Renal Cell Carcinoma Essay

Renal Cell Carcinoma Cancer is the second leading cause of death next to cardiovascular disease. There are many types of cancers, and different stages of cancer. There are also many different treatment options available today to fight this horrible disease. There are new drugs coming out that have showed significant results in prolonging life, and have helped reduce the size of tumors and slow down the progression of this disease. One of the more remarkable drugs out now is the drug Sunitinib malate or Sutent for short.

Sutent is mainly used in patients with advanced metastatic renal cell carcinoma. Renal cell carcinoma also known as hypernephroma is defined as a malignant tumor resembling the tissue of the suprarenal gland and occurring in the kidneys. Fever, loin pain, haematuria, and swelling are among the presenting symptoms, but the tumor may be symptomless for many years. Surgical removal is the initial treatment; hypernephromas are fairly insensitive to cytoxic drugs and radiotherapy- although hormone treatment may help- and are prone to spread via the bloodstream, for example, to the lungs (Black, 342).

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Renal cell carcinoma (RCC) is a form of kidney cancer and metastatic, or means that it is in advanced stages and has already begun to spread throughout other parts of the body. Metastatic renal cell carcinoma is the most common and one of most resistant tumors in urology with only a less than 10% survival rate for 5 years (Patel). RCC is more common in men than women and is most common in people over 50. There are different forms of renal cell carcinoma; clear cell, papillary, chromophobe, collecting duct, and unclassified.

The way renal carcinoma is classified into these categories is based on how the cancer cells look under a microscope. Clear cell is the most common form of RCC; about 8 out of every 10 people have this form of RCC. When observed under a microscope the cells appear very pale, and clear. Papillary is the second most common form of RCC, about 10%-15% have this form of RCC. This form has small finger-like projections (papillae) throughout the tumor. To detect this form of RCC the doctors rely on dye to make the papillae visible.

Chromophobe accounts for about 5% of RCC patients and is similar to clear cell RCC when observed under a microscope. The cells appear pale and clear, but are much larger than clear cell RCC. Collecting duct is a very rare form of RCC, and can be identified by irregular tubes forming throughout the tumor. Unclassified is the rarest form of RCC. If none of the cancer cells fall into any of the other classifications or convey several characteristics of other forms of RCC it falls under the category of unclassified.

Cancer is classified into four stages; stage I cancers are small localized cancers that are usually curable, stage II and III cancers are usually locally advanced and/or with involvement of local lymph nodes, stage IV caners usually represents inoperable or metastatic cancer. Kidney cancer is usually found in the earlier stages before it has reached mestasis, but in some cases the cancer may not be found until the later stages once it has already spread to other areas causing more symptoms. There are no simple tests to check for kidney cancer that aren’t at high risk.

Early stages of kidney cancer do not tend to present any signs or symptoms, but the later stages can. Some of the signs and symptoms are; blood in the urine, low back pain on one side, a mass or lump on the lower back or on the side, fatigue, weight loss, fever that does not go away after a few weeks, and swelling of the legs and ankles. There are many tests that can be performed to test for kidney cancer if you are at high risk, and several tests to check to see how far the cancer has spread; CT scans, urinalysis, blood tests, bone scans, MRI, A CT scan, ultrasound, IVP, Angiography, chest X-rays, lab tests, and FNA biopsy.

The cause of RCC is unknown but there are many factors that could play a role into RCC; Cigarette smoking doubles the risk for renal cell carcinoma, obesity, prolonged use of medicines containing aspirin and a compound called can lead to kidney failure and increase the risk of RCC, exposure to different substances such as cadmium and asbestos, certain inherited disorders such as von Hippel-Lindau syndrome, Birt Hogg Dube syndrome, and tuberous sclerosis are associated with an increased risk for RCC, and certain gentic factors can all play a role in kidney cancer.

There are many different forms of treatment once the cancer has been classified; surgery, “keyhole” surgery, cryotherapy, radiofrequency ablation, arterial embolization, radiation therapy, biologic therapy, and chemotherapy. In some cases surgery is not an option because the cancer has spread too far or is too advanced for the surgery to do any good. This is when chemotherapy is one of the last options. In some cases surgery may be the only option at that point, but it can be a catch 22 situation.

In some cases there may be a tumor in the kidney, but it might not actually be cancer and in this case the only option is surgery because. * Chemo doesn’t work on kidney cells because kidney cells are designed to remove toxic chemicals. * The kidney has a rich blood supply (because its job is to filter the blood) and so any attempt to biopsy a kidney tumor will spread it to other parts of the body * There is no blood marker for kidney cancer. This is when chemotherapy is one of the last options. “Marker For Kidney Cancer”) One of the most remarkable drugs available to patients with renal cell carcinoma is Sunitinib Malate a. k. a. Sutent. Sutent is a highly selective, multi-targeted tyrosine kinase inhibitor that starves tumors of blood and nutrients needed for growth and simultaneously kills cancer cells that make up tumors (“Medical News Today”). As stated earlier patients diagnosed with renal cell carcinoma have a less than 10% survival rate of five years, but with the drug Sutent the survival rate has increased.

It does not cure cancer, but it does slow down the progression. In previous trials involving patients with metastatic RCC, Sunitinib was associated with response rates of 39% and 40%. In contrast, conventional RCC second-line therapies generally have response rates of 3% – 4% (Bankhead). Not everyone has success with the drug Sutent, and find other experimental drugs that are able to give them better results such as; Temsirolimus, Lapatinib, Nexavar, and Oxydrene.

Although Sutent is able to slow down the progression and growth of cancer cells, it does have harsh side effects that include; Changes in taste; constipation; decreased appetite; diarrhea; dry, thick, or cracked skin; headache; indigestion; mouth pain or irritation; nausea; nosebleed; skin or hair discoloration; stomach pain or upset; tiredness; vomiting; weakness (“Drugs. com”). Because the side effects are so harsh the typical cycle for Sutent dosage is 37. 5 mg for four weeks, and then two weeks off. Survival Rate for Men and Women Over The Years

As you can see in the chart above the survival rate for patients with renal cell carcinoma has increased over the years. Men and women with RCC have 70% survival rate for the first year compared to a 45% survival rate in the early 1970’s. Patients have a 50% survival rate for five years now when before it was only a 28% chance. 10 year survival rate is around 45% now, and before it was 25%. This is due to new advances in medical technology and the development of newer drugs such as Sutent. My father was diagnosed with RCC July, 2008 and passed away February, 2009.

Although he was on Sutent and the cancer progression had slowed down it had already spread too far for a single drug like Sutent to work. My father’s oncologist, Dr. Rubinowitz, said “Twenty years ago we would have told you to start making funeral arrangements because RCC is such an unpredictable disease, but with the medicine available today we are not able to give you a life expectancy with this disease. I have had patients come in with stage IV RCC and live for 10 years with no complications, others are not so lucky. For any oncologist who gives you a life expectancy, he is insane and insensitive.

There is no real way of knowing anymore how long you can live with this disease. “ Since Sutent is still such a new experimental drug, there is not a lot of research showing how long one can live on Sutent. There have been cases where patients have been on Sutent for ten years, but at this point there is still no limit to how long someone can survive with RCC, with the mixture of medications and surgery. There is no cure for cancer at this point, but there are many medical advances that are helping prolong life for those that are battling this terrible disease.

With new drugs emerging all the time and having such great results in slowing down the progression of this disease, such as Sutent, we are one step closer to finding an actual cure for this disease. Works Cited Bankhead, Charles. “Three New Drugs Available To Fight Kidney Cancer. ” 98. (2006): n. pag. Web. 06 Feb 2010. . Black, Dr. Black’s Medical Dictionary. 4th edition. New York, NY: A & C Black’s Publishers Limited, 2005. Pg. 342. Print. “Marker for Kidney Cancer. ” Kidney Tumor. Web. 2 Feb 2010. “New Data Show Pfizer’s SUTENT/SU11248 Extends Overall Survival in Gleevec-resistant GIST. ” Medical News Today. 17 May 2005. Pfizer, Web. 08 Feb 2010. . Patel, Samit. “Effects of Sunitinib Malate on Metastatic Renal Cell Carcinoma. ” Internet Journal of Urology Vol. 5. 2nd edition (2008): n. pag. Web. 2 Feb 2010. http://www. ispub. com/journal/the_internet_journal_of_urology/volume_5_number_2_41/article/effects_of_sunitinib_malate_on_metastatic_renal_cell_carcino ma. html Peck, Peggy. “Other Cancers. ” Med Page Today. 01 Jan 2007. Zalman S. Agus, MD, Web. 2 Feb 2010.


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