Orginal Publication Date
MCV/Q, Medical College of Virginia Quarterly
Tumors of the upper urinary tract constitute 1% to 2% of all cancers, and each year 11,000 new cases are diagnosed in the United States. Approximately half of these patients have metastatic disease at the time of diagnosis. Hypernephroma, or renal cell carcinoma, was first described in 1863 by Grawitz. These tumors arise from tubular epithelial cells and are correctly termed renal cell carcinoma or renal cell adenocarcinoma. There is evidence that further identifies the cell of origin as being from the proximal convoluted tubular epithelium. There does not appear to be a specific racial or ethnic incidence although it occurs three times more often in men than in women. Few epidemiological studies of this disease have been undertaken, although there is some association between the use of tobacco and an increased incidence of renal cell carcinoma. The classical triad of hematuria, pain, and a palpable mass are late findings with a poor prognosis which occurs in 10% of the patients and usually represents metastatic disease. Forty percent of the patients may have hematuria or other urinary complaints. Local effects of the tumors are hematuria, pain, and a flank mass, but the presenting symptoms may include a varicocele in the male which is produced by direct pressure of the tumor on the spermatic vein or because of stasis caused by an obstructing tumor thrombus in the vena cava. Systemic toxic effects such as hyperpyrexia may be of an intermittent or variable nature. Anemia or abnormal live chemistries may also be present. Erythrocytosis, hypertension, and hypercalcemia may also be manifest.
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