Chronic lymphocytic leukemia (CLL) is a type of chronic leukemia. "Chronic" means that the leukemia usually gets worse slowly. In CLL, the bone marrow makes abnormal lymphocytes (a type of white blood cell). When the abnormal cells crowd out the healthy cells, it can lead to infection, anemia, and easy bleeding. The abnormal cells can also spread outside the blood to other parts of the body. CLL is one of the most common types of leukemia in adults. It often occurs during or after middle age. It is rare in children.
What causes chronic lymphocytic leukemia (CLL)?

CLL happens when there are changes in the genetic material (DNA) in bone marrow cells. The cause of these genetic changes is unknown, so it's hard to predict who might get CLL. There are a few factors that might raise your risk.
Who is at risk for chronic lymphocytic leukemia (CLL)?

It is hard to predict who will get CLL. There are a few factors that could raise your risk:

Age - your risk goes up as you get older. Most people who are diagnosed with CLL are over 50.
Family history of CLL and other blood and bone marrow diseases
Racial/ethnic group - CLL is more common in whites than in people from other racial or ethnic groups
Exposure to certain chemicals, including Agent Orange, a chemical that was used in the Vietnam War

What are the symptoms of chronic lymphocytic leukemia (CLL)?

In the beginning, CLL does not cause any symptoms. Later, you can have symptoms such as:

Swollen lymph nodes - you may notice them as painless lumps in the neck, underarm, stomach, or groin
Weakness or feeling tired
Pain or a feeling of fullness below the ribs
Fever and infection
Easy bruising or bleeding
Petechiae, which are tiny red dots under the skin. They are caused by bleeding.
Weight loss for no known reason
Drenching night sweats

How is chronic lymphocytic leukemia (CLL) diagnosed?

Your health care provider may use many tools to diagnose CLL:

A physical exam
A medical history
Blood tests, such as a complete blood count (CBC) with differential and blood chemistry tests. Blood chemistry tests measure different substances in the blood, including electrolytes, fats, proteins, glucose (sugar), and enzymes. Specific blood chemistry tests include a basic metabolic panel (BMP), a comprehensive metabolic panel (CMP), kidney function tests, liver function tests, and an electrolyte panel.
Flow cytometry tests, which check for leukemia cells and identify which type of leukemia it is. The tests can be done on blood, bone marrow, or other tissue.
Genetic tests to look for gene and chromosome changes

If you are diagnosed with CLL, you may have additional tests to see whether the cancer has spread. These include imaging tests and bone marrow tests.
What are the treatments for chronic lymphocytic leukemia (CLL)?

Treatments for CLL include:

Watchful waiting, which means that you don't get treatment right away. Your health care provider regularly checks to see if your signs or symptoms appear or change.
Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells.
Chemotherapy
Radiation therapy
Immunotherapy
Chemotherapy with bone marrow or stem cell transplant

The goals of treatment are to slow the growth of the leukemia cells and to give you long periods of remission. Remission means that the signs and symptoms of cancer are reduced or have disappeared. The CLL may come back after remission, and you may need more treatment.

NIH: National Cancer Institute

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What Causes Kidney Cancer?

Kidney cancer causes are unclear. At this point medical researchers have only been able to learn that kidney cancer begins much in the same way as other cancers begin: through DNA mutations. These mutations program the cells to grow and divide abnormally, forming a tumor. The cells can also spread to other parts of the body (a process known as metastasis).

A type of kidney cancer known as renal cell carcinoma is the most common variety in adults. A number of others are less common, including transitional cell carcinoma, which can begin in the kidneys but can affect the ureters. A condition known as Wilms tumor is the most common cause of kidney cancer in children.

While precise causes have been difficult to isolate, researchers have been able to discover that there are certain risk factors for kidney cancer that seem to make development more likely. It's probably not a coincidence that these possible kidney cancer causes are similar to causes that are often connected to other types of cancer.

As you get older, especially past age 65, your odds of getting kidney cancer increase.

Smokers have a higher chance of getting kidney cancer than nonsmokers do. If you quit, your chances go down.

People who are grossly overweight or morbidly obese are more likely to get kidney cancer.

High blood pressure increases your risk of kidney cancer. High blood pressure and diabetes are both extremely dangerous for those with kidney disease, but the exact connection between hypertension and kidney cancer is unclear.

Kidney failure also appears to be one of the causes of kidney cancer. Individuals who receive kidney dialysis treatments for renal insufficiency or chronic kidney failure develop kidney cancer at a higher rate than those who don't.

Hereditary factors may also play a role. People with an inherited disorder known as Von Hippel-Lindau disease seem to be prone to developing several kinds of tumors, including kidney cancer. There's also a condition known as hereditary papillary renal cell carcinoma that appears to be one of the kidney cancer causes.

Gender may be important. Statistically, more men develop kidney cancer than women.

Certain non-medical factors may helps cause kidney cancer. Environmental factors, like certain kinds of chemicals in your workplace may put you in a higher risk group. Research seems to indicate that people who work around asbestos and cadmium have higher kidney cancer rates than the normal population.

There are a number of kidney tests available to detect kidney cancer and other types of kidney problems. One method employs ultrasound to generate images of the kidneys. CT and MRI scans are other popular diagnostic tools.

Kidney cancer causes few symptoms until it progresses to a later stage. When symptoms of kidney cancer begin to appear, they're likely to include

a dark, cloudy, or even red-tinged urine stream (indicating blood in urine),
back pain in the flank region, just below the ribs,
unexplained weight loss,
fatigue and difficulty concentrating
fever, vomiting and nausea.

If you have any of these symptoms, it is important to see your medical professional as soon as you can. Your doctor will run kidney tests and use other diagnostic tools to see if you have kidney problems. Once again, the sooner kidney cancer is detected, the more likely it is there will be a happy outcome.

The incidence of kidney cancer seems to be increasing. More than 50,000 individuals are diagnosed with kidney cancer each year and this number is growing, though it isn't clear why. The death rate for kidney cancer is approximately 12,000 persons annually in the United States.

Renal Cell Carcinoma Anatomy, Epidemiology, Etiology, Clinical Signs and Symptoms, Treatment and Management. Handwritten, full lecture for medical students taking USMLE.

Renal Cell Carcinomas make up 90-95% of kidney neoplasms.

ETIOLOGY of Renal Cell Carcinoma
Smoking is the largest risk factor. Obesity and Hyppertension is a known risk factor for Renal Cell Carcinoma in Women. Occupational Exposure such as Trichloroethylene, Benzine, Herbicides, Vinyl Chloride. Drugs associated with Renal Cell Carcinoma (phenacitin). Long term dialysis increases the risk of cystic Diseases which increase risk of renal cell carcinoma.

Von Hipel Lindau - Loss of 3p increases HIF which increases angiogenesis. Also increase risk of pheochromocytoma, pancreatic cysts/islet cell tumors, retinal angiomas, CNS hemangioblastomas.

Hereditary Papillary Renal Carcinoma - MET Gene mutation of tyrosine kinase domain and will have bilateral multifocal papillary renal cell carcinoma.

Burt-Hogg-Dube Syndrome - Bilateral Multifocal oncocytoma which has a better prognosis. Also may cause pulmonary and colonic tumors.

CLINICAL SIGNS AND SYMPTOMS of Renal Cell Carcinoma.
The three most common presenting signs and symptoms is flank pain, hematuria, flank mass. A large percentage of patients may be asymptomatic. Patients with renal cell carcinoma may also have wieght loss, varicocele, malaise, fever.

Paraneoplastic syndromes are very common in renal cell carcinoma. Increase EPO may lead to polycythemia, Renin production may lead to hypetension. Finally may also have hypercalcemia, polyneuropathy.

Shauffer Syndrome - Non-metastatic Hepatic Dysfunction and therefore it is important to monitor liver function, even if no metastasis has occurred.

Metastasis to Lungs (45%), Soft tissue and Liver.

Work Up for Renal Cell carcinoma
Labs - Urinalysis, CBC, Electrolytes, Renal Profile, LFT (AST/ALT) and Serum Calcium.

Imaging - CT scan is the imaging of choice and can identify the tumor and rule out cystic mass. Also allows visualtion of Lymph nodes, Renal Vein, IVC and helps rule out angiolipoma.

For staging abdominal ;pelvic CT with or without contrast. Chest X-ray and Brain MRI.

Histology
Clear Cell Carcinoma - 75%, lipid/glycogen
Chromphilic - Bilateral mulftifocal
Chromophobic - Large polygonal Cells
Oncocytoma - Rarely metastasize
Collecting Tubules

STAGING OF Renal Cell Carcinoma
Stage 1 - Within the kidney and less than 7cm.
Stage 2 - Within the kidney and greater than 7cm.
Stage 3 - Invasion Renal Vein and Inferior Vena Cava or Adrenal Gland, but does not invade Gerota's Fascia
Stage 4 - Extends below Gerota's Fascia, invade nearby lymph nodes and metastasis to organs.

MANAGEMENT of Renal Cell Carcinoma
Surgical
Partial nephrectomy for stage 1 and sometimes stage 2
Radical Nephrectomy - remove complete removal of Gerota's fascia, Removal of kidney with adrenal gland, dissect enlarge lymph nodes.
Palliative Nephrectomy - remove kidney to alleviate pain, polycythemia and hypertension.

Adjuvant Treatment for Renal Cell Carcinoma
Biologic Response Mediators - IL2 (activates T Cell and NK), IFN
Molecular Targeting - Suritinib, Bevacizumab, Dazopomib, Temsirolimu, Sorafenib.

Chemotherapy - 5 floururacil, Vinblastine, Paclitaxel, Caboplatin, Ifosfamide, Gemcitabine.

Radiation - Renal Cell Carcinoma is not sensitive to radiation but the brain metastasize are sensitive.

Renal Artery Embolization inject ethanol or gelatin sponge pledgets in artery feeding tumor to help kill off the tumor. Also done palliative for non-surgical patient.

Table of Contents:

00:00 - Introduction
03:40 - Papillary Renal Cell Carcinoma
03:58 - Papillary Renal Cell Carcinoma
04:17 - Question
04:39 - Question
04:45 - Question
05:03 - Question
05:33 - Papillary Renal Cell Carcinoma
06:47 - Slide 41
06:58 - Papillary Renal Cell Carcinoma
07:46 - Slide 43
08:27 - Question
08:39 - Question
09:42 - Slide 46
10:06 - Question
10:19 - Question
11:17 - Question