Kidney Carcinoma

Definition
• Tumors derived from renal tubular epithelium
(cortex)
• The type of kidney cancer:
A. Renal Cell Carcinoma (Most Commonly)
B. Transitional cell carcinoma
C. Wilms tumor (nephroblastoma) -> Kids 3
years old
D. Renal sarcoma
 Epidemiology
• Renal cell carcinoma (RCC) represents 2-3% of
all cancers.
• Renal cell carcinoma is the commonest solid
lesion within the kidney and accounts for
approximately 90% of all kidney malignancies.
 Etiology
Risk factors are:
• Genetics
- The Problems with the Von Hippel Lindau tumor
suppressor gene are found in most clear cell RCCs
- The hypoxia-inducible factor (HIF) gene to be
activated when they shouldn’t be, which drives a
cell toward being cancerous.
• Smoking
• Obesity
• Hypertension
 Clinical Manifestation
Early Stadium: Asimptomatik
• Blood in the urine (mostly)
• Pain in the lower back
• A lump in the lower back or side of the waist
• Unexplained weight loss, night sweats, fever,
or fatigue (Paraneoplastic syndromes )
• The classic triad are flank pain, gross
haematuria, and palpable abdominal mass
 Diagnostic
• Physical examinations:
1. Palpable abdominal mass
2. Palpable cervical lymphadenopathy
3. Non-reducing varicocele and bilateral lower
extremity oedema, which suggests venous
involvement.
• Laboratory examination:
1. Serum creatinine,
2. Glomerular filtration rate (GFR)
3. Erythrocyte sedimentation rate
4. LED
5. LDH
• Imaging investigations
- Computed Tomography (CT)
Abdominal CT provides information on:
1. Function and morphology of the contralateral
kidney
2. Primary tumour extension (extrarenal spread)
3. Enlargement of locoregional lymph nodes
4. Condition of the adrenal glands and live
• MRI
Indication doing MRI in patients who are
allergic to intravenous CT contrast medium and
in pregnancy without renal failure.
- Biopsy
A biopsy requires a very small piece of the
kidney to be removed with a needle and then
tested for cancer cells.
Staging
 Treatment
• Surgery is the most common treatment for kidney cancer— most people
with early stage cancer (stages 1, 2, and 3) can be cured with surgery.
1. Partial nephrectomy
Only the tumor or the part of the kidney with the tumor is removed
to leave behind as much of the kidney as possible.
2. Radical nephrectomy
The entire kidney is removed. If needed, the surrounding tissues and
lymph nodes may also be removed.
3. Thermal ablation
Kills the tumor by burning or freezing it. It is most often used for small
tumors in people who are not good candidates for nephrectomy surgery.
4. Active surveillance
It is used if a small tumor is less than 4 centimeters (1 ½ inches). Most
small tumors grow slowly and they may also not be cancerous. You will need
regular monitoring and testing.
https://www.singhealth.com.sg/patient-
care/conditions-treatments/kidney-cancer-
surgery
https://uroweb.org/wp-content/uploads/10-
Renal-Cell-Carcinoma_LR.pdf