Renal Cell Carcinoma


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Presentation on Renal Cell Carcinoma

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Renal Cell Carcinoma

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