The etiology of renal cell carcinoma is still unclear, and its development is related to heredity, smoking, obesity, etc.
⒈ hereditary factors
Most renal cell carcinomas are sporadic, and hereditary renal cell carcinomas account for 2%-4% of all renal cell carcinomas. They are mostly inherited in families in an autosomal dominant manner and are caused by different genetic variants, which include both oncogenes and oncogenes. The identified hereditary renal cell carcinomas include von Hippel-Lindau (VHL) disease (bilateral multiple renal clear cell carcinomas and renal cysts), MET gene-related hereditary papillary renal cell carcinoma, hereditary smooth muscle tumor disease and renal cell carcinoma caused by abnormalities in the ferredoxin hydratase gene, Birt-Hogg-Dube (BHD) syndrome (multiple renal suspicious cell carcinoma, heterogeneous suspicious cell and eosinophilic renal tumors, papillary renal cell carcinoma), and HRPT2 gene-associated hyperparathyroidism-maxillary tumor syndrome (mixed epithelial and stromal tumors, papillary renal cell carcinoma) (Table 1).
The following groups are generally considered to be potential patients for hereditary renal cell carcinoma: (i) patients ≤45 years of age with renal cell carcinoma; (ii) bilateral/multiple renal tumors; (iii) family history of renal cell carcinoma (at least one first-degree relative and at least two second-degree relatives); (iv) history of renal cell carcinoma combined with other tumors (pheochromocytoma, gastrointestinal mesenchymal tumor, neurological hemangioblastoma, pancreatic neuroendocrine tumor, etc.), combined with other (5) Combination of rare skin lesions (smooth muscle sarcoma, angiofibroma, etc.); (6) Personal or family history of renal cell carcinoma-related syndrome. For these patients, they and their related family members can be recommended to undergo gene mutation testing.
Table 1 Common hereditary renal cell carcinoma and clinical manifestations2. Smoking
Smoking can increase the risk of developing renal cell carcinoma, and prospective studies have concluded that smoking is a moderate risk factor. The relative risk of renal cell carcinoma in people with a previous history of smoking is 1.3, while the relative risk of renal cell carcinoma in people who are smoking is 1.6.
3. Obesity
The degree of obesity is generally expressed by the body mass index, and the risk of renal cell carcinoma increases when the body mass index increases. The specific mechanism of obesity to increase the risk of renal cell carcinoma is not known, but it may be related to the increase of androgen and estrogen release by obesity, or some cytokines released by adipocytes.
4. Acquired renal cysts associated with long-term dialysis in end-stage renal disease
Patients with end-stage renal disease have a higher incidence of renal cell carcinoma compared to the general population. Patients on long-term dialysis are more likely to develop acquired renal cysts. In these patients with renal cell carcinoma, the tumors are usually bilateral, multiple, and histologically papillary.
5. Other
There is evidence that alcohol consumption, occupational exposure to trichloroethylene, and women with high estrogen levels may increase the risk of developing renal cell carcinoma. Further research is needed to investigate the potential impact of the interaction between genetic factors and environmental exposures.