Renal Cell Carcinoma

• see also Wilm's Tumour

Epidemiology

• 3% adult malignancies

• Male 2:1 female

• peak incidence 50-70 years

• increased incidence in smokers

Aetiology

• Tobacco use

• von Hippel Lindau Syndrome

Pathology

• Renal tubules

• cells are large, polygonal, clear cytoplasm (glycogen and lipid accumulation) - "clear cell carcinoma"

Spread

• Locally

• Para-aortic lymph nodes

• Renal vein to inferior vena cava

• Metastasis (rare)

  • lung - "cannonball"

  • liver

  • bone

  • (brain)

Staging

• Stage I

  • confined by renal capsule

• Stage II

  • penetrated capsule but confined by Gerotas fascia

• Stage III

  • renal vein involvement or nodal spread

• Stage IV

  • distant metastasis

Presentation

• classically

  • Haematuria

  • mass

  • flank pain

• para-nephrotic manifestations

  • Polycythaemia

  • Hypertension

  • Hypercalcaemia

• Pyrexia

• Metastases

Investigations

• Imaging

  • USS

  • IVU

  • CT

  • arteriography

• FBC

• CXR

Management

• Nephrectomy

  • metastaes may regress once primary removed

• radiotherapy if local spread

• chemotherapy / immunotherapy if distant metastases

  • a-interferon and interleukin-2

  • sibling bone marrow transplant

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