Renal adenocarcinoma

Introduction




It's the commonest malignant tumour of the kidney, also known as hypernephroma.
The peak incidence is around the age of 50-70s, male predominance.
The tumour arises from the renal tubules.
Early spread is common in Renal adenocarcinoma :

a) Direct - involving the perinephric tissue, extension into the renal veins, and then the IVC
b) Lymphatic - involving the ipsilateral para-aortic lymph nodes
c) Hematogenous - pelvic bone, vertebras, lungs, etc

Clinical features

1) History suggestive of RCC

Painless hematuria (usually a total hematuria)
General debility (lost of weight, appetite, malaise, weakness)
Bony pain and pathological fractures
Fixed loin pain (pressure over the renal capsule)
Occasionally, a loin mass is felt by the patient

Less common presentations :

a) Pyrexia of unknown origin
b) Varicocele/Bilateral pedal edema



Extension of the tumour involving the left gonadal veins or into the IVC

c) Polycythemia

Excessive production of erythropoeitin from the malignant cells
Facial, skin over palm/soles redness, recurrent venous/arterial thromboses

d) Sudden severe abdominal pain

Haemorrhage into the tumour

e) Hypertension - rare complication

2) On examination

Evidence of recent weight lost
Palpable loin mass, kidney (ballotable), may be tender
Bony tenderness
Evidence of lung metastases

Investigations

Renal ultrasound
CT abdomen, mainly for staging

Treatment

RCC is a radio and chemoresistant tumour, hence the only option is radical nephrectomy, including the perinephric tissue and ipsilateral para-aortic lymph nodes.

Category: Surgery Notes