Renal cell carcinoma

1. RENAL CELL CARCINOMA
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2. SYNONYMS
• - Adenocarcinoma
• - Hypernephroma
• - Grawitz Tumour
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3. DEFINITION
• Renal cell carcinoma (RCC) is a kidney cancer
that originates in the lining of the proximal
convoluted tubule, a part of the very small
tubes in the kidney that transport primary
urine.
RCC is the most common
type of kidney cancer in adults, responsible
for approximately 90–95% of cases.
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4. EPIDEMIOLOGY
• The most common neoplasm of the kidney
(75%) or up to 85% .
• - Arises from renal tubular cells .
• - ( 2 – 3 ) % of all adulthood cancers .
• - ( 40 % ) of patients die of cancer .
• - Most common in 6th & 7th decades .
• - Male : Female ratio 2:1
• - Blacks at an higher risk than whites.
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5. ETIOLOGY & PATHOGENESIS
• Various etiological factors implicated in the
aetiology of the RCC are as follows.
• 1.Tobacco
• 2.genetic factors
• 3.Cystic diseases of the kidney
• 4.Other risk factors
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6. TOBACCO
• - Tobacco is the major risk factor for RCC
• - Whether chewed or smoked and accounts
for 20-30% cases of RCC
• - Cigarette smokers have two-fold higher risk
of developing RCC
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7. GENETIC FACTORS
• -Hereditary and first –degree relatives of RCC
are associated with higher risk.
• Although majority of the cases of RCC
sporadic but about 5% cases are inherited.
• These cases have following associations
• 1.Von Hippel Disease (VHL)
• 2.Herediiatry Clear cell RCC
• 3.Chromophobe RCC
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8. CYTIC DISEASE OF THE KIDNEY
• -Both hereditary & Acquired cystic disease of
the kidney have increased risk of development
of RCC.
• Pt’s .. On long term dialysis develop acquired
cystic disease …….. Which may evolve into
RCC.
• Adult PCKD and Multicystic Nephroma is
associated with higher occurrence of papillary
RCC.
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9. OTHER RISK FACTORS
• Besides above, following other factors are
associated with higher incidence of RCC…..
• 1.Exposure to asbestos, heavy metals,
petrochemical products.
• 2.In women, obesity, & oestrogen therapy
• 3.Analgesic nephropathy
• 4.Tuberous sclerosis
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11. CLASSIFICATION
• Based on Cytogenetics of sporadic and familial
tumour , RCC has been Classified in to ..
• 1.Clear cell renal cell carcinoma.
• 2.Papillary renal cell carcinoma.
• 3.Chromophobe renal cell carcinoma.
• 4.Sarcomatoid type renal cell carcinoma
• 5.Collecting duct carcinoma.
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14. Renal cell carcinoma arising in the middle pole of the kidney. Fairly
circumscribed, The cut surface
demonstrates a yellowish areas, white areas, brown areas, and hemorrhagic
red areas.
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20. GROSS FINDINGS
• RCC commonly arises from the poles of the
kidney as a solitary and unilateral tumour,
more often in the upper pole.
• The tumour is generally large, golden yellow
and circumscribed.
• Papillary tumours have grossly visible papillae
and may be multifocal.
• About 1% RCC are bilateral .
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21. • C/S – of the tumour commonly shows large
areas of ischemic necrosis, cystic change and
foci of haemorrhages.
• Another significant characteristic is the
frequent presence of tumour thrombus in the
renal vein ………. Which may extend to
venacava.
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22. MICROSCOPY FINDINGS
• 1. Clear Cell Type (RCC) – 70 %
• - This is the most common pattern
• - The clear cytoplasm of tumor is due to
removal of glycogen and lipid from the
cytoplasm during the processing of the tissue .
• - The tumour cells have a variety of patterns ;
solid, trabecular and tubular, separated by
delicate vasculature.
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24. • 2. Papillary type RCC : 15%
• - The tumour cells are arranged in papillary
pattern over the fibro vascular stalks.
• The tumour cells are cuboidal with small
round nuclei
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25. • 3.Granular cell type : 8%
• - The tumour cells have abundant acidophilic
cytoplasm.
• These tumours have more marked nuclear
pleomorphisim.
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29. • Occur anywhere in the urinary tract, but they
are most common in the bladder.
• Smoking, exposure to analine or azo dyes, and
napthylamine exposure are known to be
associated with urothelial cancers.
• Urothelial tumors often are multicentric .
• These patients need careful follow-up.
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30. • Rare .
• - Often associated with chronic inflammation
resulting from stones.
• - Metastasize early and the prognosis is poor .
• -Radiosensitive
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31. SIGNS AND SYMPTOMS
• Classic triad of : Hematuria,,
• Flank pain
• Abdominal mass
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32. Signs may include:
• Malaise,weight loss and anorexia
• Abnormal urine color
• Polycythemia
• Anemia
• Fracture of hip
• Varicocele.enlargement of testicle on left side
• Pallor or plethora
• Hirsutism
• Constipation
• Hypertension
• Hypercalcemia
• Leg and ankle swelling
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33. DIAGNOSIS
• Physical examination:
• Fever
• High blood pressure
• Lab tests:
• Complete blood count
• Urineanalysis
• 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
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34. STAGING
• Based on examination, imaging and 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
• T2: The tumor is larger than 7cm across but is still in the
kidney
• T3: The tumor is growing into a major vein or tissue around
the kidney but not into adrenals or beyond Gerota,s fascia
• T4: The tumor has spread beyond Gerota,s fascia. It may
have grown into the adrenal gland
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35. TNM STAGING
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37. STAGING
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38. TREATMENT
• 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 cytoreductive surgery.
• 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 laproscopic techniques
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39. • RADICAL NEPHRECTOMY:
• Surgical removal of kidney along with adrenal
gland, retroperitoneal lymphnodes,
perinephric fat an 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 kinase inhibitors
including
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41. 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%
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43. SUMMARY
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