Kidney cancer

Adenocarcinoma of the kidney spreads per continuitatem (into the surrounding structures, angioinvasion - IVC), sometimes by lymphogenous spread (lumbar nodes) and especially by hematogenous spread (lungs, bones, liver). It comes from the cells of the tubules.

Forms of the cancer

 * Light cell - makes up about 70%
 * light cells, thanks to glycogen and lipids
 * light cells, thanks to glycogen and lipids


 * Papillary - 10-15%
 * papillary structure, contains psammoma bodies.
 * papillary structure, contains psammoma bodies.


 * Granular - 8%
 * acidophilic cytoplasm, cellular atypia.


 * Chromophobic - 5%
 * contains clear cells with perinuclear halo + granular cells


 * Sarcomatoid - 1.5%
 * vortex atypical spindle cells.


 * From collecting channels - 0.5%
 * structure with tubular and papillary pattern

Histopathological grading
Histopathological grading of renal adenocarcinoma:
 * GX = degree of the differentiation can not be assessed,
 * G1 = well differentiated,
 * G2 = moderately differentiated,
 * G3-4 = poorly differentiated to undifferentiated.

Clinical manifestations

 * Up to 60% of patients are asymptomatic, the tumor is diagnosed as an accidental finding on sonography or CT,
 * Triad (in an advanced tumor) - macrohematuria, lumbalgia, palpable tumor - in about 6-10% of diagnosed tumors,
 * hematuria,
 * general symptoms: anemia, fatigue, anorexia, cachexia, etc.,
 * pathological fracture and bone pain,
 * symptoms of a tumor thrombus: acute varicocele, lower limb edema, pulmonary embolism.

Diagnostics
When finding an expansive kidney process:
 * excretory urography,
 * US, CT examination with an abdominal and chest contrast (staging),
 * angiography, cavography (injection of the inferior vena cava with a contrast agent - tumor thrombus is being sought, nowadays replaced by MRI).

Treatment

 * 1) Surgical,
 * 2) * radical nephrectomy (preferably transabdominal, laparoscopic and open transperitoneal approach) - including the fat sheath and Gerota's fascia, adrenalectomy in tumors over 5 cm in the upper pole, regional lymphadenectomy is no longer performed (kidney cancer metastasizes mainly by hematogenous spread, non-lymphatic), tumors up to 8–10 cm are operated laparoscopically, without invasion of perirenal structures and tumor thrombus,
 * 3) * conservation operations - resection of a pole (tumor up to 5 cm) or excision of a tumor by lumbotomy or laparoscopy, or ablation methods (RFA, cryoablation). Indications for conservation surgery are: anatomically or functionally solitary kidney, bilateral tumor and hereditary forms of tumors),
 * 4) * advanced carcinoma - resection of solitary metastasis, embolization during massive hematuria, palliative radiation during bone pain,
 * 5) chemo-radiotherapy - the tumor is chemo- and radioresistant, vinblastine has an effect,
 * 6) immunotherapy (IFNα, IL-2) - since the 90s, effect on metastasis treatment, partial remission in 15% of patients (IL-2),
 * 7) biologic therapy (since 2006) - sunitinib, sorafenib, they doubled patient's survival, angiogenesis inhibitors such as bevacizumab.

Tumor thrombus
Kidney cancer grows into the veins:
 * renal vein - nephrectomy,
 * lower vena cava below the level of the diaphragm - cavotomy,
 * lower vena cava above the level of the diaphragm - a two-cavity operation with extracorporeal circulation and assisted by a cardiac surgeon.

Related Articles

 * Clear cell kidney cancer (preparation)
 * Benign kidney tumors