Renal Cell Carcinoma
95 RENAL CELL CARCINOMA
Brett B. Abernathy M.D.
1. How common is renal cell carcinoma?
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In the United States, 30,000 new cases of renal cell carcinoma are predicted for 2004 and 2005, about 3% of all adult malignancies.
2. How is kidney cancer detected?
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The classic triad of hematuria, flank pain, and an abdominal mass is used; however, this triad is found in only about 10% of cases. About 20% of renal cell carcinomas are associated with a paraneoplastic syndrome. Many solid renal tumors are detected incidentally by a computed tomography (CT) scan of the abdomen performed for another reason.
3. Are all solid masses in the kidney renal cell carcinoma?
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No. Other solid masses include angiomyolipomas, oncocytomas, sarcomas, and metastatic lesions. However, all solid masses should be presumed to be renal cell carcinoma until proven otherwise.
4. What is the unique relationship between renal cell carcinoma and its vasculature?
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Renal cell carcinoma has a tendency to invade its own venous drainage. Tumor thrombus may extend along the renal vein into the inferior vana cava and even to the right atrium.
5. How should suspected involvement of the vena cava be evaluated?
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Magnetic resonance imaging or venacavography.
6. How is renal cell carcinoma treated?
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Surgery is the optimal treatment for localized renal cell carcinoma. The standard operation is a radical nephrectomy, including everything within Gerota’s fascia. Radical nephrectomy can also be performed laparoscopically or with hand-assisted laparoscopic techniques.
7. Does the whole kidney have to be removed in all cases of renal cell carcinoma?
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No. Nephron-sparing surgery can be performed in cases of bilateral renal cell carcinoma or renal cell carcinoma in a solitary kidney. Because of the risk of postoperative tumor recurrence, nephron-sparing surgery in the presence of a normal contralateral kidney is, at best, controversial.
8. How is metastatic renal cell carcinoma treated?
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Chemotherapy has been disappointing. The most encouraging results to date are with interleukin-2 (IL-2) treatment; some evidence of definite durable responses has been noted. Research is ongoing using IL-2 with other forms of immune-enhancing strategies. Some forms of adoptive immunotherapy have been encouraging.
KEY POINTS: RENAL CELL CARCINOMA
1. The classic triad is hematuria, flank pain, and an abdominal mass; however, this traid is found in only 10% of cases.
2. Surgery is the optimal treatment for localized renal cell carcinoma.
3. Stauffer’s syndrome is diagnosed with elevated liver function tests in the presence of renal cell carcinoma that normalize after nephrectomy and tumor removal; it is thought to be a type of paraneoplastic syndrome.
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Abernathy’s Surgical Secrets, Updated Edition (Book w / Student Consult)
Author / s: Harken Alden H., Abernathy Charles, Moore Ernest Eugene
Year: 2004
Pages: 473
Publishers: Elsevier Mosby; 5th Bk & Acc edition
ISBN: 0323034160
