Angiogenesis is the defining biological feature of
clear-cell renal cell carcinoma (ccRCC). Loss of Von Hippel–Lindau (VHL)
function stabilises hypoxia-inducible factors (HIFs), upregulating vascular
endothelial growth factor (VEGF) and allied mediators that produce a
hypervascular, leaky, and fragile tumour vasculature. This chapter offers a concise,
clinically oriented review of renal cell carcinoma (RCC) angiogenesis centred
on an exceptional case: a right-sided ccRCC with intratumoral arteriovenous
(AV) shunting and venous collaterals that communicated with the second part of
the duodenum, presenting as severe upper gastrointestinal (GI) bleeding. We
translate the mechanism into management, emphasising rapid stabilisation,
diagnostic angiography, endovascular embolisation, and definitive surgery; then
situate contemporary systemic therapy [VEGF/VEGF receptor (VEGFR) tyrosine
kinase inhibitors (TKIs), immuno-oncology–TKI (IO–TKI) combinations, and HIF-2α
inhibition] within decision frameworks that clinicians can apply. An expanded
discussion links vessel biology to imaging signatures, resistance,
perioperative strategies, and follow-up care. This case serves as a central
framework for demonstrating how timely, multidisciplinary coordination can
prevent catastrophic haemorrhage and ensure durable oncological control.
Author(s) Details
Rajan Ravichandran
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Roshan Reddy
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Velmurugan
Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra
Institute of Higher Education & Research, Chennai, India.
Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-68-8/CH7
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