RENAL CELL

CARCINOMA
(Hydronephroma=Grawitz’s tumour)

‘ASYURA BINTI MOHD. REZA

 INTRODUCTION
• Adenocarcinoma
• The most common neoplasm of kidneys (75%)
• Arises from renal tubular cells
• Common in men
 PATHOLOGY

1) The cut surface : usually yellowish/dull white, semi-transparent with

areas of hemorrhage.
2) Tumour is often divided into lobules, some are cystic.
3) Larger tumour : irregular in shape with central hemorrhage and necrosis.
 MODE OF SPREAD
• Local spread: renal vein
• Distant spread : bone
• Hematogenous spread : through inferior vena
cava  lungs (Cannonball appearance)
• Lymphatic spread : para aortic lymph nodes
and beyond (only when the tumor breach
Gerato’s fascia)
 CLINICAL FEATURES
• Asymptomatic in the beginning
• Triad of loin pain, loin mass & hematuria (10%) 
indicate advanced disease
• Hematuria : the most common complaint
• Left vericocele when tumour spread to left renal
vein
• Metastases symptoms : bone pain, chronic
cough, hemoptysis
• Atypical symptoms : persistent fever, cachexia,
anaemia, polycythaemia, hypertension, nephrotic
syndrome
STAGING
 INVESTIGATIONS
INITIAL TEST
TEST REASON
Full blood count Anaemia, polycythaemia
Renal profile Assess remaining renal function
ESR Increased in RCC
Serum calcium Hypercalcaemia (Paraneoplastic syndrome)
Coagulation Pre-surgery investigation
profile
Liver function - Impaired in metastases or
test Paraneoplastic syndrome
- ALP increase in bone metastases

Chest x-ray Cannon ball appearance (liver metastases)

TEST TO CONFIRM DIAGNOSIS & STAGING
TEST REASON
Transabdominal ultrasound - To look for origin of mass, cystic/solid
- Sign of metastases in liver and lymph
node enlargement
Contrast CT scan of abdomen - For TNM staging
- Demonstrate the extent of lesion
MRI of abdomen If renal function is impaired in order to
permit contrast
Transesophageal If suspected spread of tumour from IVC
echocardiogram involving right atrium
Excretory urography Able to assess renal function and any filling
defect indicating presence of mass
PET scan Most sensitive but not widely available
 TREATMENT
• RCC responds poorly to radiotherapy or
conventional chemotherapy.
• Immunotherapy of cytokine IL-2 shows some
benefits but still not widely recommended.

Mainstay of treatment : Nephrectomy

Partial/ complete nephrectomy and removal of
ureter and a cuff of bladder
Types of approach:
- loin
- transabdominal
 PROGNOSIS
• 70% of patients : well after 3 years post-
nephrectomy
• 60% of patients : well after 5 years post-
nephrectomy