResultsThe index had excellent internal reliability at all three time points (alphas ≥ 0.83). Baseline scores were able to discriminate patients across Karnofsky performance status, number of metastatic sites, and risk group categories (ps < .01). Mean index scores declined over time likely indicative of the toxic nature of the administered treatments. Distribution- and anchor-based methods converged on a minimally important difference estimate of 2 to 3 points.ConclusionThe 8-item index of patient-reported symptoms of renal cell carcinoma appears to be a psychometrically sound measure. It is a brief, reliable, and valid measure that can easily be adapted for use in clinical trials and observational studies.

Strong significant correlation between MMP-9 and systemic symptoms in patients with localized renal cell carcinoma

Objectives To identify a relationship between clinical symptoms and matrix metalloproteinase (MMP)-2 and MMP-9, tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2, and membrane type MMP-1. Methods Tumor samples from 232 patients with renal cell carcinoma with no distant metastasis were immunohistochemically stained for MMP-2 and MMP-9, TIMP-1 and TIMP-2, and membrane type MMP-1. The immunoreactivity of these factors was analyzed by semiquantitative multivariate analysis for correlation with clinical symptoms. Results Patard’s criteria were used to classify symptoms at initial tumor clinical presentation, with three groups defined: S1, S2, and S3. The cancer-specific 5-year survival rate was 88.7%, 74.7%, and 67.6% for S1 (145 patients), S2 (69 patients), and S3 (18 patients), respectively ( P = 0.0015). Multiple logistic regression analysis of preference was used to determine whether differences in the contribution of the symptoms were statistically significant. A maximal tumor diameter of 40 mm or greater and positive venous invasion were associated with a 262% and 281% increase in the odds of local symptoms, respectively. MMP-9 positive cases were associated with a 2979% increase in the odds of systemic symptoms with significance. Conclusions This study found a strong significant correlation between the histopathologic expression of MMP-9 and the systemic symptoms of renal cell carcinoma. We propose the histopathologic measurement of MMP-9 as a useful tool for assessing the prognosis of patients with renal cell carcinoma with systemic symptoms.

Solitary metastasis in a nasal fossa as the first manifestation of a renal carcinoma

Renal cell carcinoma is an uncommon tumor in adults. Metastasis in the nasal fossa is rare, and can become apparent as a result of repeated epistaxis. We report a patient with renal cell carcinoma presenting with epistaxis secondary to a metastasis in the right nasal fossa. The primary tumor was treated with nephrectomy and the nasal fossa metastasis was treated successfully with embolization, chemoimmunotherapy, surgery, and radiotherapy. The presence of repeated epistaxis may very occasionally be the first symptom of renal cell carcinoma, and systemic treatment combined with local treatment may enable adequate control of the disease.

Paraneoplastic Signs and Symptoms of Renal Cell Carcinoma: Implications for Prognosis

Renal cell carcinoma (RCC) can present with a wide range of signs and symptoms. To our knowledge we report the first study to describe the frequency of paraneoplastic findings in a modern RCC series and assess the prognostic significance of each finding. Using the kidney cancer database at our institution 1,046 patients undergoing nephrectomy for RCC between 1989 and 2001 were assessed. The prognostic significance of symptoms present at diagnosis and findings on preoperative laboratory evaluation were examined in a univariate analysis as well as on multivariate analysis controlling for TNM stage, Fuhrman grade and Eastern Cooperative Oncology Group performance status (ECOG-PS). Mean followup to date of death or last contact for all patients was 40.3 months. Median time to death was 19.3 months. Most paraneoplastic signs and symptoms correlated with poor survival, although on multivariate analysis hypoalbuminemia, weight loss, anorexia and malaise predicted shorter survival. The frequency of each of these findings was 19.9%, 22.9%, 10.6% and 19.1%, respectively. Cachexia, defined as the presence of at least 1 of these findings, was noted in 35.3% of patients. Cachexia did not predict a higher recurrence rate in patients with localized disease and only malaise correlated with a decreased likelihood of responding to immunotherapy. Cachexia, defined as hypoalbuminemia, weight loss, anorexia or malaise, predicts worse survival after controlling for well established indicators of prognosis (TNM stage, Fuhrman grade and ECOG-PS). Consideration should be given to expanding the ECOG-PS to include measures for cachexia when applied to patients with RCC.

RENAL CELL CARCINOMA: PROGNOSTIC SIGNIFICANCE OF INCIDENTALLY DETECTED TUMORS

We determined the prognostic significance of incidentally discovered renal cell carcinoma in the era of increased incidental detection. We reviewed the records of 633 consecutive patients who underwent radical or partial nephrectomy for renal cell carcinoma at our institution between 1987 and 1998. Patients were divided into those who were asymptomatic and tumor was diagnosed incidentally and those diagnosed after presenting with any of the classic symptoms of renal cell carcinoma or subsequent metastasis. All renal cell carcinoma lesions were assigned a stage and grade according to 1997 TNM criteria. All patients were followed postoperatively to assess survival rates, and monitor recurrence and metastasis. Of the 633 patients 95 (15%) were treated for incidentally discovered renal cell carcinoma and 538 (85%) presented with symptoms secondary to renal cell carcinoma at diagnosis. Patient age and sex distribution were similar in the 2 groups. Stage I lesions were observed in 62.1% of patients with incidental renal cell carcinoma and in 23% with symptomatic renal cell carcinoma. In contrast, stage IV lesions were present in 27.4% of patients with incidental versus 54% with symptomatic renal cell carcinoma. Thus, incidental lesions were of significantly lower stage than those causing symptoms (p <0.001). Similarly 15.8% of incidental but 42.4% of symptomatic lesions were grade 3 or 4 (p = 0.006). Patients were followed postoperatively for a mean of 47 months plus or minus 40 months. The 5-year cancer specific survival rate was significantly higher for incidental than for symptomatic tumors (85.3% versus 62.5%). Likewise, the local and distal recurrence rates were higher for symptomatic lesions. When adjusted for stage, no difference in survival was noted in the 2 groups for stages I to III disease and a minimally significant difference was noted for stage IV cancer. Multivariate analysis of stage and grade attributed the survival difference in stage IV disease to the significantly higher grade of symptomatic lesions. At presentation incidental tumors are of significantly lower stage and grade than tumors producing symptoms. Subsequently these clinically and histologically less aggressive lesions lead to better patient survival and decreased recurrence. Thus, the detection of renal cell carcinoma before symptom onset enables treatment of less aggressive tumors and provides a better prognosis for patients. Given these data efforts should be directed toward the development of a screening protocol to detect these lesions early, so that they may be prevented from progressing to the point when symptoms are apparent and prognosis becomes worse. In addition, the significant correlation of tumor grade with survival in our study further demonstrates the prognostic value of tumor grade and molecular markers for the future evaluation and treatment of renal cell carcinoma.

Pathological fracture of the patella as the first presentation of renal cell carcinoma

The patella is a rare site for a metastasis to occur. We present a patient whose presenting symptom of renal cell carcinoma was a pathological fracture of the patella.

Lower gastrointestinal bleeding as the initial presenting symptom of renal cell carcinoma

Renal cell carcinoma is known as one of the “great mimics encountered in clinical medicine,” along with syphilis and tuberculosis (1). It can present clinically as a wide range of symptoms, with a classic triad described as hematuria, pain, and a palpable abdominal mass (2, 3). However, this triad is present only in <20% of patients with renal cell carcinoma (4). Gastrointestinal bleeding has been described in renal cell carcinoma, although mainly secondary to metastasis in the upper gastrointestinal tract, with few cases due to local invasion. Lower gastrointestinal bleeding as a presenting symptom of an invasive primary renal cell carcinoma has been described in only one patient in the literature (2). Our patient is the first in whom a colonoscopic biopsy was used as a successful diagnostic modality.

Can symptoms predict the prognosis of renal cell carcinoma? A multivariate analysis of 320 patients

The well-known, classical symptoms of renal cell carcinoma (RCC) are abdominal or flank pain, a palpable mass, and hematuria. However, the number of patients with this classical triad has been decreasing recently. This is especially true in Japan where health screening programs detect many incidental renal cell carcinomas. This study reevaluated the presenting symptoms of RCC as prognostic factors. It also showed that patients found to have RCC by health screening had a significantly low hazard ratio and a good prognosis. To evaluate the presenting symptoms as prognostic factors for survival, we retrospectively studied 320 patients with renal cell carcinoma between 1978 and 1995. The following symptoms were evaluated as prognostic factors: large amount of hematuria, any hematuria (including microscopic and macroscopic), flank and/or abdominal pain, a palpable mass, malaise, weight loss, pyrexia, and the reason for examining the kidneys. Survival curves were calculated by the Kaplan-Meier method, and univariate analysis was performed using the log-rank test and Cox's proportional hazard model. Significant factors were then chosen for Cox's multivariate proportional hazard test to evaluate their relative prognostic value. The median follow-up period was 29 months. The overall survival rate at 1, 5, and 10 years was 90.0%, 77.6%, and 69.9%, respectively. The chi-square test revealed a close relationship between flank and/or abdominal pain and local tumor extent; pyrexia and lymph node and distant metastasis; and incidental detection by health screening with no local invasion or distant metastasis. Of the 8 prognostic factors evaluated, univariate and multivariate analysis showed that flank and/or abdominal pain and pyrexia were poor prognostic factors, while patients with tumors found by routine health screening or during workup of other diseases showed a good outcome.

Renal cell carcinoma in autosomal dominant polycystic kidney disease.

To provide information on the clinical presentation, diagnosis, pathology, and biologic behavior of renal cell carcinoma in patients with autosomal dominant polycystic kidney disease (ADPKD), three cases seen at this institution between 1955 and 1992, as well as the cases reported in the literature, were reviewed in detail. No male predominance was observed (12 men, 13 women) in the 25 patients who met the inclusion criteria. The age of presentation was earlier than that seen in the general population (45 versus 61 yr). Fever, night sweats, and weight loss were prominent at presentation. Fever is a more common presenting symptom of renal cell carcinoma in ADPKD (32%) than in the general population (7%). Twenty percent of the patients had metastatic disease at presentation. Even with computed tomography and magnetic resonance, the diagnosis was difficult and often delayed, and the accumulation of 111In-labeled white blood cells can wrongly suggest a cyst infection. Renal cell carcinoma in ADPKD is more often concurrently bilateral (12 versus 1 to 5%), multicentric (28 versus 6%), and sarcomatoid in type (33 versus 1 to 5%) than in the general population. Because previous studies have failed to demonstrate a higher prevalence of renal cell carcinoma in ADPKD, this information suggests either a malignant potential restricted to a small subset of patients with this disease or an alteration in the biologic behavior of renal cell carcinoma when it develops in the setting of ADPKD.

Incidental Renal Cell Carcinoma

We reviewed the cases of incidental renal cell carcinoma that had been treated at the Kitasato University Hospital between July, 1971 and December, 1989. Forty one of the 170 (24.1%) cases were found without any direct signs of renal cell carcinoma. The patients were between 30 and 78 years old (mean 55.0 years) and consisted of 29 males and 12 females. Fifteen cases were detected at the general health check-up and the remaining 26 during the postoperative follow-up for other malignant tumors or other diseases. Twenty three cases were identified by ultrasonography followed by computed tomography (CT) and excretory pyelography in 4 cases each. Especially, the number of patients incidentally found by ultrasonography had increased in the recent 8 years. Urinalysis did not show any microhematuria in 31 of the 37 cases (83.7%), and no tumor mass could be detected by excretory pyelography in 3 cases. We believe that ultrasonography may be valuable as a screening modality for early detection of renal cell carcinoma and should be used as a screening method at the routine health check-up.