eMedicine Specialties > Oncology > Carcinomas of the Genitourinary Tract

Renal Cell Carcinoma: Differential Diagnoses & Workup

Author: Kush Sachdeva, MD, Southern Oncology and Hematology Associates, South Jersey Healthcare, Fox Chase Cancer Center Partner
Coauthor(s): Bagi RP Jana, MD, Assistant Professor, University of Central Florida College of Medicine; Attending Physician, Department of Medicine, Florida Hospital Cancer Institute, Orlando; Mansoor Javeed, MD, FACP, Clinical Assistant Professor of Medicine, University of California Davis; Consultant, Sierra Hematology-Oncology Medical Center; Issam Makhoul, MD, Associate Professor, Department of Medicine, Division of Hematology/Oncology, University of Arkansas for Medical Sciences; Brendan Curti, MD, Director, Genitourinary Oncology Research, Robert W Franz Cancer Research Center, Earle A Chiles Research Institute, Providence Cancer Center
Contributor Information and Disclosures

Updated: Jun 25, 2009

Differential Diagnoses

Lymphoma, Non-Hodgkin
Pyelonephritis, Acute
Pyelonephritis, Chronic
Wilms Tumor

Other Problems to Be Considered

Abscess
Angiomyolipoma (benign neoplasm)
Oncocytoma (benign neoplasm)
Metastasis from distant primary
Metastatic melanoma
Renal adenoma (benign neoplasm)
Renal cyst
Renal infarct
Sarcoma
Transitional cell carcinoma of renal pelvis

Workup

Laboratory Studies

  • Laboratory studies in the evaluation of renal cell carcinoma should include a workup for paraneoplastic syndromes. Initial studies are as follows:
    • Urine analysis
    • CBC count with differential
    • Electrolytes
    • Renal profile
  • Liver function tests (AST and ALT)
  • Calcium
  • Erythrocyte sedimentation rate
  • Prothrombin time
  • Activated partial thromboplastin time
  • Other tests indicated by presenting symptoms

Imaging Studies

  • A large proportion of patients diagnosed with renal cancer have small tumors discovered incidentally on imaging studies. A number of diagnostic modalities are used to evaluate and stage renal masses, including the following:
    • Excretory urography
    • CT scan
    • Ultrasonography
    • Arteriography
    • Venography
    • MRI
    • PET
  • Determining whether a space-occupying renal mass is benign or malignant can be difficult. Radiologic studies should be tailored to enable further characterization of renal masses, so that nonmalignant tumors can be differentiated from malignant ones.
  • Excretory urography is not used frequently in the initial evaluation of renal masses because of its low sensitivity and specificity. A small- to medium-sized tumor may be missed by excretory urography.
  • Contrast-enhanced CT scanning has become the imaging procedure of choice for diagnosis and staging of renal cell cancer and has virtually replaced excretory urography and renal ultrasound. In most cases, CT imaging can differentiate cystic masses from solid masses and supplies information about lymph node, renal vein, and inferior vena cava involvement.
  • Ultrasound examination can be useful in evaluating questionable cystic renal lesions if CT imaging is inconclusive. Large papillary renal tumors are frequently undetectable by renal ultrasound.
  • Renal arteriography is not used in the evaluation of a suspected renal mass as frequently now as it was in the past. When inferior vena cava involvement is suspected, either inferior venacavography or MRI angiography is used. MRI is currently the preferred imaging technique. Knowledge of inferior vena cava involvement is important in planning the vascular aspect of the operative procedure.
  • A bone scan is recommended for bony symptoms with elevated alkaline phosphatase level.
  • PET imaging remains controversial in kidney cancer. Its sensitivity for detecting metastatic lesions is better than for determining the presence of cancer in the renal primary site.

Procedures

Percutaneous cyst puncture and fluid analysis is used in the evaluation of potentially malignant cystic renal lesions detected by ultrasonography or CT imaging.

Histologic Findings

Renal cell carcinoma has 5 histologic subtypes, as follows: clear cell (75%), chromophilic (15%), chromophobic (5%), oncocytoma (3%), and collecting duct (2%).

  • Unusually clear cells with a cytoplasm rich in lipids and glycogen characterize clear cell carcinoma, which is most likely to show 3p deletion.
  • Chromophilic tumors tend to be bilateral and multifocal and may have trisomy 7 and/or trisomy 17.
  • Large polygonal cells with pale reticular cytoplasm characterize chromophobic carcinoma, which does not exhibit 3p deletion.
  • Renal oncocytoma consists predominantly of eosinophilic cells, in a characteristic nested or organoid pattern, that rarely metastasize and do not exhibit 3p deletion or trisomy 7 or 17.
  • Collecting duct carcinoma is an unusual variant characterized by a very aggressive clinical course. This tends to affect younger patients and may present with local or widespread advanced disease. These cells can have 3 different types of growth patterns, (1) acinar, (2) sarcomatoid, and (3) tubulopapillary. The sarcomatoid variant, which can occur with any histologic cell type, is associated with a significantly poorer prognosis.

Table 1. Pathologic Classification of Renal Cell Carcinoma

Open table in new window

[ CLOSE WINDOW ]
Table

Cell Type

Features

Growth Pattern

Cell of Origin

Cytogenetics

Clear cell

Most common

Acinar or sarcomatoid

Proximal tubule

3p-

Chromophilic

Bilateral and multifocal

Papillary or sarcomatoid

Proximal tubule

+7, +17, -Y

Chromophobic

Indolent course

Solid, tubular, or sarcomatoid

Cortical collecting duct

Hypodiploid

Oncocytic

Rarely metastasize

Tumor nests

Cortical collecting duct

Undetermined

Collecting duct

Very aggressive

Papillary or sarcomatoid

Medullary collecting duct

Undetermined

Cell Type

Features

Growth Pattern

Cell of Origin

Cytogenetics

Clear cell

Most common

Acinar or sarcomatoid

Proximal tubule

3p-

Chromophilic

Bilateral and multifocal

Papillary or sarcomatoid

Proximal tubule

+7, +17, -Y

Chromophobic

Indolent course

Solid, tubular, or sarcomatoid

Cortical collecting duct

Hypodiploid

Oncocytic

Rarely metastasize

Tumor nests

Cortical collecting duct

Undetermined

Collecting duct

Very aggressive

Papillary or sarcomatoid

Medullary collecting duct

Undetermined

Staging

  • The Robson modification of the Flocks and Kadesky system is uncomplicated and is used commonly in clinical practice. This system was employed to correlate stage at presentation with prognosis. The Robson staging system is as follows:
    • Stage I - Tumor confined within capsule of kidney
    • Stage II - Tumor invading perinephric fat but still contained within the Gerota fascia
    • Stage III - Tumor invading the renal vein or inferior vena cava (A), or regional lymph-node involvement (B), or both (C)
    • Stage IV - Tumor invading adjacent viscera (excluding ipsilateral adrenal) or distant metastases
  • The tumor, nodes, and metastases (TNM) classification is endorsed by the American Joint Committee on Cancer (AJCC). The major advantage of the TNM system is that it clearly differentiates individuals with tumor thrombi from those with local nodal disease. In the Robson system, stage III inferior vena caval involvement (IIIA) is the same stage as local lymph node metastases (IIIB). Although patients with Robson stage IIIB renal carcinoma have greatly decreased survival rates, the prognosis for patients with stage Robson IIIA renal carcinoma is not markedly different from that for patients with Robson stage I or II renal carcinoma. The TNM classification system is as follows:
    • Primary tumor (T)
      • TX - Primary tumor cannot be assessed
      • T0 - No evidence of primary tumor
      • T1 - Tumor 7 cm or smaller in greatest dimension, limited to the kidney
      • T2 - Tumor larger than 7 cm in greatest dimension, limited to the kidney
      • T3 - Tumor extends into major veins or invades adrenal gland or perinephric tissues but not beyond the Gerota fascia
      • T3a - Tumor invades adrenal gland or perinephric tissues but not beyond the Gerota fascia
      • T3b - Tumor grossly extends into the renal vein(s) or vena cava below the diaphragm
      • T3c - Tumor grossly extends into the renal vein(s) or vena cava above the diaphragm
      • T4 - Tumor invading beyond the Gerota fascia
    • Regional lymph nodes (N) - Laterality does not affect the N classification
      • NX - Regional lymph nodes cannot be assessed
      • N0 - No regional lymph node metastasis
      • N1 - Metastasis in a single regional lymph node
      • N2 - Metastasis in more than 1 regional lymph node
    • Distant metastasis (M)
      • MX - Distant metastasis cannot be assessed
      • M0 - No distant metastasis
      • M1 - Distant metastasis
    • AJCC stages
      • AJCC stage I - T1, N0, M0
      • AJCC stage II - T2, N0, M0
      • AJCC stage III - T1-2, N1, M0 or T3a-c, N0-1, M0
      • AJCC stage IV - T4; or any T, N2, M0; or any T, any N, M1
    • The division of patients with renal cell carcinoma into low-, intermediate-, and high-risk groups with or without metastases may be useful in choosing appropriate therapy for them.3,4

More on Renal Cell Carcinoma

Overview: Renal Cell Carcinoma
Differential Diagnoses & Workup: Renal Cell Carcinoma
Treatment & Medication: Renal Cell Carcinoma
Follow-up: Renal Cell Carcinoma
References
[ CLOSE WINDOW ]

References

  1. American Cancer Society. Statistics for 2007. American Cancer Society. Available at http://www.cancer.org/docroot/STT/STT_0.asp. Accessed November, 2007.

  2. Robson CJ, Churchill BM, Anderson W. The results of radical nephrectomy for renal cell carcinoma. J Urol. Mar 1969;101(3):297-301. [Medline].

  3. Jonasch et al. Renal Cell Carcinoma. In: Kantarjian HM, Wolff RA, Koller CA, eds. MD Anderson Manual of Medical Oncology. New York, NY: McGraw-Hill; 2006.

  4. Zisman A, Pantuck AJ, Wieder J, Chao DH, Dorey F, Said JW. Risk group assessment and clinical outcome algorithm to predict the natural history of patients with surgically resected renal cell carcinoma. J Clin Oncol. Dec 1 2002;20(23):4559-66. [Medline].

  5. Escudier B, Koralewski P, Pluzanska A, et al. A randomized controlled double-blind phase III study (AVOREN) of bevacizamab/interferon--AZA vs placebo/interferon--AZA as first-line therapy in metastatic renal cell carcinoma. J Clin Oncol. 2007;25(suppl)18 part 1 ABS 3.

  6. Amato RJ. Chemotherapy for renal cell carcinoma. Semin Oncol. Apr 2000;27(2):177-86. [Medline].

  7. Atzpodien J, Kirchner H, Hanninen EL, et al. European studies of interleukin-2 in metastatic renal cell carcinoma. Semin Oncol. Dec 1993;20(6 Suppl 9):22-6. [Medline].

  8. Bosniak MA. The small (less than or equal to 3.0 cm) renal parenchymal tumor: detection, diagnosis, and controversies. Radiology. May 1991;179(2):307-17. [Medline].

  9. Bukowski RM. Cytokine combinations: therapeutic use in patients with advanced renal cell carcinoma. Semin Oncol. Apr 2000;27(2):204-12. [Medline].

  10. Childs R, Chernoff A, Contentin N, et al. Regression of metastatic renal-cell carcinoma after nonmyeloablative allogeneic peripheral-blood stem-cell transplantation. N Engl J Med. Sep 14 2000;343(11):750-8. [Medline].

  11. Chow WH, Devesa SS, Warren JL, Fraumeni JF Jr. Rising incidence of renal cell cancer in the United States. JAMA. May 5 1999;281(17):1628-31. [Medline].

  12. Culine S, Bekradda M, Kramar A, et al. Prognostic factors for survival in patients with brain metastases from renal cell carcinoma. Cancer. Dec 15 1998;83(12):2548-53. [Medline].

  13. Fisher RI, Rosenberg SA, Sznol M, et al. High-dose aldesleukin in renal cell carcinoma: long-term survival update. Cancer J Sci Am. Dec 1997;3 Suppl 1:S70-2. [Medline].

  14. Flanigan RC, Salmon SE, Blumenstein BA, Bearman SI, Roy V, McGrath PC. Nephrectomy followed by interferon alfa-2b compared with interferon alfa-2b alone for metastatic renal-cell cancer. N Engl J Med. Dec 6 2001;345(23):1655-9. [Medline].

  15. Fossa SD. Interferon in metastatic renal cell carcinoma. Semin Oncol. Apr 2000;27(2):187-93. [Medline].

  16. Fyfe G, Fisher RI, Rosenberg SA, et al. Results of treatment of 255 patients with metastatic renal cell carcinoma whoreceived high-dose recombinant interleukin-2 therapy. J Clin Oncol. Mar 1995;13(3):688-96. [Medline].

  17. Hilton S. Imaging of renal cell carcinoma. Semin Oncol. Apr 2000;27(2):150-9. [Medline].

  18. Holtl L, Rieser C, Papesh C, et al. CD83+ blood dendritic cells as a vaccine for immunotherapy of metastatic renal-cell cancer. Lancet. Oct 24 1998;352(9137):1358. [Medline].

  19. Horoszewicz JS, Murphy GP. An assessment of the current use of human interferons in therapy of urologicalcancers. J Urol. Nov 1989;142(5):1173-80. [Medline].

  20. Hudes G, Carducci M, Tomczak P, Dutcher J, Figlin R, Kapoor A. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med. May 31 2007;356(22):2271-81. [Medline].

  21. Hudes G, Carducci M, Tomczak P, Dutcher J, Figlin R, Kapoor A, et al. Temsirolimus, interferon alfa, or both for advanced renal-cell carcinoma. N Engl J Med. May 31 2007;356(22):2271-81. [Medline].

  22. Iliopoulos O, Eng C. Genetic and clinical aspects of familial renal neoplasms. Semin Oncol. Apr 2000;27(2):138-49. [Medline].

  23. Javidan J, Stricker HJ, Tamboli P, et al. Prognostic significance of the 1997 TNM classification of renal cell carcinoma. J Urol. Oct 1999;162(4):1277-81. [Medline].

  24. Law TM, Motzer RJ, Mazumdar M, et al. Phase III randomized trial of interleukin-2 with or without lymphokine- activated killer cells in the treatment of patients with advanced renal cell carcinoma. Cancer. Sep 1 1995;76(5):824-32. [Medline].

  25. Linehan MW, Berton Z, Bates S. Cancer of Kidney and Ureter. In: Devita VT Jr, et al eds. Principles and Practice of Oncology. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2001:1362-1396.

  26. Margolin KA. Interleukin-2 in the treatment of renal cancer. Semin Oncol. Apr 2000;27(2):194-203. [Medline].

  27. McLaughlin JK, Lipworth L. Epidemiologic aspects of renal cell cancer. Semin Oncol. Apr 2000;27(2):115-23. [Medline].

  28. Minasian LM, Motzer RJ, Gluck L, et al. Interferon alfa-2a in advanced renal cell carcinoma: treatment results and survival in 159 patients with long-term follow-up. J Clin Oncol. Jul 1993;11(7):1368-75. [Medline].

  29. Motzer RJ, Bander NH, Nanus DM. Renal-cell carcinoma. N Engl J Med. Sep 19 1996;335(12):865-75. [Medline].

  30. Motzer RJ, Hudes GR, Curti BD, McDermott DF, Escudier BJ, Negrier S. Phase I/II trial of temsirolimus combined with interferon alfa for advanced renal cell carcinoma. J Clin Oncol. Sep 1 2007;25(25):3958-64. [Medline].

  31. Motzer RJ, Hudes GR, Curti BD, McDermott DF, Escudier BJ, Negrier S, et al. Phase I/II trial of temsirolimus combined with interferon alfa for advanced renal cell carcinoma. J Clin Oncol. Sep 1 2007;25(25):3958-64. [Medline].

  32. Motzer RJ, Mazumdar M, Bacik J. Effect of cytokine therapy on survival for patients with advanced renal cellcarcinoma. J Clin Oncol. May 2000;18(9):1928-35. [Medline].

  33. Motzer RJ, Mazumdar M, Bacik J, et al. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol. Aug 1999;17(8):2530-40. [Medline].

  34. Motzer RJ, Michaelson MD, Redman BG, Hudes GR, Wilding G, Figlin RA. Activity of SU11248, a multitargeted inhibitor of vascular endothelial growth factor receptor and platelet-derived growth factor receptor, in patients with metastatic renal cell carcinoma. J Clin Oncol. Jan 1 2006;24(1):16-24. [Medline].

  35. Motzer RJ, Russo P. Systemic therapy for renal cell carcinoma. J Urol. Feb 2000;163(2):408-17. [Medline].

  36. Negrier S, Escudier B, Lasset C, et al. Recombinant human interleukin-2, recombinant human interferon alfa-2a, or both in metastatic renal-cell carcinoma. Groupe Francais d''Immunotherapie. N Engl J Med. Apr 30 1998;338(18):1272-8. [Medline].

  37. Novick AC, Streem S, Montie JE, et al. Conservative surgery for renal cell carcinoma: a single-center experience with 100 patients. J Urol. Apr 1989;141(4):835-9. [Medline].

  38. Oliver RT, Nethersell AB, Bottomley JM. Unexplained spontaneous regression and alpha-interferon as treatment for metastatic renal carcinoma. Br J Urol. Feb 1989;63(2):128-31. [Medline].

  39. Osoba D, Rodrigues G, Myles J, et al. Interpreting the significance of changes in health-related quality-of- life scores. J Clin Oncol. Jan 1998;16(1):139-44. [Medline].

  40. Parkinson DR, Sznol M. High-dose interleukin-2 in the therapy of metastatic renal-cell carcinoma. Semin Oncol. Feb 1995;22(1):61-6. [Medline].

  41. Pyrhonen S, Salminen E, Ruutu M, et al. Prospective randomized trial of interferon alfa-2a plus vinblastine versus vinblastine alone in patients with advanced renal cell cancer. J Clin Oncol. Sep 1999;17(9):2859-67. [Medline].

  42. Rabinovitch RA, Zelefsky MJ, Gaynor JJ, Fuks Z. Patterns of failure following surgical resection of renal cell carcinoma: implications for adjuvant local and systemic therapy. J Clin Oncol. Jan 1994;12(1):206-12. [Medline].

  43. Rini BI, Vogelzang NJ, Dumas MC, et al. Phase II trial of weekly intravenous gemcitabine with continuous infusion fluorouracil in patients with metastatic renal cell cancer. J Clin Oncol. Jun 2000;18(12):2419-26. [Medline].

  44. Ritchie AW, Chisholm GD. The natural history of renal carcinoma. Semin Oncol. Dec 1983;10(4):390-400. [Medline].

  45. Robson JS. Advances in the treatment of renal disease. Practitioner. Oct 1969;203(216):483-93. [Medline].

  46. Rosenberg SA, Lotze MT, Muul LM et al,. A progress report on the treatment of 157 patients with advanced cancer using lymphokine-activated killer cells and interleukin-2 or high-dose interleukin-2 alone. N Engl J Med. Apr 9 1987;316(15):889-97. [Medline].

  47. Russo P. Renal cell carcinoma: presentation, staging, and surgical treatment. Semin Oncol. Apr 2000;27(2):160-76. [Medline].

  48. Simon JW, Marshall FF. Kidney and Ureter. In: Abeloff MD, et al, eds. Clinical Oncology. 2nd ed. New York, NY: Churchill Livingstone; 2000:1784-1799.

  49. Sleijfer DT, Janssen RA, Buter J, et al. Phase II study of subcutaneous interleukin-2 in unselected patients with advancedrenal cell cancer on an outpatient basis. J Clin Oncol. Jul 1992;10(7):1119-23. [Medline].

  50. Stadler WM, Vogelzang NJ. Low-dose interleukin-2 in the treatment of metastatic renal-cell carcinoma. Semin Oncol. Feb 1995;22(1):67-73. [Medline].

  51. Van Brussel JP, Mickisch GH. Prognostic factors in renal cell and bladder cancer. BJU Int. May 1999;83(8):902-8; quiz 908-9. [Medline].

  52. Vogelzang NJ, Stadler WM. Kidney cancer. Lancet. Nov 21 1998;352(9141):1691-6. [Medline].

  53. Yagoda A, Abi-Rached B, Petrylak D. Chemotherapy for advanced renal-cell carcinoma: 1983-1993. Semin Oncol. Feb 1995;22(1):42-60. [Medline].

  54. Yang JC, Haworth L, Sherry RM, et al. A randomized trial of bevacizumab, an anti-vascular endothelial growth factorantibody, for metastatic renal cancer. N Engl J Med. Jul 31 2003;349(5):427-34. [Medline].

  55. Yang JC, Sherry RM, Steinberg SM, et al. Randomized study of high-dose and low-dose interleukin-2 in patients with metastaticrenal cancer. J Clin Oncol. Aug 15 2003;21(16):3127-32. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

renal cell adenocarcinoma, hypernephroma, hypernephroid tumor, Grawitz tumor, von Hippel-Lindau syndrome, VHL syndrome, VHL disease, hereditary papillary renal carcinoma, HPRC, familial renal oncocytoma, FRO, Birt-Hogg-Dube syndrome, BHDS, hereditary renal carcinoma, HRC, Stauffer syndrome, renal cancer, pheochromocytoma, pancreatic cysts, epididymal cystadenomas, endolymphatic sac tumors, central nervous system hemangioblastomas, retinal angiomas, islet cell tumors, fibrofolliculomas, colonic polyps, colonic tumors, pulmonary cysts, paraneoplastic syndromes, hypercalcemia, nonmetastatic hepatic dysfunction, polyneuromyopathy, amyloidosis, anemia, dermatomyositis, hypertension, varicocele, cigarette smoking, obesity, unopposed estrogen therapy, asbestos exposure, cystic kidneydisease, renal dialysis, tuberous sclerosis, renal cell carcinoma

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Kush Sachdeva, MD, Southern Oncology and Hematology Associates, South Jersey Healthcare, Fox Chase Cancer Center Partner
Disclosure: Nothing to disclose.

Coauthor(s)

Bagi RP Jana, MD, Assistant Professor, University of Central Florida College of Medicine; Attending Physician, Department of Medicine, Florida Hospital Cancer Institute, Orlando
Bagi RP Jana, MD is a member of the following medical societies: American Medical Association and American Society of Clinical Oncology
Disclosure: Nothing to disclose.

Mansoor Javeed, MD, FACP, Clinical Assistant Professor of Medicine, University of California Davis; Consultant, Sierra Hematology-Oncology Medical Center
Mansoor Javeed, MD, FACP is a member of the following medical societies: American College of Physicians and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Issam Makhoul, MD, Associate Professor, Department of Medicine, Division of Hematology/Oncology, University of Arkansas for Medical Sciences
Issam Makhoul, MD is a member of the following medical societies: American Society of Clinical Oncology and American Society of Hematology
Disclosure: Nothing to disclose.

Brendan Curti, MD, Director, Genitourinary Oncology Research, Robert W Franz Cancer Research Center, Earle A Chiles Research Institute, Providence Cancer Center
Brendan Curti, MD is a member of the following medical societies: American College of Physicians, American Society of Clinical Oncology, Oregon Medical Association, and Society for Biological Therapy
Disclosure: Nothing to disclose.

Medical Editor

Michael Perry, MD, MS, MACP, Nellie B Smith Chair of Oncology Emeritus, Professor, Department of Internal Medicine, Division of Hematology and Oncology, University of Missouri/Ellis Fischel Cancer Center
Michael Perry, MD, MS, MACP is a member of the following medical societies: Alpha Omega Alpha, American Association for Cancer Research, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society of Clinical Oncology, American Society of Hematology, International Association for the Study of Lung Cancer, and Missouri State Medical Association
Disclosure: Bionumerik Consulting fee Consulting; Proactya Consulting fee Consulting; GSK Consulting fee Consulting; NovoNordisk Consulting fee Consulting; Amgen Honoraria Speaking and teaching; GSK Consulting fee Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Wendy Hu, MD, Consulting Staff, Department of Hematology/Oncology and Bone Marrow Transplantation, Huntington Memorial Medical Center
Wendy Hu, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Blood and Marrow Transplantation, American Society of Hematology, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Jules E Harris, MD, Clinical Professor of Medicine, Division of Hematology/Medical Oncology, Department of Internal Medicine, University of Arizona College of Medicine at Tucson; Consulting Staff, Arizona Cancer Center
Jules E Harris, MD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Association of Immunologists, American Society of Hematology, and Central Society for Clinical Research
Disclosure: GlobeImmune Salary Consulting; Amplimed Consulting fee Consulting; FibroGen Consulting fee Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.