Current and Future Trends in the Treatment of Renal Cancer Thomas Keane, David Gillatt, Christopher P. Evans, Andrea Tubaro  European Urology Supplements  Volume 6, Issue 3, Pages 374-384 (March 2007) DOI: 10.1016/j.eursup.2006.12.006 Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 1 Computed tomography scan of the patient in clinical scenario I, which revealed a large right renal tumour (stage cT3b, N0, M0) filling the inferior vena cava and extending to below the hepatic veins. European Urology Supplements 2007 6, 374-384DOI: (10.1016/j.eursup.2006.12.006) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 2 Cancer-specific survival for patients with inferior vena cava levels I, II, and III [9]. Reprinted from Moinzadeh A, et al. J Urol 2004;171;598–601. Copyright 2004, with permission from Elsevier Inc. European Urology Supplements 2007 6, 374-384DOI: (10.1016/j.eursup.2006.12.006) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 3 Kaplan-Meier overall survival estimates for patients with metastasis, tumour thrombus, and Eastern Cooperative Oncology Group performance status ≤1 at diagnosis who underwent nephrectomy or no treatment [8]. Reprinted from Zisman A, et al. J Urol 2003;169:909–16. Copyright 2003, with permission from American Urological Association. European Urology Supplements 2007 6, 374-384DOI: (10.1016/j.eursup.2006.12.006) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 4 Computed tomography scan of the patient in clinical scenario II, which revealed a mass on the right kidney, with lymph node involvement. European Urology Supplements 2007 6, 374-384DOI: (10.1016/j.eursup.2006.12.006) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 5 Molecular pathophysiology of clear-cell renal cell cancer (RCC). Inactivation of the tumour suppressor gene von Hippel-Lindau (VHL) results in an absence of VHL gene product, pVHL. Cells lacking pVHL accumulate high levels of hypoxic-inducible factor (HIF), which is known to activate several pathways that facilitate the progression of RCC through angiogenesis (mediated by vascular endothelial growth factor [VEGF] and platelet-derived growth factor [PDGF], through erythropoietin, a glycoprotein hormone that increases red cell production, and increased metabolism in Glut-1 and transforming-growth factor [TGF]-α stimulation of autocrine growth). European Urology Supplements 2007 6, 374-384DOI: (10.1016/j.eursup.2006.12.006) Copyright © 2006 European Association of Urology Terms and Conditions

Fig. 6 Computed tomography scan of the patient in clinical scenario III, which revealed a 6-cm left anterior lower-pole renal mass in a nodular kidney. European Urology Supplements 2007 6, 374-384DOI: (10.1016/j.eursup.2006.12.006) Copyright © 2006 European Association of Urology Terms and Conditions