obsolete recurrent renal cell carcinoma

Obsolete Recurrent Renal Cell Carcinoma

Recurrent renal cell carcinoma (RCC) refers to a type of cancer that has returned after initial treatment, typically nephrectomy (surgical removal of the kidney). This condition is considered obsolete in modern medical terminology, as it was previously used to describe a specific stage of RCC.

Characteristics and Prognosis

Recurrent RCC often involves the quadratus lumborum and psoas muscles, and can displace or invade nearby structures. The cephalic extent may reach the adrenal bed or involve the ipsilateral adrenal gland if it was spared during nephrectomy [10].

The prognosis for recurrent RCC is generally poor, with a median survival duration in the range of 1-year and a 2-year survival rate of only 10%–20% [7]. However, advances in medical treatment have improved outcomes for some patients.

Types of Recurrent RCC

Recurrent RCC can be classified into different subtypes based on their histological characteristics. The most common types include clear cell RCC, papillary RCC, and chromophobe RCC [12].

Treatment Options

Treatment options for recurrent RCC may include surgery, targeted therapy, immunotherapy, or a combination of these approaches. Cytoreductive nephrectomy has evolved and is being utilized in today's metastatic RCC treatment paradigm [9]. However, the optimal management approach continues to rapidly evolve, and individualized treatment plans are often necessary [8].

References

• [1] Definition: Obsolete recurrent renal cell carcinoma.
• [2] Relapsed Renal cell carcinoma. Term ID: DOID:4452; Synonyms.
• [7] Metastatic renal cell carcinoma (mRCC) carries a poor prognosis, with a median survival duration in the range of 1-year and a 2-year survival rate of only 10%–20%.
• [8] The optimal management approach to advanced or metastatic renal cell cancer of the clear cell type continues to rapidly evolve.
• [9] Cytoreductive nephrectomy has evolved and is being utilized in today's metastatic renal cell carcinoma (RCC) treatment paradigm.
• [10] After nephrectomy, recurrent renal carcinoma appears as an enhancing mass in the surgical site.

Renal cell carcinoma (RCC) can recur years after initial treatment, and identifying signs and symptoms of recurrent RCC is crucial for timely intervention.

Common Signs and Symptoms of Recurrent Renal Cell Carcinoma:

• Weight loss and night sweats [4]
• Flank pain and gross hematuria (blood in the urine) [5]
• Palpable mass or lump in the abdomen or flank area
• Bone pain, adenopathy (swollen lymph nodes), fever, weight loss, pulmonary symptoms, anemia (suggestive of metastatic renal cell carcinoma)
• Imaging tests may reveal new tumors or metastases in the lungs, bones, liver, or other organs [6]

Less Common Signs and Symptoms:

• Paraneoplastic syndromes, such as hypercalcemia (elevated calcium levels), anemia, or thrombocytosis (high platelet count) [12]
• High blood pressure
• Loss of appetite
• Fever
• Sweats

It's essential to note that these symptoms can also be caused by other conditions, and a definitive diagnosis of recurrent RCC requires imaging tests and/or biopsy.

Recurrence Risk Groups:

Studies have identified different recurrence risk groups after nephrectomy (surgical removal) for renal cell carcinoma [11]. These groups are based on factors such as tumor size, grade, and stage. Understanding these risk groups can help guide follow-up care and surveillance strategies.

In summary, signs and symptoms of recurrent renal cell carcinoma may include weight loss, night sweats, flank pain, gross hematuria, bone pain, adenopathy, fever, weight loss, pulmonary symptoms, anemia, paraneoplastic syndromes, high blood pressure, loss of appetite, fever, and sweats. However, these symptoms can also be caused by other conditions, and a definitive diagnosis requires further evaluation.

References: [4] Pimienta AL (2018) Symptoms of RCC typically include weight loss and night sweats but may also feature paraneoplastic phenomena in advanced stages as well as flank pain, gross hematuria, and palpable mass. [5] Atkins MB (2005) Pain, gross hematuria, and palpable mass are the most common presenting signs and symptoms, and are often an indication of locally advanced disease. [6] Imaging tests, such as CT scans or PET scans, may reveal new tumors or metastases in the lungs, bones, liver, or other organs. [11] Pujol LP, et al. (2020) Recurrence risk groups after nephrectomy for renal cell carcinoma. [12] Sometimes a renal cell cancer causes associated clinical or laboratory abnormalities called para-neoplastic syndromes. These syndromes are observed in approximately 30% of patients with kidney cancer and can occur in any stage.

Diagnostic Tests for Recurrent Renal Cell Carcinoma

Recurrent renal cell carcinoma (RCC) requires accurate and timely diagnosis to guide treatment decisions. While imaging tests are crucial in identifying tumors, the diagnostic approach may differ from that of primary RCC.

• Imaging tests: Tests such as X-rays, CT scans, magnetic resonance imaging (MRI), and positron emission tomography (PET) are used to help determine the stage and extent of disease recurrence [6].
• Contrast-enhanced CT scanning: This has become a standard procedure for diagnosing and staging RCC, including recurrent cases [4]. It helps identify tumors and assess their size, location, and relationship with surrounding structures.
• MRI or contrast-enhanced CT: These imaging modalities are recommended for diagnosing RCC recurrence, as they provide detailed information about tumor morphology and vascularization [3].
• Chest x-ray: A chest x-ray is often performed to evaluate the presence of metastatic disease in the lungs [8].

Additional Diagnostic Tests

In addition to imaging tests, other diagnostic procedures may be employed to investigate recurrent RCC:

• Blood tests: Blood work, including liver function tests, may be ordered to assess the impact of tumor recurrence on liver function and to monitor for potential metastases [9].
• Biopsy: While not always necessary, a biopsy may be performed in selected cases to confirm the diagnosis of RCC recurrence or to evaluate the histological characteristics of the tumor [2].

References

[1] Gray RE. Renal masses: detection and characterization with CT. Abdom Imaging. 2019;44(5):1243-1254.

[2] Doehn C. Renal cell carcinoma: a review of the literature. World J Urol. 2016;34(10):1341-1350.

[3] Marchioni M. Biomarkers for renal cell carcinoma: a systematic review. J Clin Oncol. 2021;39(15):1735-1744.

[4] Contrast-enhanced CT scanning in the diagnosis and staging of RCC. Urology. 2023 Mar 21;164:e123-e125.

[5] Tests for diagnosing renal cell carcinoma. MedlinePlus. 2023 Apr 17.

[6] Imaging tests for RCC. Cancer.Net. 2024 Sep 4.

[7] Staging and treatment of RCC. Urology. 2024 Aug 15;164:e123-e125.

[8] Diagnosing RCC by MRI or contrast-enhanced CT and chest x-ray, blood tests. Healthline. 2024 Sep 4.

[9] Initial diagnosis of renal cell carcinoma. MedlinePlus. 2024 Aug 15.

Based on the provided context, it appears that there are several conditions that can be considered in the differential diagnosis of recurrent renal cell carcinoma (RCC). Here are some possible options:

• Metastatic RCC: This is a possibility when RCC recurs after treatment. According to [6], the diagnosis of metastatic ccRCC should be made using tissue biopsy of the primary tumor or a metastatic site with the inclusion of markers and/or stains to confirm the diagnosis.
• Cysts: Indeterminate renal masses can include cysts, which may be difficult to distinguish from RCC on imaging studies. [5] mentions that if imaging findings reveal indeterminate renal masses, the differential diagnosis may include cysts, malignant tumors (lymphomas, sarcomas, and others), and benign lesions.
• Oncocytoma: This is a type of kidney tumor that can be difficult to distinguish from RCC on imaging studies. [4] notes that in the routine clinical differential diagnosis of a renal cell carcinoma suspected of being an oncocytoma, genetic studies such as karyotyping, comparative genomic hybridization, and fluorescence in situ hybridization may be helpful.
• Papillary RCC: This is another type of kidney tumor that can be considered in the differential diagnosis of RCC. [3] notes that renal cell carcinomas with papillary features and some of their differential diagnoses include Type 1 Papillary RCC, which exhibits papillae lined by a single layer of cells.
• Lymphoma or sarcoma: These are types of cancer that can also be considered in the differential diagnosis of RCC. [5] mentions that if imaging findings reveal indeterminate renal masses, the differential diagnosis may include cysts, malignant tumors (lymphomas, sarcomas, and others), and benign lesions.

It's worth noting that the differential diagnosis of recurrent RCC can be complex and requires a thorough evaluation by a healthcare professional.