Renal cell carcinoma (RCC) treatment in Israel

Treatment of renal cell carcinoma (RCC) in Israel.

In recent years, there has been a steady increase in the incidence of kidney carcinoma all over the world and in Israel. Despite early detection of tumors, mortality from kidney cancer has also increased over the past two decades.

Carcinoma of the kidney (RCC) or renal cell carcinoma counts for about 80-70 percent of kidney cancer. About 98 percent of kidney cancer cases are accidental, and only 2 percent are associated with hereditary syndromes. Most kidney tumors are found during ultrasound or CT scan of the abdominal cavity, as a result of symptoms that are not necessarily associated with a kidney tumor. In the absence of other effective treatments, in Israel, removal of the tumor by surgery is the first major treatment in most cases.

Leading physicians of Israel in the field of treatment of kidney carcinoma:

Dr. Andrei Nadu (Israel) – Head of the Department of Laparoscopic Surgery, Department of Urology, Rabin Medical Center, Doctor of Medical Sciences, lecturer at the Sackler Medical School, Tel Aviv University. Urological and oncourological surgery. Operations on the kidney. Laparoscopic and robotic nephrectomy (partial, complete and radical), removal of a kidney tumor. Laparoscopy and robotic surgery of the bladder and prostate.

Dr. Raanan Berger (Israel) – Head of the Cancer Institute, Head of the Clinical Research Department at the Sheba Medical Center, Tel Ha-Shomer. Specialist in oncourology and precision (personalized) cancer treatment: cancer (carcinoma) of the kidneys, cancer of the prostate, bladder cancer, testicles cancer.

About 98 percent of kidney cancers are accidental and are sometimes associated with risk factors such as smoking and obesity. Only 2 percent of diseases appear as a result of hereditary syndromes, for example, Hippel-Lindau syndrome (VHL), Birt-Hogg syndrome-Dubé (BHD), Hereditary leiomyomatosis and renal cell carcinoma (HLRCC), Hereditary papillary carcinoma of the PCC and others.

Israeli physicians have made significant progress in understanding the molecular processes associated with the development of various types of kidney cancer:

Clear Renal Cell Carcinoma (CRCC). 80-70 percent of kidney cancer. In families with von Hippel-Lindau syndrome, these tumors appear at a younger age, and sometimes in different kidneys. In 60 percent of sporadic tumors of this type, mutations of the VHL gene are found that cause the accumulation of high concentrations of alpha factor and growth factors (transforming factor, vascular endothelial growth factor and others).

Papillary renal cell carcinoma (PRCC). It is 10-15 percent of malignant tumors of the kidneys. This form is five times more common in men. It is also common in the terminal stage of kidney disease. In most cases, this carcinoma does not metastasize, and therefore mortality is less than 10 percent within 5 years.

Most papillary tumors are random. Some of them are associated with hereditary diseases:

♦ Papillary renal cell carcinoma is an autosomal dominant disease that causes multiple papillary tumors. The gene responsible for the appearance of tumors was detected on chromosome 7 and expresses the oncogene MET (a factor of mesenchymal-epithelial transition), which produces a protein used as a growth receptor (tyrosine kinase).

♦ Syndrome, hereditary leiomyomatosis and renal cell carcinoma is an autosomal dominant disease that causes the formation of leiomyoma under the skin and in the uterus, as well as papillary renal tumors, usually single. The histological appearance of these tumors differs from the first type of carcinoma. This type of tumor, as a rule, metastasizes in the early stages. The gene affected by this disease is FH, which encodes the enzyme fumarate hydratase (Fumarate Hydratase).

Chromophobic kidney cancer – Chromophobic kidney carcinoma.

It counts about 4% of kidney tumors. Chromophobic carcinoma occurs from the epithelial cells of the cortex of collecting ducts. The name of the tumor is associated with weak cytoplasm, which often have an almost transparent structure. In most cases, these tumors do not metastasize, even when they reach large sizes. However, there are also types of eosinophilic tumors (sarcomatoid tumors), which are much more aggressive. These tumors occur in 15 percent of patients with a rare hereditary disease: Birt-Hogg-Dubé syndrome. The BHD gene is considered a tumor suppressor gene that encodes a folliculin protein. Damage to this gene is associated with the appearance of multiple renal tumors.

Carcinoma of the collecting ducts of the kidney. In Israel, less than one percent of tumors collecting the ducts of the kidneys occur. This disease usually manifests itself at a progressive stage and has a poor prognosis. One of its forms: medullary carcinoma has been described mainly in African-American patients or carriers of the gene of sickle-cell anemia. This form also has a high malignancy.

Most kidney tumors are detected during ultrasound or computed tomography of the abdomen, as a result of symptoms that are not necessarily associated with a tumor in the kidneys. Hypertension and the appearance of blood in the urine may also indicate the presence of a malignant tumor. For diagnostics it is necessary to conduct a number of studies.

Diagnosis of kidney carcinoma.
Typically, tumors that are detected by chance are often located within the kidney.

About 15-20 percent of the renal cell carcinomas that are currently found in visualization tests in Israel, usually by accident, are benign tumors, such as renal adenoma, oncocytoma, and renal angiomyolipoma.

Most solid formations in the kidneys are malignant tumors arising in epithelial cells – kidney and sarcoma carcinoma. In children, the most common tumor is nephroblastoma, and in 80 percent of cases it is detected up to 5 years.

Simple kidney cysts, regardless of their size or quantity, are not malignant and do not require treatment or follow-up. Sometimes it is difficult to distinguish between bleeding in a simple cyst (hemorrhagic cyst) or the accumulation of a hyperplane cyst from a tumor mass. In these cases, you can use magnetic resonance imaging (MRI) or PET-CT (positron emission tomography – computed tomography). In some cases, a cystic formation with calcification sites or tissue inside is detected. Such formation is defined as a complex cyst and is supposed to be cystadenocarcinoma.

Bosniac cyst. There are 4 types of complex cysts:

Type 1 – Cysts with thin, even walls and uniform contents.
Type 2 – Cysts with one or two thin layers in them and accumulated dense fluid, or cysts with a dense water content, but without manifestation after injection of contrast material (hyperdense kidney cyst). Types 1 and 2 are not suspicious, and further investigation is not required.

Type 3 – Cysts with thick uneven walls, cysts with several intervals between them, thick partitions, with or without strong calcification. Such tumors are recommended to be removed, but often these are benign processes.
Type 4 – Cystic masses with many cavities and irregular thick septa. Such cysts should be removed because of the high risk of developing cystadenocarcinoma.

After studying the size and location of the tumor in the kidneys, a computed tomography of the chest and abdominal cavity is needed to determine the stage of the disease. If the tumor penetrates the kidney or hollow vein, if the lymph nodes are metastasized, the malignant process will develop and spread to the lungs, liver or bones.

Biopsy of renal cell carcinoma.

In kidney tumors, a biopsy is performed in rare cases. To make a decision about a biopsy, consultation of the urologist of the surgeon is necessary. If the tumor is large, usually malignant, the treatment will usually be surgical, and a biopsy is not required in this case. Today, when most tumors are found in the form of small masses, up to 20 percent of which are benign, it is sometimes decided to perform a biopsy before starting treatment. New research has shown that fine needle biopsy is not associated with tumor scattering, and when biopsy is performed under the control of computed tomography, pathological diagnosis is more accurate.

If you or someone from your loved ones is diagnosed with kidney carcinoma, contact us. We will promptly organize a consultation with the leading urologist in Israel. The doctor will conduct an examination and review the CT scan. If necessary, an additional diagnosis will be assigned, in order to establish an accurate diagnosis. If the tumor can be removed by a laparoscopic or robotic route, this is the best method for complete recovery.