1. Dr H.Niroomand M.D. Aja University Of Medical Sience Epidemiology & Etiology

3.  accounts for 2% to 3% of all adult malignant neoplasms most lethal of the common urologic cancers 30% to 40% of patients with RCC have died of theirCancer Epidemiology

4.  12 new cases are diagnosed per100,000 population per year male-to-female predominance of 3 : 2 (6,7 th decades)primarily a disease of the elderly Epidemiology

5.  The majority of cases are sporadic only 2% to 3% are familial Epidemiology

6.  The incidence of RCC has increased since the 1970s : 3% per year for whites For African-Americans 4% per year largely related to the more prevalent use of ultrasonography and CT Epidemiology

7.  RCC in childhood : - is uncommon (2.3-6.6) - Mean age is 8 to 9 years - RCC is as common as Wilms tumor during the 2th decade of life. Stage for stage, children and young adults may respond better to surgical therapy Epidemiology

8.  traditionally thought to arise primarily from the proximal convoluted tubules( clear cell and papillary ) chromophobe and collecting duct RCC, are derived from the more distal components of the nephron Etiology

9.  accepted environmental risk factor : 1 - Tobacco exposure:. Relative risks:1.4 to 2.5. All forms of tobacco use implicated. risk increases with cumulative dose. accounts for 20% to 30% of cases of RCC in men and 10% to 20% in women Etiology

10.  2- Obesity: - increased relative risk of 1.07 for each unit of rising body mass index - >40% of cases of RCC in the US may be causally linked to obesity - increased insulin-like growthfactor-1, increased circulating estrogen, increased arterionephrosclerosis & local inflammation Etiology

11.  3 - Hypertension : - Diuretics and other antihypertensive medications implicated - hypertension, rather than the treatment, that increases the risk - The proposed mechanisms: hypertension-induced renal injury and inflammation, metabolic or functional changes in the renal tubules Etiology

12.  Although a number of other potential etiologic factors have been identified in animal models, including : viruses,lead compounds, and more than 100 chemicals such as aromatic hydrocarbons no specific agent has been definitively established as causative in human RCC Etiology

13.  family history of RCC may also be a factor ; one study showed a relative risk of 2.9 for individuals with a first- or second-degree relative with RCC Etiology

14.  Familial Renal Cell Carcinoma (RCC) Syndromes: 1-von Hippel-Lindau Disease ( Clear cell RCC, Hemangioblastomas of the CNS Retinal angiomas,Pheochromocytoma ) 2- Familial Papillary Renal Cell Carcinoma 3-Hereditary Leiomyomatos and RCC (Type 2 papillary RCC, Cutaneous leiomyomas Uterine leiomyomas ) 4- Birt-Hogg-Dubé Syndrome Etiology

15. Thank you