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Kidney cancer
Renal cell carcinoma (RCC) is a malignant neoplasm arising from the renal parenchyma and represents the most common kidney malignancy in adults, with peak incidence in males aged 60–70 years. Its etiology is multifactorial, involving genetic predisposition, environmental exposures, and lifestyle factors. Early-stage RCC is typically clinically silent, which often leads to delayed diagnosis. Consequently, early detection and long-term surveillance are critical for preserving renal function, optimizing quality of life, and improving survival outcomes.
Major risk factors include:
- Tobacco smoking: Strong dose-dependent association; carcinogens in cigarette smoke significantly increase RCC risk (current smokers have ~50% higher risk; former smokers ~20–30% higher compared to never-smokers).
- Obesity and metabolic disorders: Excess body weight (BMI ≥30 kg/m²), hypertension, and diabetes mellitus are independently associated with elevated incidence, largely mediated through altered lipid peroxidation, chronic inflammation, and insulin/IGF-1 signaling pathways.
- Hereditary genetic syndromes: Markedly increased risk in patients with von Hippel-Lindau (VHL) disease, hereditary papillary RCC, Birt–Hogg–Dubé syndrome, tuberous sclerosis complex, and succinate dehydrogenase (SDH)-deficient RCC syndromes.
- Chronic kidney disease: Patients with end-stage renal disease (especially those on long-term dialysis) and acquired cystic kidney disease exhibit substantially higher incidence of RCC.
Early detection through appropriate imaging in high-risk populations and ongoing multidisciplinary management are essential for delaying disease progression, preserving residual renal function, and maintaining long-term quality of life.
Early-stage renal cell carcinoma (RCC) is frequently asymptomatic or presents with nonspecific symptoms. As the tumor progresses, the following clinical manifestations may emerge:
- Flank or lateral abdominal pain: Typically dull, aching, or persistent; pain may intensify in advanced stages due to tumor capsular distension, retroperitoneal extension, or hemorrhage.
- Hematuria: Microscopic or gross hematuria represents a classic warning sign and occurs in approximately 50–60% of patients at diagnosis; painless gross hematuria is particularly suggestive.
- Palpable abdominal/flank mass: Detectable in advanced disease (historically part of the “classic triad,” now seen in <10% of cases due to earlier detection).
- Constitutional symptoms: Unintentional weight loss, fatigue, and cachexia, indicative of paraneoplastic cytokine-mediated systemic effects or chronic disease burden.
- Systemic/paraneoplastic manifestations: Fever (often of unknown origin), night sweats, anemia (due to erythropoietin dysregulation or chronic inflammation), and secondary polycythemia (in ~1–5% of cases from tumor erythropoietin production).
Some patients may additionally experience anorexia, profound lethargy, or localized edema, necessitating prompt clinical evaluation and nursing intervention.
醫療專業英文翻譯（偏臨床及醫學文獻風格）：
Diagnosis of renal cell carcinoma (RCC) relies on a multimodal approach designed to achieve early detection, accurate histological subtyping, precise staging, and development of individualized nursing care plans:
- Imaging studies
- Abdominal ultrasonography: Initial screening modality for detecting renal masses and characterizing cystic versus solid lesions.
- Contrast-enhanced computed tomography (CT): Gold standard for preoperative evaluation of tumor size, local extension (perinephric fat/stranding, renal vein/inferior vena cava thrombus), lymph node involvement, and distant metastasis.
- Magnetic resonance imaging (MRI): Preferred in patients with contrast allergy, renal insufficiency, or when detailed assessment of venous thrombus extent or complex cystic lesions (Bosniak classification) is required.
- Positron emission tomography-CT (PET-CT): Selectively utilized for detection of occult distant metastases, restaging in recurrent disease, or evaluation of response to systemic therapy in metastatic RCC.
- Laboratory investigations
- Serum biochemistry, complete blood count, and renal function tests (eGFR, creatinine): Essential for baseline assessment of renal reserve, surgical candidacy, and systemic inflammatory status.
- Tumor markers (e.g., carbonic anhydrase IX [CA-IX]): Limited specificity but may serve as adjunctive tools for postoperative surveillance and monitoring treatment response in selected cases.
- Histopathological examination
- Percutaneous renal biopsy or surgical specimen analysis: Provides definitive diagnosis, WHO/ISUP histological subtype classification (clear cell, papillary, chromophobe, etc.), Fuhrman/ISUP nuclear grading, and assessment of sarcomatoid/rhabdoid differentiation or necrosis.
- Molecular and genetic testing
- Germline and somatic sequencing for VHL, MET, FH, BAP1, SETD2, PBRM1, and other driver mutations: Facilitates confirmation of hereditary syndromes (e.g., von Hippel-Lindau disease), prognostic stratification, selection of targeted therapies (e.g., VEGF-TKIs, mTOR inhibitors, immune checkpoint inhibitors), and family risk counseling.
醫療專業英文翻譯（偏臨床及醫學文獻風格）：
Nursing and supportive care strategies for renal cell carcinoma (RCC) can be categorized into conventional treatment modalities and personalized supportive approaches, with the primary goals of delaying disease progression, preserving quality of life, enhancing immune function, protecting residual renal function, and promoting overall health:
Surgical Management
- Indicated for localized or locally advanced tumors; options include partial nephrectomy (nephron-sparing surgery) or radical nephrectomy, with regional lymphadenectomy when indicated.
- Postoperative care integrates nutritional support, wound care, pain management, early mobilization, and psychological counseling to accelerate recovery, preserve renal function, and restore activities of daily living.
Targeted Therapy and Immunotherapy
- First-line systemic therapy for advanced, metastatic, or postoperative recurrent RCC; selection guided by risk stratification (IMDC/MSKCC criteria) and molecular profiling (e.g., PD-L1 status).
- Commonly includes tyrosine kinase inhibitors (TKIs: sunitinib, pazopanib, cabozantinib), anti-VEGF monoclonal antibodies (bevacizumab), mTOR inhibitors, or immune checkpoint inhibitors (nivolumab, pembrolizumab, combination nivolumab + ipilimumab, or ICI + TKI combinations).
- Supportive care focuses on immune enhancement, rigorous toxicity monitoring (hypertension, hand-foot syndrome, hypothyroidism, immune-related adverse events), and nutritional optimization to sustain treatment tolerance and overall well-being.
Chemotherapy
- Limited efficacy in conventional cytotoxic chemotherapy for clear-cell RCC due to intrinsic resistance; occasionally considered in non-clear-cell histologies (e.g., collecting duct carcinoma, sarcomatoid differentiation) or as part of clinical trials.
- Supportive measures emphasize nutritional maintenance, fluid/electrolyte balance, antiemetic therapy, and myelosuppression management to minimize adverse effects and preserve physical function.
Nutritional and Intravenous Supportive Therapy
- High-dose intravenous vitamin C, glutathione, essential amino acid formulations, and trace element infusions may be administered to improve cellular energy metabolism, support antioxidant capacity, maintain immune competence, and facilitate physiological recovery.
- Dietary recommendations: High-quality protein intake adjusted to residual renal function (eGFR-guided), abundant vegetables and fruits rich in antioxidants, whole grains; strict limitation of high-fat, ultra-processed foods, and sodium to protect renal function and reduce cardiovascular comorbidity.
Individualized Monitoring and Long-term Care
- Serial surveillance with contrast-enhanced CT/MRI, laboratory studies (renal panel, CBC, liver function), and emerging molecular biomarkers (e.g., circulating tumor DNA) to enable early detection of recurrence or progression.
- Development of patient-specific care plans with dynamic adjustment of nutritional, lifestyle, and psychosocial interventions.
- Specialized nursing protocols for patients with chronic inflammation, immunocompromised states, hereditary syndromes, or high-risk metabolic profiles to optimize long-term survivorship, preserve renal function, and enhance overall quality of life.
