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Abstract
Renal cell carcinoma (RCC) represents 2–3% of all malignancies and approximately 50% of patients develop metastatic disease The 5-year survival rate is 60%; for patients with metastatic disease, the 2-year survival is 0–20%. A geographical variation exists and there is also evidence of a genetic predisposition.
The most common cause of inherited RCC is von Hipple-Lindau (VHL) disease, a dominant inherited cancer syndrome; 70% of patients with VHL will develop RCC by the age of 60. A number of precursor lesions in RCC have been identified, although their clinical significance is unknown. Intratubular epithelial dysplasia has been reported in 23–28% of patients with RCC and is typified by characteristic features, including epithelial crowding, large nuclei and an increased nucleus:cytoplasm ratio. Clearly, this high incidence implies that not all precursor lesions progress to RCC.
The most viable treatment option for small RCC is a radical nephrectomy, while partial nephrectomy has proven of value in elective conditions. It is important in the partial procedure to remove the tumor with a healthy margin. Cytoreductive therapy prior to immunotherapy can offer several theoretical advantages.
Prospective randomized trials have shown a significant survival advantage as well as a significantly longer time to disease progression in patients treated with reductive surgery prior to immunotherapy