RENAL CELL CARCINOMA

(ADENOCARCINOMA OF THE KIDNEY)

EPIDEMIOLOGY AND RISK FACTORS
Renal cell carcinomas account for 85% of renal
cancers in adults.
The tumors occur most often in older individuals,
usually in the sixth and seventh decades of life,
and show a 2:1 male preponderance.
TOBACCO is the most significant risk factor.
ADDITIONAL RISK FACTORS:
o Obesity (particularly in women)
o Hypertension
o Unopposed estrogen therapy
o Exposure to asbestos, petroleum products,
and heavy metals
There is also an increased incidence in patients with
chronic renal failure and acquired cystic
disease and in tuberous sclerosis.

CLASSIFICATION
The classification of renal cell carcinoma is based on
correlative cytogenetic, genetic, and histologic studies
of both familial and sporadic tumors. The major types
of tumor are as follows
Clear cell carcinoma is the most common type
(70-80%)
Papillary carcinoma (10-15%)
Chromophobe renal carcinoma (5%)
Collecting duct (Bellini duct) carcinoma (1%)

MORPHOLOGY
Renal cell carcinomas may arise in any portion of the
kidney, but more commonly affects the poles.
Clear cell carcinomas arise most likely from
proximal tubular epithelium, and usually occur as
solitary unilateral lesions.
Papillary tumors, thought to arise from distal
convoluted tubules, can be multifocal and
bilateral.
CLEAR CELL
PAPILLARY
proximal tubular
distal convoluted

epithelium
tubules
solitary
multifocal
unilateral
bilateral
Papillary carcinomas are the most common type
of renal cancer in patients who develop
dialysis-associated cystic disease.
One of the striking characteristics of renal cell
carcinoma is its tendency to invade the renal
vein and grow as a solid column of cells within this
vessel. Further growth may produce a continuous
cord of tumor in the inferior vena cava that may
extend into the right side of the heart.
CLINICAL FEATURES
The three classic diagnostic features of renal cell
carcinoma are costovertebral pain, palpable
mass, and hematuria, but these are seen in only
10% of cases.
o The most reliable of the three is
hematuria.
Renal cell carcinomas produce a number of
paraneoplastic syndromes, ascribed to
abnormal hormone production, including
polycythemia, hypercalcemia, hypertension,
hepatic dysfunction, feminization or
masculinization, Cushing syndrome,
eosinophilia, leukemoid reactions, and
amyloidosis.
One of the common characteristics of this tumor is its
tendency to metastasize widely before giving
rise to any local symptoms or signs.
The most common locations of metastasis:
1. lungs (more than 50%)
2. bones (33%)
3. regional lymph nodes
4. liver
5. adrenal
6. brain
NEPHRECTOMY has been the treatment of
choice, but partial nephrectomy to preserve renal
function is being done with increasing frequency and
similar outcome.