Some people experience a range of emotions when they are told they have VHL. Anger, shock, anxiety, worry about your health, guilt about possibly passing the gene on to children are all normal reactions.Uncertainty is another problem. Because VHL is variable, even within families, we can’t say how any one person will be affected in the future. As several family members can be affected this can also be difficult. Screening results and possible treatment interventions may be different for family members at different times. People in the family that do not inherit the gene can feel guilty when other close relatives have
VHL is often inherited from a parent. About a quarter of all people diagnosed with VHL have no family history of the disease, but can pass VHL on to their children.Our bodies contain thousands of coded messages called genes that send instructions to our body on how to function; for example, what colour to make our eyes or how tall we will grow. The VHL gene makes a protein that is important for the normal function of cells. A mutation (fault) in this gene alters the message the gene sends to the body and causes an increased chance of one of the VHL tumours developing.
You may hear many different words used to describe a gene that is not working properly. The gene may be said to be faulty, altered or changed. The technical term is a mutation which means that the instruction that the gene sends to the body may be different, just as a spelling mistake may alter the meaning of a word.We all have two copies of each of our genes; we get one copy from our mother, the other copy from our father. People with VHL have one faulty copy and one normal copy. When we have children we pass just one of each copy on; the other comes from the other parent.Therefore, each of the children of someone with VHL has a one in two (50%) chance that they will inherit the altered gene. If a person has not inherited a mutation, then they cannot pass it on to their children
Detection of the type of tumors specific to VHL is critical to properly diagnosing the disease. For individuals who have a family history of VHL, detection of only one type of tumor specific to VHL may be sufficient to make a diagnosis. For those patients without a family history of the disease, at least two types of VHL tumors should be identified to confirm a diagnosis. Genetic testing also may helpful in diagnosing the disease. Please contact your GP or your consultant for a blood test should you suspect you have this condition.
It is possible to look for a specific fault in the gene in an affected person. This can be done from a blood sample, since blood cells contain copies of all of our genes. This result will take a couple of months. It is known that current techniques are not yet good enough to find all gene changes, even when the diagnosis of VHL is certain.If the fault in the gene is found then this information can be used to test other members of the family to see whether or not they also have the faulty gene. This test is much quicker taking two to four weeks for a result.If the faulty gene has not been identified, then it may be possible to follow the gene through the family using DNA markers. This will give us a very good indication as to who is likely to carry the faulty gene within a family. Taking this information, alongside screening results, it may be possible to stop the screening programme on those people who are unlikely to have inherited the faulty gene.
Your family history may suggest there is a possibility that you have inherited VHL disease, for example children of a parent with VHL disease each have a one in two (50%) risk of developing the disease regardless of whether they are boys or girls.In the past all children at risk were offered screening very like that offered to people with definite VHL. The screening began with regular eye checks at five years and other checks were added in as the children grew into adulthood.The development of a gene test for VHL has meant that children can be tested, (usually around the age of four or five) to see whether or not they need screening. Those who test negative are not at risk of passing VHL on to their own children in the future. Those with the faulty gene will be screened appropriately.Some parents decide that they would rather the child made his or her own decision about gene testing when they are older. Therefore the child would be screened with eye checks and testing is then offered to them as they grow older and understand more about VHL and their risk. This test for children is only possible if we have been able to identify the specific VHL mutation in the family.
A hemangioblastoma is a benign, highly vascular tumor that can occur in the brain, spinal cord, and retina (the light-sensitive tissue that lines the back of the eye). This tumor accounts for about 2% of brain tumors. As it enlarges, it presses on the brain and can cause neurological symptoms, such as headaches, weakness, sensory loss, balance and coordination problems, and/or hydrocephalus (a buildup of spinal fluid in the brain). Most hemangioblastomas occur sporadically. However, some people develop hemangioblastomas as part of a genetic syndrome called von Hippel-Lindau syndrome. These people usually develop multiple tumors within the brain and spinal cord over their lifetime.
Hemangioblastomas of the central nervous system
Microsurgical treatment of hemangioblastomas of the CNS is often ineffective, as the tumors tend to recur after surgery. Stereotactic radiotherapy, a safe, non-invasive method for shrinking tumors, may present a better alternative. It has been shown that small- and medium-sized tumors don’t tend to re-grow after this type of treatment.
Hemangioblastomas of the retina / optic nerve
Hemangioblastomas of the retina are typically treated with a laser, cryotherapy, or plaque radiotherapy .
Renal cell carcinoma
Depending on the extent of the disease, renal cell carcinoma may either be treated with nephron-sparing surgery (removing the tumor while sparing the unaffected portion of the kidney) or a radical nephrectomy (removal of the whole kidney). It is important for you to understand and in some cases educate your consultant on VHL as the removal of the tumor should be done to help prevent the spread of the cancerous cells to other parts of the body, but should only be done if the tumour reaches a certain size. Speak to your specialist for further information.
Complications of VHL disease are much easier to treat if they are detected early. For this reason, once the diagnosis is made it is recommended that patients enter an annual screening programme where different parts of the body involved in VHL can be checked out.In this region, patients are offered an annual appointment at a joint neurological/genetics clinic. During the visit they have a consultation and general check up with a clinical geneticist, neurologist and genetic counsellor. They may have their blood pressure checked and a neurological examination performed. The patient also has a detailed eye examination with a consultant ophthalmologist at least once a year.Depending on the age of the patient, MRI scans of the abdomen, brain or spinal cord are arranged. Finally, patients are asked to make a 24-hour urine collection after clinic to check for phaeochromocytomas.
9Von Hippel-Lindau disease (VHL)The frequency of the different tests and screening programme reflects the natural history of the different features of VHL. For example, eyes and kidneys are checked on an annual basis. On the other hand, brain and spinal cord tumours grow slowly, and we know they can be present on scans for many years without causing symptoms. Therefore, some patients choose to have brain or spine scans only if they have symptoms. Other people prefer to have a brain or spine scan every few years.If tumours are detected which need treatment the patient is referred to the specialist for that part of the body. They will discuss in detail how the particular problem should be treated. The majority of VHL tumours can be treated successfully, particularly when detected early.
Although there is no cure for VHL, the associated tumors can be treated. Early detection and treatment of tumors significantly improves a patient’s diagnosis. Left untreated, VHL may result in blindness, permanent brain damage, or death. Depending on the location of the tumors, our neurosurgical specialists may also collaborate with urologists, ophthalmologists, endocrinologists, and other physicians.
von Hippel Lindau (VHL) disease patients battle a series of malignant and benign
tumours/cysts their whole lives.
The gene that is involved in VHL is also involved in other more common cancers, such as kidney
cancer and breast cancer. If researchers are able to overcome the gene mutation for VHL, they
may be able to do the same for other cancers. Manifestations commonly occur on the retina,
brain and spinal cord, kidneys, pancreas, inner ears and adrenal glands (pheochromocytoma).
VHL disease occurs in 1 in 36,000 births.