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Is Clear Cell Carcinoma Curable

Ccrcc Prognosis Capabilities Based On Differentially Expressed Lncrnas

Treatment of Metastatic Non-Clear Cell Renal Cell Carcinoma

The differentially expressed lncRNAs for which relative expression levels were below 1 in more than 10% of all subjects were eliminated from subsequent analyses. Similarly, lncRNAs were excluded if they lacked adequate clinical information. The final prognostic analysis included a total of 530 samples with expression data for 370 lncRNAs. Samples from the TCGA dataset were divided into training and validation sets, which were randomly selected from 530 tumor samples to verify the prognostic risk model.

The prognostic significance of lncRNAs was primarily measured by univariate Cox proportional hazard regression . Statistically significant indicators, including lncRNAs, were further confirmed via multivariate Cox stepwise regression. Furthermore, the relationships between the expression of these 6 lncRNAs and various clinicopathological features were assessed by Students t-tests and Spearman correlation analysis.

What Should You Tell The Patient And The Family About Prognosis

Since treatment of metastatic RCC rarely produces complete responses, and cure is unlikely, current therapy is focused on control of disease progression. The median overall survival of these patients was in the range of 14 to 16 months during the cytokine era, and recently, median survivals of 23 to 26 months have been reported with various targeted agents.

The prognosis for patients with advanced metastatic disease can be estimated by utilizing the MSKCC criteria. They can be classified as having favorable, intermediate, or poor-risk disease, with median survivals of 28.0, 13.6 and 4.6 months. This data is from the cytokine era recent reports indicate that with utilization of the current treatment paradigm, median survivals of 20.7 and 5.3 months in the intermediate and poor-risk groups respectively. In favorable-risk patients, median survival is now approaching 3 years.

The goal of therapy in metastatic RCC patients is to maximize therapeutic benefit, delay the development of a disease burden that becomes life threatening, and maximize a patients quality of life and convenience. This translates into selection of therapy with the optimal risk/benefit ratio for an individual patient. Unfortunately, only limited clinical criteria are available that predict efficacy, and ultimately multiple sequential treatments with available agents is utilized.

Prognosis Of Ovarian Clear Cell Cancer Compared With Other Epithelial Cancer Types: A Populationbased Analysis

  • Affiliations: Department of Medical Oncology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China, Department of Surgical Oncology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China, Department of Oncology, Affiliated Cancer Hospital of Nantong University, Nantong, Jiangsu 226000, P.R. China, Department of Medical, The Children’s Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China, Department of Hematology and Medical Oncology, The Second People’s Hospital, Quzhou, Zhejiang 324000, P.R. China
  • Pages: 1947-1957
  • Copyright: ©Liuet al. This is an open access article distributed under theterms of CreativeCommons Attribution License.

  • This article is mentioned in:

    Abstract

    Introduction

    Patients and methods

    Patients
    Statistical analysis

    Results

    Demographics and clinicalcharacteristics of the study population

    Table I.

    39.6P< 0.001

    Numbers do not add up to100% due to rounding errors.

    Comparison of survival rates betweenCCC and other epithelial cancer types

    Table III.

    P< 0.001

    a Including American Indian/AK Native, PacificIslander.

    Discussion

    Acknowledgements

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    Mammalian Target Of Rapamycin Signaling Pathway

    The constitutively activated mTOR signaling pathway plays a significant role in the tumorigenesis and growth of RCC. The mTOR pathway can be activated by cancer cells via different mechanisms, including loss of p53, mutations in upstream components of PI3K , and paracrine growth factor production, or via mTOR complexes such as TSC1/2, PTEN, Lkb1, and Nf1.42 mTOR inhibitors, also known as rapalogs , inhibit the phosphorylation of mTOR, resulting in altered translation of messenger RNA that codes for the proteins involved in cell survival, cell proliferation, and angiogenesis.42

    Temsirolimus, an mTOR inhibitor, was compared with IFN- in a phase III Global Advanced Renal Cell Carcinoma three-arm trial involving patients with previously untreated, poor-prognosis mRCC, divided into treatment groups with temsirolimus, IFN-, and a combination of temsirolimus and IFN-. The temsirolimus arm demonstrated superior OS versus IFN- , although the addition of temsirolimus to IFN- in the combination group did not show any improved survival versus IFN- alone.43 Temsirolimus is indicated for use in intermediate- and especially poor-risk patients in the first-line setting under select circumstances .93

    Other approved therapies include selective monoclonal antibodies, such as bevacizumab, directed against VEGF, which also inhibit angiogenesis and therefore impede tumor growth.44

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    What Is Stage 3 Cervical Cancer

    Adenocarcinoma with clear cells

    Stage 3 cervical cancer is when cancer has spread to the lower part of the vagina or the pelvic walls. With stage 3 cervical cancer, tumors may block the ureters . Stage 3 cervical cancer has:

    • Spread to the lower part of the vagina or pelvic walls
    • May have spread to lymph nodes
    • Not spread to distant sites

    Stage 3 is split into A, B and C. Cancer has spread to:

    • 3A: The lower part of the vagina but not the pelvic walls
    • 3B: The walls of the pelvis and is blocking 1 or both ureters
    • 3C: Nearby pelvic or para-aortic lymph nodes the tumor can be any size

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    What Are The Treatment Options For Stage 4 Kidney Cancer

    The type of treatment your doctor delivers mainly depends on the stage of your cancer. In stage 4, the cancer has already advanced to distant sites. Surgery is generally not an option in this stage.

    Surgery is possible in cases where the tumor and metastasis can be differentiated so that the cancerous cells are successfully removed by isolation.

    If the cancer has spread to the lungs, lung removal partially may help remove the cancer.

    But, your doctor will also consider your overall health condition to determine whether it is possible and safe for you to go through a major surgery such as partial lung removal.

    If surgery isnt an option to treat stage 4 kidney cancer, other options may be considered. These may include such as:

    • embolization: it is the blocking of blood flow to the cancer cells
    • radiation therapy: it uses high-energy radiation beams to target cancer cells. But, its not usually successful when the cancer has spread to several locations.

    It is important that you follow your doctors advice. Attend to the appointments regularly and on time, and take your medications. Follow the lifestyle changes your doctor advises

    Tatheer Zehra Zaidi is a clinical pharmacist and pharmacologist with a masters degree in pharmacy practice. She aims to deliver a positive contribution in the field of healthcare and research. She received her bachelors and masters degrees from Jamia Hamdard New Delhi and then joined Spirant Communication Private LTD as a Medical content writer.

    Transitional Cell Carcinoma Of The Kidney

    Transitional cell carcinoma of the kidney is rare. It starts in the transitional cells located in the lining of the renal pelvis. Transitional cells stretch or change shape to accommodate the flow and storage of urine.

    When the tumor is superficial and there is no spread, this type of cancer is curable in around 90% of patients. Deeply invasive tumors that remain confined to the renal pelvis have a cure rate of 10%15%. Once metastasis has occurred, a cure is no longer possible. However, treatments may help reduce spread and prolong life.

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    How Is Ccrcc Treated

    Treatments for people with ccRCC include surgery and immunotherapy. Treatment will depend on how much the cancer has grown.

    Surgery: Once ccRCC is diagnosed, you may have surgery to remove the cancer and part of the kidney surrounding it. In early stage ccRCC, part of the kidney with the cancer is taken out. If ccRCC is in the middle of the kidney, or if the tumor is large, sometimes the entire kidney must be removed. In later stage ccRCC, removal of the kidney is controversial but may be appropriate in some patients.

    Immunotherapy: Immunotherapy helps the bodys immune system fight the cancer cells.

    Targeted therapy: Targeted therapy targets the changes in cancer cells that help them grow, divide, and spread. Some targeted therapies that are used to treat clear cell renal carcinoma include cabozantinib, axitinib, sunitinib, sorafenib, and pazopanib.

    Other treatments can be used that do not involve removing the kidney, such as:

    • Radiation therapy, which uses radiation to kill the tumor cells
    • Thermal ablation, which uses heat to kill the tumor cells
    • Crysosurgery, which uses liquid nitrogen to freeze and kill the tumor cells

    Selection Of Clinical Outliers

    What is the best front line treatment for metastatic clear cell RCC in 2018?

    We defined exceptional clinical outliers as patients with advanced stage disease whose PFS, TFI following second-line chemotherapy or OS were two SDs beyond the median of the advanced stage disease cohort . Conversely, for those with unusually poor outcomes, we selected patients with stage I OCCC with a PFS of less than 12 months and/or an OS of less than 2 years.

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    Tnm Staging And The Stages Of Kidney Cancer

    Kidney cancer is described in stages that the American Joint Committee on Cancer developed. The system is better known as the TNM system.

    • T refers to the tumor. Doctors assign a T with a number thats based on the size and growth of the tumor.
    • N describes whether the cancer has spread to any nodes in the lymph system.
    • M means the cancer has metastasized.

    Based on the characteristics above, doctors assign RCC a stage. The stage is based on the size of the tumor and the spread of the cancer.

    There are four stages:

    • Stages 1 and 2 describe cancers in which the tumor is still in the kidney. Stage 2 means that the tumor is larger than seven centimeters across.
    • Stages 3 and 4 mean the cancer has either spread into a major vein or nearby tissue or to lymph nodes.
    • Stage 4 is the most advanced form of the disease. Stage 4 means that the cancer has spread to the adrenal gland or has spread to distant lymph nodes or other organs. Because the adrenal gland is attached to the kidney, the cancer often spreads there first.

    Five-year survival rates for kidney cancer are based on the percentage of people who live at least 5 years with the disease after its been diagnosed.

    The reports the percentage of people living 5 years or more after diagnosis according to three stages based on data from the National Cancer Institute.

    These stages are:

    • localized
    • regional
    • distant

    According to the ACS, the RCC survival rates based on these three stages are:

    • localized:

    Treatments may include:

    How Does Ccrcc Form

    Scientists are always working to understand how cancer forms, but it can be hard to prove. Because ccRCC can run in families, we know that changes in the VHL gene are important in causing ccRCC. The VHL gene is also changed in ccRCC from people without a family history of Von Hippel-Lindau syndrome. Scientists have learned a lot about what the VHL gene does in the body. This has given scientists clues about treatments to try for ccRCC.

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    What Other Additional Laboratory Studies May Be Ordered

    In patients with advanced or metastatic RCC, routine hematologic and biochemical studies are recommended. Hemoglobin levels, calcium and serum albumin, and serum LDH should be obtained to allow MSKCC classification of the untreated newly diagnosed RCC patient. There are no biomarkers or other specialized laboratory studies that are helpful during the initial evaluation. In the future, SNP analyses and tumor genetic studies may be helpful in this regard.

    No sponsor or advertiser has participated in, approved or paid for the content provided by Decision Support in Medicine LLC. The Licensed Content is the property of and copyrighted by DSM.

    Prognosis And Survival For Kidney Cancer

    Pathology Outlines

      If you have kidney cancer, you may have questions about your prognosis. A prognosis is the doctors best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, the treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.

      A prognostic factor is an aspect of the cancer that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.

      The following are prognostic and predictive factors for kidney cancer.

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      Management Of The Neck

      Surgery is the mainstay of treatment for cervical lymph node metastases, which are grouped into five levels .2). With clinical evidence of nodal disease it is clear that the neck requires treatment, traditionally in the form of a neck dissection. Surgery has moved away from radical neck dissections towards modified and selective neck dissections . This preserves function, especially in relation to the accessory nerve, which if sacrificed usually gives rise to a stiff and painful shoulder. If clinical evidence of the presence of enlarged cervical nodes is lacking, but the expected incidence of node metastases is greater than 20%, it is common practice to treat the neck . The incidence of involved cervical lymph nodes for different sites and stages of tumour is known from retrospective studies.w2 Watching and waiting, to see if a node appears, is also practised, and no prospective randomised trials compare the two approaches. Prophylactic treatment of the neck may reduce the rate of systemic metastatic disease.

      Early Diagnosis Surgery While Cancer Is Confined To Kidney Are Key But Pharmacological Agents Are Used For Stage Iv

      The National Cancer Institute estimates that by the end of 2020 there will be 73750 new cases of kidney and renal pelvis cancer representing 41 of all new cancer diagnoses with. Metastatic renal cell carcinoma is cancer in your kidneys that has spread to other parts of your body. Since stage 4 kidney cancer has spread throughout the body its difficult to completely remove the cancer from the body. The kidneys are located on either side of the spine towards the lower back. My moms own oncologist different from the one that did the biopsy is also very optimistic. Renal Cell Carcinoma RCC has the highest mortality rate of the genitourinary cancers and the incidence of RCC has risen steadily.

      The urine may appear red pink or brown. Renal Cell Carcinoma RCC has the highest mortality rate of the genitourinary cancers and the incidence of RCC has risen steadily. In 2007 I successfully battled prostate cancer and was cured so I assumed this cancer was somehow spreading from the long-gone prostate. Read his amazing story about being a long-term stage 4 kidney cancer survivor. Kidney cancer is sometimes eliminate by removing the kidney or parts of it.

      The type of treatment you receive depends on the stage of cancer. Renal cell cancer can recur come back many years after initial treatment. Stage 1 RCC can be treated surgically. Sometimes you can feel it from the outside. Clear cell renal cell carcinoma is also called conventional renal cell carcinoma.

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      Combined Immune Checkpoint Inhibitors And Antiangiogenic Targeted Therapies

      After immune checkpoint inhibitors and antiangiogenic targeted therapies were found to improve outcomes, the combination of these two approaches has been studied in clinical trials and shown to result in longer OS when compared with monotherapy.

      Pembrolizumab plus axitinib

      Evidence :

    • An open-label, phase III randomized controlled trial comparing sunitinib with the combination of pembrolizumab and axitinib enrolled 861 patients who had received no previous systemic therapy for metastatic disease.
    • With 12.8 months median follow-up, 1-year OS was 90% in the pembrolizumab plus axitinib arm compared with 78% in the sunitinib arm .
    • Median progression-free survival was also prolonged .
    • The objective response rate was 59.3% with combination therapy compared with 35.7% with sunitinib .
    • Grade 3 or higher adverse event rates were similar: 75.8% of the pembrolizumab/axitinib patients compared with 70.6% patients in the sunitinib arm.
    • Avelumab plus axitinib

      Evidence :

    • An open-label phase III randomized trial compared the combination of avelumab and axitinib with sunitinib monotherapy in 560 patients with previously untreated stage IV programmed cell death-ligand-1 positive renal cell carcinoma . This trial specified two primary endpoints: PFS and OS among patients with PD-L1-positive tumors. PFS among the entire study population was a secondary endpoint.
    • With a median follow-up of less than 1 year, there was no significant difference in OS between the two arms.
    • What Are Stage 1 Cervical Cancer Treatments

      Biology of Clear Cell Renal Cell Carcinoma

      The treatments for stage 1 cervical cancer vary for women depending on whether they want to be able to have children in the future or not.

      For those who wish to maintain fertility, the initial treatments are:

      • Cone biopsy: Removing a cone-shaped piece of tissue from the cervix. Whether it warrants additional treatment depends on the results of the biopsy.
      • If the cones edge has negative margins, that means the edges do not contain cancer cells, and the surgery removed it all. You will need to be monitored to ensure the cancer doesnt return, but no more treatment is required.
      • If the edges of the cone have positive margins , cancer may be left behind, which will require 1 of 2 treatments:
      • Repeat cone biopsy
      • Radical trachelectomy
      • This procedure involves removing the cervix, upper vagina and tissue surrounding the cervix.
      • Becoming pregnant after this surgery may be more difficult, and some women experience fertility issues. However, there are options to preserve fertility.
      • The pregnancy following a trachelectomy will result in a cesarean section for the birth of the baby.
    • If the cancer is in the blood or lymph vessels, and the cone biopsy comes back with negative margins, the pelvic lymph nodes will be removed.
    • For those who are done having children, the options are different:

    • Lymph node removal will depend on whether the lymph nodes are involved.
    • Medical treatment involves radiation or drugs to treat cancer.
    • External beam radiation to the pelvis
    • is internal radiation therapy
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