Constitutional Symptoms

Nonspecific symptoms, including cachexia, anorexia, weight loss, and fatigue, are common presenting features in up to one-third of patients with large RCC. The etiology is not well established, but the cancer cachexia is likely cytokine-mediated. Tumor necrosis factor alpha is the cytokine most commonly involved by altering fat metabolism and appetite regulation (Laski and Vugrin 1987). Other cytokines including interleukin-1, interleukin-6, and interferon gamma, have also been implicated in cancer cachexia (Tsukamoto et al. 1992; Walther et al. 1998). In a series of 1,046 patients treated by radical nephrectomy for renal cell carcinoma, cachexia (defined as hypoalbuminemia, weight loss, and malaise), predicts worse survival after controlling for well-established prognosticators, including TNM and Fuhrman grade (Kim and al. 2003). Fever has been associated with renal cell carcinoma in approximately 20 %. In patients evaluated for fever, a renal cell carcinoma was found in up to 2% (Weinstein et al. 1961). The etiology of fever associated with renal cell carcinoma has not been clearly elucidated, but it has been postulated that the following factors may be involved: tumor necrosis with secretion of tissue pyrogens, tumor-produced toxins or pyrogens, prostaglandins, and immune mechanisms (Sufrin et al. 1989). Interleukin-6 has been incriminated in the genesis of fever. In a study evaluating 71 patients with renal cell carcinoma, 25% had higher levels of interleukin-6,78 % of whom had fever. There is no correlation of fever with necrosis or inflammatory changes in the tumor. The fever disappears after nephrectomy and may recur when metastasis develops (Tsukamoto et al. 1992).

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