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Renal Cell Carcinoma

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Presentation on Renal Cell Carcinoma

Presentation on Renal Cell Carcinoma

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  • 1. RENAL CELL CARCINOMA
    Designed By: Farooq Shah
  • 2. 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.
  • 3. 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
  • 4. 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.
  • 5. 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.
  • 6. 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.
  • 7. 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
  • 8. 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
  • 9. 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
  • 10. STAGING (CONTINUED)
  • 11. 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
  • 12. 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.
  • 13. 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%
  • 14.
  • 15. THANK YOU

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