الفهرس 
Surgical AnatomyOnly 14 pages are availabe for public view
 |  | from | 188 |  |  |
| | | from | 188 | | |
Abstract
Renal cell carcinoma is a malignancy arises from proximal renal tubular epithelium, it accounts for only 2–3% of cancers. 2% of RCC clusters in families. Both sporadic and hereditary forms are associated with VHL tumor suppressor gene. Hereditary RCC syndromes include VHL disease, hereditary papillary RCC, hereditary leiomyomata and RCC, and Birt-Hogg Dube syndrome.
The clear cell type is the most common type (about 75%) with other less common cell types including papillary, chromophobe, and collecting duct tumors. Many risk factors have been identified including as smoking, obesity, hypertension end-stage renal disease with long-term hemodialysis, kidney transplantation, and acquired renal cystic disease.
Currently, most RCCs are detected incidentally by the frequent use of imaging examinations. Contrast-enhanced CT scan remain the gold standard for detecting and characterizing renal masses FDG-PET/CT might have a complementary role as a problem-solving tool in cases that was equivocal using conventional imaging. Physical examination has limited role in diagnosing RCC.
Surgical intervention remains the only effective treatment for localized RCC, and also plays a role in metastatic RCC because of the resistant nature of RCC to conventional chemotherapy and radiotherapy.
Over the past two decades cytokine-based Immunotherapy (IL-2 and INF-a) were the standard treatment for metastatic, recurrent or unresectable RCC with overall response only around 10% and significant toxicities.
The expanding understanding of the genetic and molecular bases of renal cell carcinoma has led to the development of various targeted agents, changing the therapeutic options for this disease by significantly extending the progression-free and overall survival. FDA approved seven drugs (sunitinib, sorafenib, pazopanib, axitinib, bevacizumab, temsirolimus, and everolimus) over the period from 2005-2012. Also many other agents undergoing investigation which may expand the treatment list for RCC.
These targeted therapies constitute a growing arsenal against advanced RCC, lengthening progression free survival and overall survival significantly more than immune-based therapies.
With the merge of these novel targeted drugs a new type of assessment of response appears to be of importance such as disease stabilization instead of tumor shrinkage.
Different spectrum of toxicities clearly exists with these newer agents. Class-effects Averse events such as hypertension, fatigue, and gastrointestinal disturbances are common with all the antiangiogenic agents as they have similar mechanisms of action.
Although treatment associated adverse events are common, the majority reported during clinical trial experiences were grade 1 or 2 in severity and manageable with intervention in the form of supportive measures and/or dosage modification.
Many strategies such as adjuvant, neoadjvant, combination, and sequential therapy are under clinical trials to determine the best treatment plans to RCC patients.