- Benign tumours of the kidney are rare
- All renal neoplasms should be regarded as potentially malignant
- Renal cell carcinomas arise from the proximal tubule cells
- Alternative names include:
- Hypernephroma - initially believed to arise from adrenal gland
- Clear cell carcinoma - histologically have small nuclei and abundant cytoplasm
- Grawitz tumour
- Male : female ratio is approximately 2:1
- Increased incidence seen in von Hippel-Lindau syndrome
- Pathologically may extend into renal vein and inferior vena cava
- Blood born spread can result in 'cannon ball' pulmonary metastases
Clinical features
- 10% present with classic trial of haematuria, loin pain and a mass
- Other presentation include a pyrexia of unknown origin, hypertension
- Polycythaemia due to erythropoietin production
- Hypercalcaemia due to production of a PTH-like hormone
Investigations
- Diagnosis can often be confirmed by renal ultrasound
- CT scanning allows assessment of renal vein and caval spread
- Echocardiogram should be considered if clot in IVC extends above diaphragm
Robson Staging
- Stage 1 - Confined to the kidney
- Stage 2 - Involvement of perinephric fat but Gerota's fascia intact
- Stage 3 - Spread into renal vein
- Stage 4 - Spread into adjacent or distant organs
- Prognosis depends on pathological stage, tumour size, nuclear grade and histological type
Management
- Unless extensive metastatic disease it invariably involves surgery
- Surgical option usually involves a radical nephrectomy
- Kidney approached through either a transabdominal or loin incision
- Renal vein ligated early to reduce tumour propagation
- Kidney and adjacent tissue (adrenal, perinephric fat) excised
- Lymph node dissection of no proven benefit
- Solitary (e.g. lung metastases) can occasionally be resected
- Radiotherapy and chemotherapy have little role
Bibliography
El-Gallery R. Surgical management of renal tumours. Radiol Clin North Am 2003;
41: 1053-1065
Lee F, Patel H R. Kidney cancer: current management guidelines. Hosp Med
2002; 63: 214-217.
Russco P. Renal cell carcinoma:
presentation, staging and surgical treatment. Semin Oncol
2000; 27: 106-176.
Whang Y E, Godley P A. Renal cell carcinoma. Curr Opin Oncol 2003; 15:
213-216.
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