kidney cancer or renal carcinoma
on kidney cancer
What is kidney cancer ?
Kidney cancer or known as renal cell carcinoma is primary malignancies affecting the kidney.
What is the cause and association of kidney cancer ?
80% of kidney cancer consists of renal cell carcinoma while another 10% is papillary carcinoma 9 uncommon) Both are derived from proximal tubular cells . 10 % are transitional cell carcinoma that derived from renal pelvis.
It is associated with inherited condition: Von Hippel lindau disease, tuberous sclerosis, polycystic kidneys and familial renal cell carcinoma. Also associated with smoking and chronic dialysis.
Renal cell carcinoma can be associated with abnormal liver function test in the absence of liver metastases, a phenomenon known as Stauffer's syndrome.
What is the epidemiology of kidney cancer ?
Kidney cancer is uncommon, it is around 3% of adult malignancies with male to female ratio is 2:1 and peak incidence around 40-60 years.
How does it present ?
Kidney cancer presentation depends on the type of kidney cancer.
Renal cell carcinoma- usually present late, being asymptomatic in 90% of cases. Present with classical triad of hematuria ( blood in the urine ) ,flank pain ( pain in abdominal region) and abdominal mass in 10% of patient only.
Transitional cell carcinoma- usually present earlier with hematuria.
Systemic sign of malignancy - weight loss, malaise, paraneoplastic syndrome, fever of unknown origin , symptoms of high calcium level and polycythemia.
Generally patient may present with palpable renal mass, redness on the face, anemia and high bolld pressure.
A left sided tumor on extending onto the left renal vein can obstruct the left testicular veins and causing left sided varicocele.
What is the pathology behind kidney cancer ?
Kidney cancer can be staged using the Robson staging :
Stage 1; tumor confined to the renal parenchyma
stage 2 : tumor extend to perinephric fat and adrenal gland.
stage 3; involves local vessels or nodes
stage4 ; spreads to adjacent or distant organs.
Renal cell carcinoma; macroscopically arise from any portion of the kidney, usually the poles, appearing as aspherical mass composed of yellow -white tissue that may have necrosis, haemorrhage and calcified.
Microscopically, 90% adenocarcinomas with small nuclei and abundant clear cytoplasm, other granular cells, occasionally sacromatoid, Spreads is often along the renal vein , with tumor emboli to he lung.Metastasis is also to the lymph nodes, bones liver and skin.
How to investigate kidney cancer ?
the investigation reqiures:
urine- dipstick to detect hematuria or cell study 9 ( cytology )
Blood- full blood count, urea and electrolytes, liver function test, and in 75% raised ESR.
Imaging- abdominal ultrasounds . Most useful first line investigation.Can distinguish between solid mass and cystic structure.Kidney , urinary and bladder scan and IVU are limited, being able only to detect large lesions that change the renal contour or compress the ureters. CT scans with contrast or MRI scans are more sensitive and also allow staging.
How to manage kidney cancer ?
Surgical - transabdominal or loin radical nephrectomy is the standard treatment with resection of perinephric fat , Gerota fascia and ipsilateral adrenal gland . Partial nephrectomy, ( nephron sparing) may be appopriate to some patient.
Radiotherapy and chemotherapy - renal cell carcinoma is notoriously resistant to chemotherapeutic agent but radiotherapy may be used for metastatic lesions,
Immunotherapy- interleukin -2 and gamma -interferon have limited response rates ( 15%- 20%)
What is the complication of kidney cancer ?
The complication includes ;
renal cell carcinoma- distant metastases ( 50% affect the lung, 33% affect the bone,) Local invasion ( inferior vena cava obstruction, invasion of perinephric fat ). Local haemorrhage , clot colic. Paraneoplastic syndromes are present in 30%
Transitional cell carcinoma- Obstruction of urinary outflow and hydronephrosis.
What is the prognosis of kidney cancer ?
Depends on type and stage of tumors. Following resection of localised disease, 5 years survival is 70% - 80% with nodal extension and metastases is 30% and less than 10%.
kidney cancer statistics
kidney cancer surgical approach
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