- Renal tumours include renal cell tumours, mesenchymal tumours, and neuroendocrine tumours in both children and adults. Renal cell carcinoma, specifically clear cell RCC, accounts for around 70% of kidney cancers. - Treatment depends on tumour stage and grade. Organ-confined tumours may be managed with active surveillance, partial or radical nephrectomy. Advanced or metastatic disease may receive radiation, immunotherapy, targeted drug therapy or palliative care. - Nephron-sparing surgery aims to preserve renal function when possible for small, low-stage tumours. Complications include bleeding and impaired kidney function.

1. Renal tumours Andrew Potter Registrar Radiation Oncology Royal Adelaide Hospital

3. Renal cell carcinoma (Renal adenocarcinoma)

10. TNM staging Invasion beyond Gerota’s fascia T4 Extends into IVC above diaphragm or wall of IVC T3c Gross extension into renal vein or IVC T3b Direct invasion of adrenal gland, perirenal and/or sinus fat T3a Tumour extends into major veins or adrenal or perinephric tissue but not beyond Gerota’s fascia T3 Tumour >7cm, confined to kidney T2 >4cm but <7cm, confined to kidney T1b ≤ 4cm, confined to kidney T1a Tumour confined to kidney, <7cm T1 No evidence of primary tumour T0 Primary tumour cannot be assessed TX T - primary tumour

11. TNM staging Distant metastases M1 No distant metastases M0 Metastases cannot be assessed MX M - distant metastases Metastases in >1 regional lymph node N2 Metastasis in a single regional lymph node N1 Regional lymph nodes not involved N0 Nodes cannot be assessed NX N - regional lymph nodes

12. Stage groupings M1 Any N Any T M0 N2 Any T M0 N1 T4 M0 N0 T4 IV M0 N1 T2 M0 N1 T1 M0 N0 T3 III M0 N0 T2 II M0 N0 T1 I

27. 3D CT reconstruction

45. Renal pelvis/ureteric carcinoma

50. TNM staging Tumour invades adjacent organs or through kidney into perinephric fat T4 (For ureter only) tumour invades into periureteric fat T3 (For renal pelvis only) tumour invades into peripelvic fat or into renal parenchyma T3 Tumour invades muscularis T2 Tumour invades subepithelian connective tissue T1 Carcinoma in situ Tis Papillary, non-invasive carcinoma Ta No evidence of primary tumour T0 Primary tumour cannot be assessed TX T - primary tumour

51. TNM staging Distant metastases M1 No distant metastases M0 Metastases cannot be assessed MX M - distant metastases Metastases in a single regional lymph node (>2 but ≤5cm max), or multiple nodes (≤5cm max) N2 Metastasis in a single regional lymph node (≤2cm max) N1 Regional lymph nodes not involved N0 Nodes cannot be assessed NX N - regional lymph nodes

52. Stage groupings M0 N0 Ta 0a M0 N0 Tis 0is M1 Any N Any T M0 N1-N3 Any T M0 N0 T4 IV M0 N0 T3 III M0 N0 T2 II M0 N0 T1 I

57. Wilms’ tumour (Nephroblastoma)

66. NWTSG V regimens Rhabdoid tumour of kidney I-IV 24 weeks Carboplatin + VP16 + CPA Yes Clear cell sarcoma of kidney I-IV 24 weeks VCR + CPA + VP16 + ADR Yes Anaplastic II-IV Focal anaplasia II-IV 24 weeks VCR + ActD + ADR Yes Favourable III-IV Anaplastic I 18 weeks VCR + ActD No Favourable I-II Duration Chemo RT Histology Stage

67. NWTSG V radiotherapy # if lung mets on CXR * 10.8Gy/6# flank or 10.5Gy/7# abdomen 12Gy whole lung, Abdo RT 12Gy whole lung, Abdo RT if operative stage II/III 12Gy whole lung # Abdo RT if operative stage III IV 10Gy to flank or abdomen * III 10Gy to flank 10Gy to flank No RT II 10Gy to flank No RT I Clear cell or rhabdoid Anaplastic Favourable histology Stage

86. Outcomes OS OS DFS DFS 81% 95% 86% 96% 81% 90% 85% 93% 69% 65% IV NWTSG V SIOP-9 86% 87% I-III 4 years 72% 70% IV 86% 89% I-III 2 years