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Renal cell carcinoma
- 1. RENAL CELL CARCINOMA SUNIL KUMAR.P1SUNIL KUMAR.P
- 2. SYNONYMS • - Adenocarcinoma • - Hypernephroma • - Grawitz Tumour 2SUNIL KUMAR.P
- 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. 3SUNIL KUMAR.P9
- 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. 4SUNIL KUMAR.P
- 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 5SUNIL KUMAR.P
- 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 6SUNIL KUMAR.P
- 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 7SUNIL KUMAR.P
- 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. 8SUNIL KUMAR.P
- 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 9SUNIL KUMAR.P
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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. 11SUNIL KUMAR.P
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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. 14SUNIL KUMAR.P
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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 . SUNIL KUMAR.P 20
- 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. SUNIL KUMAR.P 21
- 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. SUNIL KUMAR.P 22
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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 SUNIL KUMAR.P 24
- 25. • 3.Granular cell type : 8% • - The tumour cells have abundant acidophilic cytoplasm. • These tumours have more marked nuclear pleomorphisim. SUNIL KUMAR.P 25
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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. 29SUNIL KUMAR.P
- 30. • Rare . • - Often associated with chronic inflammation resulting from stones. • - Metastasize early and the prognosis is poor . • -Radiosensitive 30SUNIL KUMAR.P
- 31. SIGNS AND SYMPTOMS • Classic triad of : Hematuria,, • Flank pain • Abdominal mass 31SUNIL KUMAR.P
- 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 32SUNIL KUMAR.P
- 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 33SUNIL KUMAR.P
- 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 34SUNIL KUMAR.P
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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 38SUNIL KUMAR.P
- 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 39SUNIL KUMAR.P
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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% 41SUNIL KUMAR.P
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