This information is intended to provide a general overview of Von Hippel-Lindau Disease (VHL). It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider for any health concerns or before making any decisions related to your health.
Von Hippel-Lindau disease (VHL) is a rare, inherited condition caused by a mutation in the von Hippel-Lindau gene. This genetic change leads to the development of various tumours and cysts throughout the body, most commonly in the eyes, ears, brain, spinal cord, pancreas, adrenal glands, and kidneys.
Normally, the VHL gene produces a protein that helps regulate cell growth. When the gene is mutated, the body fails to produce healthy copies of this protein, and the affected cells behave as if they are starved of oxygen. This triggers the abnormal formation of numerous blood vessels, which in turn leads to the development of tumours and cysts in those areas.
VHL is usually passed from a parent to a child, with a person having a 50% chance of inheriting the disease if a parent has it. It can also occur in a patient as a new, non-inherited mutation that develops before birth.
VHL is broadly categorised into two main types:
Patients rarely develop a tumour known as a pheochromocytoma.
Patients develop pheochromocytoma in 10-15% of cases.
While the majority of VHL-associated tumours are benign (non-cancerous and do not spread to other parts of the body), they can still grow large enough to damage organs. VHL can also cause malignant (cancerous) tumours, primarily renal cell carcinoma (kidney cancer) or pancreatic neuroendocrine tumours, which can invade nearby tissue and spread.
Benign growths in the inner ear.
Benign tumours, typically found in the cerebellum (part of the brain), spinal cord, or brain stem.
Tumours beginning in the retina of the eye.
The most common type of kidney cancer, affecting approximately 40% of VHL patients and the most frequent cause of disease-related death.
These include benign serous cystadenomas (cysts) and potentially malignant pancreatic neuroendocrine tumours (NETs).
A tumour of the adrenal glands.
VHL symptoms are highly variable, often vague, and depend entirely on the location, size, and effect of the tumours or cysts. In some instances, VHL may not cause any noticeable symptoms.
These symptoms are caused by the overproduction of hormones and may include:
Diagnosing VHL can be complex due to the vague nature of symptoms and the many parts of the body it affects. However, diagnosing the disease and finding tumours early is critical for successful treatment and a better quality of life.
As a genetic condition, VHL itself is diagnosed through genetic testing, which involves analysing a blood sample for specific changes in the DNA.
Patients with the VHL genetic mutation should undergo regular, active surveillance for the development of tumours and cysts, guided by established screening protocols.
Doctors use various methods to screen and diagnose VHL-related tumours, including:
Treatment for VHL is highly personalised, depending on the location and specific issues caused by the tumours and cysts. Because VHL can cause multiple problems, SSCHRC brings together a team of experts from several disciplines to coordinate care and ensure the most advanced and effective treatments possible.
Surgery, often including minimally invasive or laser techniques, is a primary treatment for many VHL-associated problems. Surgeons at SSCHRC perform a large number of VHL procedures each year using advanced techniques. Treatment plans often coordinate surgeries for different growths to reduce the total number of procedures a patient must undergo and minimise recovery time.
A newly developed targeted therapy is now available for patients with VHL-related hemangioblastomas of the brain and spine, kidney cancer, and pancreatic neuroendocrine tumours. This promising option may allow some patients to avoid surgery for specific growths.
These are usually removed through minimally invasive surgery. If surgery is not possible, they may be treated with radiation therapy.
Small, slow-growing tumours may only require observation. Large, fast-growing, or symptom-causing tumours are removed surgically or treated with focused-beam or stereotactic radiation therapy. The new targeted therapy is also an option for hemangioblastomas of the brain and spine.
Tumours in the outer regions of the retina can be treated using laser photocoagulation or cryotherapy. For detachment or scarring, a surgical procedure called vitrectomy may be considered. Tumours in very delicate areas, like the optic disc, are often not treated due to the risk of damage.
Kidney tumours are typically removed surgically if they grow larger than three centimetres or are growing quickly. SSCHRC offers advanced treatments, including:
The new targeted therapy is also available for VHL-related kidney cancer. If the cancer spreads beyond the kidney, treatments may include immunotherapy, chemotherapy, anti-angiogenesis (blood vessel starving) medications, and other targeted therapies.
Benign cysts and cystadenomas rarely require treatment. If a cyst becomes very large, fluid may be drawn out with a needle to shrink it. Pancreatic neuroendocrine tumours (NETs) require close monitoring and are usually removed surgically if they grow larger than three centimetres. The targeted therapy is also an option for pancreatic NETs.
Surgery is the main treatment. To prevent complications from severe high blood pressure during the operation, patients must take medication for two to three weeks before the procedure. Removal may involve removing the whole adrenal gland (adrenalectomy) or a cortex-sparing approach, which removes only the tumour and the inner part of the gland. Minimally invasive laparoscopic surgery may also be an option. If both adrenal glands are removed, patients will require lifelong hormone replacement medication.