WHAT IS RENAL CELL CARCIMONA (RCC)? Cancer arising from the lining of proximal convoluted tubule. The most common type of kidney cancer. Also known as Renal Adenocarcinoma or Grawitz's Tumor. Most lethal of all the genitourinary tumors.
HOW DO YOU CLASSIFY RCC? Clear cell renal cell carcinoma. Papillary renal cell carcinoma. Chromophobe renal cell carcinoma. Collecting duct carcinoma. Chromophobe Clear Cell Papillary
EPIDIMOLOGY OF RCC The incidence of renal cell carcinoma is rising steadily. More common in men than women, male to female ratio is 1.6:1. Blacks at an higher risk than whites.
WHAT LEADS TO RCC? Cigarette smoking. Obesity. Hypertension. Family history of the disease. Patients with inherited diseases like von HippelLindau disease. Hysterectomy is associated with doubled risk. Dialysis patients with acquired cystic disease of kidney show greater risk.
PATHOLOGY The gross and microscopic appearance is highly variable. May present as reddened areas where blood vessels have bled and cysts containing watery fluids. Lite microscopy shows tumor cells forming cords, papillae, tubules or nests. RCC cells may be clear, granular, mixed clear and granular or sarcomoid and spindle. Most of the tumors are mixed and they are most aggressive.
SIGNS AND SYMPTOMS Classic triad of : Hematuria,, Flank pain Abdominal mass Signs may include: Malaise,weight loss and anorexia Abnormal urine color Polycythemia Anemia Fracture of hip Varicocele.enlargement of testicle on left side Pallor or plethora Hirsutism Constipation Hypertension Hypercalcemia Leg and ankle swelling
DIAGNOSIS Physical examination: Fever High blood pressure Lab tests: Complete blood count Urinanalysis Serum calcium Imaging tests: Ultrasound abdomen Abdominal CT scan MRI scan PET scan Renal angiography Intravenous pyelogram Chest x ray Bone scan Biopsy Fine needle aspiration Core needle biopsy
STAGING Based on examination,imaging and biopsy AJCC (TNM) staging system: T categories for kidney cancer: T0: No evidence of primary tumor T1: The tumor is only in the kidney and is 7cm or less across T1a: The tumor is 4cm across or smaller T1b: The tumor is larger than 4cm but not larger than 7cm T2: The tumor is larger than 7cm across but is still in the kidney T2a: The tumor is more than 7cm but not more than 10 T2b: The tumor is more than 10cm across T3: The tumor is growing into a major vein or tissue around the kidney but not into adrenals or beyond Gerota,s fascia T3a: The tumor is growing into the main vein or into fatty tissue around the kidney T3b: The tumor is growing into the venacava leading into the heart T3c: The tumor has grown into the part of venacava that is within the chest or growing into the wall of that blood vessel T4: The tumor has spread beyond Gerota,s fascia. It may have grown into the adrenal gland
STAGING (CONTINUED) N categories for kidney cancer: N0: No spread to nearby lymph nodes N1: tumor has spread to nearby lymph nodes M categories for kidney cancer: M0: There is no spread to distant lymph nodes or other organs M1: Distant metastasis is present ,distant lymph nodes and to organs like lungs, bone, brain and liver
HOW TO TREAT RCC? If only in kidneys, it can be cured 90% of the time with surgery. If it has spread outside the kidneys into the nodes or the main vein, it must be treated with cytoreductive surgery. RRC is resistant to chemo and radiotherapy in most cases May respond to immunotherapy PARTIAL NEPHRECTOMY: For treating small renal tumors(< 4cm) Bilateral renal cell carcinoma It can be done via laproscopic techniques RADICAL NEPHRECTOMY: Surgical removal of kidney along with adrenal gland, retroperitoneal lymphnodes, perinephric fat and Gerota's fascia In cases where the tumor has spread into the renal vein, IVC and right atrium, this portion of tumor can be surgically removed as well. Medications like tyrosine kinase inhibitors including nexavar and rapamycin have shown to improve the prognosis for advanced RCC.
PROGNOSIS For tumors less than 4cm 5 year survival rate is 90-95% For larger tumors confined to kidneys without venous invasion survival is 80-85% For tumors that extend through the renal capsule n local fascia survivability reduces to near 60% For metastasis to lymph nodes survival rate is around 5-15% For spread to other organs 5 year survival rate is less than 5%