Renal Cell Carcinoma

Presentation on Renal Cell Carcinoma

1. Designed By: FarooqShah

2. WHAT IS RENAL CELL
CARCIMONA (RCC)?
Cancer arising from
the lining of proximal
convoluted tubule.
The most common
type of kidney cancer.
Also known as Renal
Adenocarcinomaor
Grawitz'sTumor.
Most lethal of all the
genitourinary tumors.

3. HOW DO YOU CLASSIFY
RCC?
Clear cell renal cell carcinoma.
Papillary renal cell carcinoma.
Chromophoberenal cell carcinoma.
Collecting duct carcinoma.
Chromophob
e
Clear Cell Papillary

4. EPIDIMOLOGY OF RCC
The incidence of renal cell carcinoma is
rising steadily.
More common in men than women,
male to female ratio is 1.6:1.
Blacks at an higher risk than whites.

5. WHAT LEADS TO RCC?
Cigarette smoking.
Obesity.
Hypertension.
Family history of the disease.
Patients with inherited diseases like von
HippelLindaudisease.
Hysterectomy is associated with
doubled risk.
Dialysis patients with acquired cystic
disease of kidney show greater risk.

6. PATHOLOGY
The gross and microscopic
appearance is highly variable.
May present as reddened
areas where blood vessels
have bled and cysts
containing watery fluids.
Litemicroscopy shows tumor
cells forming cords, papillae,
tubules or nests.
RCC cells may be clear,
granular, mixed clear and
granular or sarcomoidand
spindle.
Most of the tumors are mixed
and they are most
aggressive.

7. SIGNS AND SYMPTOMS
Classic triad of : Hematuria,,
Flank pain
Abdominal mass
Signs may include:
Malaise,weightloss and anorexia
Abnormal urine color
Polycythemia
Anemia
Fracture of hip
Varicocele.enlargementof testicle on left side
Pallor or plethora
Hirsutism
Constipation
Hypertension
Hypercalcemia
Leg and ankle swelling

8. DIAGNOSIS
Physical examination:
Fever
High blood pressure
Lab tests:
Complete blood count
Urinanalysis
Serum calcium
Imaging tests:
Ultrasound abdomen
Abdominal CT scan
MRI scan
PET scan
Renal angiography
Intravenous pyelogram
Chest x ray
Bone scan
Biopsy
Fine needle aspiration
Core needle biopsy

9. STAGING
Based on examination,imagingand biopsy
AJCC (TNM) staging system:
T categories for kidney cancer:
T0: No evidence of primary tumor
T1: The tumor is only in the kidney and is 7cm or less across
T1a: The tumor is 4cm across or smaller
T1b: The tumor is larger than 4cm but not larger than 7cm
T2: The tumor is larger than 7cm across but is still in the kidney
T2a: The tumor is more than 7cm but not more than 10
T2b: The tumor is more than 10cm across
T3: The tumor is growing into a major vein or tissue around the
kidney but not into adrenals or beyond Gerota,sfascia
T3a: The tumor is growing into the main vein or into fatty
tissue around the kidney
T3b: The tumor is growing into the venacavaleading into
the heart
T3c: The tumor has grown into the part of venacavathat is
within the chest or growing into the wall of that blood
vessel
T4: The tumor has spread beyond Gerota,sfascia. It may have
grown into the adrenal gland

10. STAGING (CONTINUED)

11. STAGING (CONTINUED)
N categories for kidney cancer:
N0: No spread to nearby lymph nodes
N1: tumor has spread to nearby lymph
nodes
M categories for kidney cancer:
M0: There is no spread to distant lymph
nodes or other organs
M1: Distant metastasis is present
,distant lymph nodes and to organs like
lungs, bone, brain and liver

12. HOW TO TREAT RCC?
If only in kidneys, it can be cured 90% of the time with
surgery.
If it has spread outside the kidneys into the nodes or the
main vein, it must be treated with cytoreductivesurgery.
RRC is resistant to chemo and radiotherapy in most
cases
May respond to immunotherapy
PARTIAL NEPHRECTOMY:
For treating small renal tumors(< 4cm)
Bilateral renal cell carcinoma
It can be done via laproscopictechniques
RADICAL NEPHRECTOMY:
Surgical removal of kidney along with adrenal gland,
retroperitoneal lymphnodes, perinephricfat and Gerota's
fascia
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.
Medications like tyrosine kinaseinhibitors including
nexavarand rapamycinhave shown to improve the

13. PROGNOSIS
For tumors less than 4cm 5 year survival
rate is 90-95%
For larger tumors confined to kidneys
without venous invasion survival is 80-85%
For tumors that extend through the renal
capsule n local fascia survivability reduces
to near 60%
For metastasis to lymph nodes survival
rate is around 5-15%
For spread to other organs 5 year survival
rate is less than 5%

15. THANK YOU