Cancer, Renal Cell


Article Author:
Karen Garfield


Article Editor:
Chad LaGrange


Editors In Chief:
Casey Ciresi


Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes


Updated:
6/4/2019 7:10:33 PM

Introduction

Renal cell carcinomas (RCCs), which originate within the renal cortex, are responsible for 80% to 85% of all primary renal neoplasms. Transitional cell carcinomas, which originate in the renal pelvis, comprise approximately 8%. Other parenchymal epithelial tumors, such as oncocytomas, collecting duct tumors, angiomyolipomas, and renal sarcomas, occur infrequently. In children, nephroblastoma and Wilms tumor are common. Medullary renal carcinoma is a rare but aggressive form of renal cell cancer that seen in sickle cell disease. Other less common subtypes are clear cell, papillary, and chromophobe malignancies.[1][2][3]

Etiology

The exact cause of RCC is unknown. The following factors increase a person's risk for renal cancer: older age, obesity, hypertension, chronic renal failure, dialysis treatment, polycystic kidney disease, African American race, sickle cell disease, and renal stones.[4][5]

The following hereditary diseases increase the risk of RCC: tuberous sclerosis, Von Hippel-Lindau syndrome  Birt-Hogg-Dube syndrome, hereditary papillary renal carcinoma, and hereditary leiomyomatosis and renal cell carcinoma (HLRCC).

Many studies have suggested that workplace exposure to certain substances increases the risk of RCC. Some of these substances are cadmium, herbicides, asbestos, and trichloroethylene.

Epidemiology

RCC is the most common type of kidney cancer in adults. It occurs most often in men ages 50 to 70.

Globally, the incidence of RCC varies, with the highest rates observed in the Czech Republic and North America. In the United States, there are approximately 63,000 new cases and almost 14,000 deaths each year.

In the United States, incidence rates of RCC have been on the rise through the mid-2000s. Most of the increases since the 1980s occurred in early-stage tumors.[6]

Pathophysiology

The proximal renal tubular epithelium is the kidney tissue from which RCC arises. The two forms are sporadic: nonhereditary and hereditary. The structural alterations of both forms occur on the short arm of chromosome 3 (3p).

Families at high risk for developing renal cancer were studied, which led to the cloning of genes. The genes whose alteration resulted in RCC formation were tumor suppressors (VHL, TSC) or oncogenes (MET).

Histopathology

Subtypes of renal cell cancer include:

  • Clear cell- most common and contains a cytoplasm rich in glycogen and lipids. This subtype is likely to be associated with 3p deletion.
  • Chromophilic masses are often bilateral and be associated with trisomy 7/17
  • Chromophobic lesions have large polygonal cells but rarely have 3p deletion
  • Oncocytoma lesions have predominance of eosinophilic cells but rarely exhibit any chromosomal defects. These lesions are least likely to spread
  • Collecting duct are very aggressive, occur in young people and often present with advanced disease

History and Physical

In the early stages, when the mass is small (less than 3 centimeters), renal cell cancer is typically asymptomatic. Approximately 25% of patients are asymptomatic, and the solid renal mass is an incidental finding during a routine radiological study.

As the mass grows, symptoms may include hematuria, back pain, flank mass, fatigue, weight loss, anemia, fever, and/or high serum calcium level.

The classic clinical triad of flank pain, hematuria, and flank mass is not common, presenting in only 10% of patients. When this classic triad is present, it usually indicates advanced disease.

Evaluation

A urine test may show hematuria. Urine analysis may detect cancer cells in the urine. A blood test may show anemia or high serum calcium levels.[7][8]

If RCC is suspected, renal and bladder ultrasound is usually the first radiographic test. If the renal ultrasound shows a solid mass or a complex cyst with septations or nodules, the next test should be a dedicated CT scan of the kidneys, ureters, and bladder before and after IV contrast with delayed imaging of the entire abdomen and pelvis.

If the renal ultrasound is negative, but the patient has unexplained hematuria, a CT scan before and after IV contrast should be the next test as small solid renal masses can be easily missed on ultrasound and small renal stones also can be missed on ultrasound.

On CT scan, RCC will typically demonstrate significant enhancement; usually, greater than 20 Hounsfield units (HU), more after contrast. Typically, postcontrast HU of renal cancer measure about 141 HU. The subtypes papillary cell and clear cell may enhance less than RCC.

CT scan is used to stage RCC. CT scan will detect lymphadenopathy and invasion to the renal vein or inferior vena cava or invasion to adjacent organs. CT scan can detect metastatic disease to the bones of the abdomen and pelvis only. Whole body bone scan is the test of choice to detect bone metastases. Chest CT scan also should be obtained, as RCC presents with lung metastases in about 10% to 20%. The use of PET-CT is controversial but is helpful for distant metastases.

Abdominal MRI is just as good as CT scan for diagnosing and staging RCC but is more subject to limitations such as respiratory motion artifact because the images take longer to acquire.

Treatment / Management

Treatment depends on the stage of the tumor. See staging."

  • For stage I renal cell cancer measuring less than 7 centimeters and confined to the kidney, nephrectomy or partial nephrectomy is the treatment of choice and is usually curative. Radiofrequency ablation or cryotherapy is an option in patients with bilateral tumors and small cortical tumors. Imaging surveillance is an option in elderly patients with a short life expectancy who are not good surgical candidates, as many renal cell cancers are slow growing.
  • For stage II renal cell cancer, laparoscopic radical nephrectomy is the treatment of choice.
  • For stage III renal cell cancer, open radical nephrectomy is the standard of care. Adrenalectomy or extensive lymph node dissection is only recommended when abdominal CT shows evidence of adrenal or lymph node invasion.
  • Stage IV renal cell cancer is not curable. Treatment is palliative. Treatment may include tumor embolization, external-beam radiation therapy, and nephrectomy, but these treatments are not aimed at cure, rather prolonged survival and palliation. Immunotherapy and chemotherapy can prolong survival. Drugs that may be used to reduce the risk of complications from bone metastases include bisphosphonates and Xgeva.[9][10]

Differential Diagnosis

The differential diagnosis of other solid renal tumors includes the following: renal oncocytoma, lipid-poor renal angiomyolipoma, renal metastases, renal lymphoma, solitary fibrous tumor (very rare), and multilocular cystic nephroma.

Other renal abnormalities that can mimic RCC include the following: a prominent column of Bertin, renal abscess, renal infarct, and complex renal cyst. 

The finding of a prominent column of Bertin is typically a questionable ultrasound finding which requires cross-sectional imaging CT scan or MRI to confirm. 

The finding of renal access typically has other clinical findings to support such as pyelonephritis, high white blood cell (WBC) count, fever, and chills.

The finding of renal infarct is usually associated with vascular abnormalities such as renal vein thrombosis or trauma related.

To differentiate a complex renal cyst from renal cell cancer, radiologists use the Bosniak classification.

Staging

Below is the Robson staging for RCC; although it has largely been replaced by the TNM staging which is much more complicated.

Robson staging:

  • Stage I: limited to kidney
  • Stage II: involvement of perinephric fat but remains limited to Gerota's fascia
  • Stage III
  • IIIa: renal vein involvement
  • IIIb: nodal involvement
  • IIIc: both IIIa and IIIb
  • Stage IV
  • IVa: direct invasion of adjacent organs/structures
  • IVb: distant metastases

TNM staging (seventh edition)

  • T1
  • T1a: limited to kidney, greater than 4 cm
  • T1b: limited to kidney, greater than 4 cm but less than 7 cm
  • T2: limited to kidney, greater than 7 cm
  • T2a: limited to kidney, greater than 7 cm but not more than 10 cm
  • T2b: limited to kidney, greater than 10 cm
  • T3: tumor/tumor thrombus extension into major veins or perinephric tissues but not into ipsilateral adrenal gland or beyond the Gerota fascia
  • T3a: spread to renal vein
  • T3b: spread to infra-diaphragmatic IVC
  • T3c: spread to supradiaphragmatic IVC or invades the wall of the IVC
  • T4: involves ipsilateral adrenal gland or invades beyond Gerota's fascia
  • N0: no nodal involvement
  • N1: metastatic involvement of regional lymph node/sM
  • M0: no distant metastases
  • M1: distant metastasesStage groupings
  • Stage I: T1 N0 M0
  • Stage II: T2 N0 M0
  • Stage III: T3 or N1 with M0
  • Stage IV: T4 or M1

Prognosis

The prognosis depends on stage on histology of the cell type.

  • Stage 1 has a 90% 5-year survival rate.
  • Stage 2 has a 50% 5-year survival rate.
  • Stage 3 gas a 30 % 5-year survival rate.
  • Sagte 4 has a 5% 5-year survival rate.

Papillary RCC has the best 5-year survival rate, 90%. Clear cell cancer subtype has second-best 5-year survival, 70%.

Enhancing Healthcare Team Outcomes

Evidence-based approach to renal cell cancer

Renal cell cancer is relatively common in the US and often presents with nonspecific signs and symptoms. The malignancy is ideally managed with a multidisciplinary team that includes a urologist, nephrologist, oncologist, and a geneticist. Over the past two decades, the mortality rates from this malignancy have dropped because of earlier detection and treatment. five-year survival for stage 1 cancer is greater than 90% and 79% for stage 2 renal cancer. For those with lymph node involvement, the survival drops to less than 40% over five years. Factors associated with improved survival include obesity, good performance status, complete excision of the primary and a long disease-free interval from the time of surgery to the presence of metastases. Patients with a family history should be educated about the need for other members of the family to undergo screening. Patients at high risk for renal cell cancer should also be educated about the signs and symptoms; as earlier the cancer is managed, the better the prognosis.[11][12] (Level V)


Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Cancer, Renal Cell - Questions

Take a quiz of the questions on this article.

Take Quiz
A Grawitz tumor is commonly found in the:



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which is not a common presentation of a renal cell cancer?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Where does renal cell cancer most commonly metastasize?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
The risk factor commonly associated with renal cancer is:



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
The test of choice for making diagnosis of renal cell cancer is:



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
The most common subtype of renal cell cancer is:



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which is true of renal cell adenocarcinoma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is not true of the metastatic lesions of renal cell carcinoma to the lung?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the most common malignancy of the urinary system in elderly individuals?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 59-year-old male with gross hematuria. Kidney biopsy reveals enlarged nuclei, with prominent nucleoli and abnormal nuclei. Staining reveals presence of mucin in the cytoplasm. The patient may have which of the following?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the risk factor most commonly associated with renal cancer?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the most common subtype of renal cell cancer?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A patient presents with left-sided flank pain, an abdominal mass, and hematuria. What is the most likely diagnosis?

(Move Mouse on Image to Enlarge)
  • Image 1677 Not availableImage 1677 Not available
    Contributed by Scott Dulebohn, MD
Attributed To: Contributed by Scott Dulebohn, MD



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A mother brings in her 3-year-old daughter for evaluation after feeling a "lump" in her abdomen while giving her a bath. The child has been healthy and has no significant past medical history. She has had normal growth and development to date. There is no family history of significant medical problems. On physical exam, the child is well-appearing, laughing and playing on her mother's lap. Her physical exam is notable for a large, firm mass palpable on the left side of her abdomen. Which of the following is the LEAST likely cause of abdominal masses in children?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the 5-year survival rate for bone metastasis from kidney cancer?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following drugs is approved for use in patients with resistant renal cell carcinoma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the most appropriate therapy for nonmetastatic renal cell carcinoma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is not associated with a predisposition to renal cell carcinoma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is true regarding solid renal masses?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What can an angiomyolipomas mimic on a CT?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
If a solid renal mass does not contain macroscopic fat, which of the following is an important ancillary finding?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
CT shows a renal mass that is just a little too dense for a cyst Hounsfield units of 24 pre-contrast and just barely enhances going from 24 to 36. What should be done?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Can renal cell carcinoma contain fat?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is true regarding papillary renal cell carcinoma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Renal cell carcinoma (RCC) in Von Hippel-Lindau disease may be distinguished from spontaneous RCC by...



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A CT scan of the abdomen shows a solid heterogeneously enhancing left renal mass without fat involvement, with direct invasion to the left renal vein. What is the Robson stage?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following factors is NOT predictive of a poorer survival benefit for a patient with metastatic renal cell carcinoma being considered for cytoreductive nephrectomy?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 60 year old man presents with macroscopic hematuria. CT scan with IV contrast shows a 3 cm complex cystic mass with multiple thin enhancing septations. Follow up CT scan with IV contrast 1 year later shows a 3.8 cm lesion with progressive septal thickening and nodular enhancement. Which of the following is correct?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A 3 cm echogenic right renal mass is detected on routine abdominal ultrasound. Which is true?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is a specific clinical sign suggestive of renal cell carcinoma?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Cancer, Renal Cell - References

References

Kuroda N,Sugawara E,Kusano H,Yuba Y,Yorita K,Takeuchi K, A review of ALK-rearranged renal cell carcinomas with a focus on clinical and pathobiological aspects. Polish journal of pathology : official journal of the Polish Society of Pathologists. 2018     [PubMed]
Grünwald V, [Risk-adapted (immuno)therapy for renal cell carcinoma]. Der Urologe. Ausg. A. 2018 Oct 22     [PubMed]
Ding M,Lu X,Wang C,Zhao Q,Ge J,Xia Q,Wang J,Zen K,Zhang CY,Zhang C, The E2F1-miR-520/372/373-SPOP axis modulates progression of renal carcinoma. Cancer research. 2018 Oct 22     [PubMed]
van Leeuwaarde RS,Ahmad S,Links TP,Giles RH, Von Hippel-Lindau Syndrome null. 1993     [PubMed]
Ganguly S,Chandra A,Chatterjee IB, Pathobiology of cigarette smoke-induced invasive cancer of the renal pelvis and its prevention by vitamin C. Toxicology reports. 2018     [PubMed]
Capitanio U,Bensalah K,Bex A,Boorjian SA,Bray F,Coleman J,Gore JL,Sun M,Wood C,Russo P, Epidemiology of Renal Cell Carcinoma. European urology. 2018 Sep 19     [PubMed]
Ward RD,Tanaka H,Campbell SC,Remer EM, 2017 AUA Renal Mass and Localized Renal Cancer Guidelines: Imaging Implications. Radiographics : a review publication of the Radiological Society of North America, Inc. 2018 Oct 19     [PubMed]
Liaw CW,Winoker JS,Mehrazin R, Imaging Protocols for Active Surveillance in Renal Cell Carcinoma. Current urology reports. 2018 Aug 13     [PubMed]
Jonasch E, Updates to the Management of Kidney Cancer. Journal of the National Comprehensive Cancer Network : JNCCN. 2018 May     [PubMed]
Dabestani S,Marconi L,Kuusk T,Bex A, Follow-up after curative treatment of localised renal cell carcinoma. World journal of urology. 2018 May 16     [PubMed]
Rolley C,Aubert C,Baize N,Bigot P, [Management of metastatic renal cell carcinomass]. Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2018 Aug 30     [PubMed]
Joshi SS,Handorf EA,Zibelman M,Plimack ER,Uzzo RG,Kutikov A,Smaldone MC,Geynisman DM, Treatment Facility Volume and Survival in Patients with Metastatic Renal Cell Carcinoma: A Registry-based Analysis. European urology. 2018 Sep     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Nurse-Corrections (CCN). The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Nurse-Corrections (CCN), it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Nurse-Corrections (CCN), you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Nurse-Corrections (CCN). When it is time for the Nurse-Corrections (CCN) board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Nurse-Corrections (CCN).