Karcinom ledviny

Adenocarcinoma of the kidney spreads per continuitat (into surrounding structures, angioinvasion - IVC), lymphogenically few (lumbar nodes) and especially hematogenously (lungs, bones, liver). It is based on tubule cells.

Forms of cancer

 * Light cell - makes up about 70%


 * bright cells, thanks to glycogen and lipids


 * Papillary - 10-15%


 * papillary structure, contains psamomatous bodies.


 * Granular - 8%


 * acidophilic cytoplasm, cellular atypia.


 * Chromophobic - 5%


 * contains clear cells with perinuclear halo + granular cells


 * Sarcomid - 1.5%


 * vortex atypical spindle cells.


 * From collecting channels - 0.5%


 * structure with tubular and papillary pattern

Clinical manifestations

 * Up to 60% of patients are asymptomatic, the tumor is diagnosed as an incident (accidental finding on a sonography),
 * trias (in advanced tumor) - macrohematuria, lumbalgia, palpable tumor - in about 6–10% of diagnosed tumors,
 * acute varicocele,
 * renal colic (clot, tumor mass),
 * pathological fracture.

Diagnostics

 * When an expansive kidney process is found:


 * excretory urography,
 * Ultrasound, CT examination with contrast of the abdomen and chest (staging),
 * angiography, cavography (injection of the inferior vena cava with a contrast agent - a tumor thrombus is being sought, now replaced by MRI).

Treatment

 * 1) Surgical – nephrectomy,
 * 2) *nephrectomy (preferably transabdominal approach, laparoscopically and openly transperitoneal) radical - including fat sheath and Gerot's fascia, in tumors over 5 cm in the upper pole in adrenalectomy, regional lymphadenectomy is no longer performed as standard (kidney cancer metastasizes mainly hematogenously, not lymphoscopically), operate on tumors up to 8−10 cm, without invasion of perirenal structures and tumor thrombus,
 * 3) *conservation surgery - resection of the pole (tumor up to 5 cm) or excision of the tumor from lumbotomy or laparoscopically, (indications of conservation surgery: anatomically or functionally solitary kidney, bilateral tumor and hereditary forms of tumors),
 * 4) *advanced carcinoma - resection of solitary metastasis, in massive hematuria embolization, in bone pain palliative radiation,
 * 5) chemo-radiotherapy - the tumor is chemo- and radioresistant, the effect is vinblastine,
 * 6) imunoterapie (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, doubled patient survival, angiogenesis inhibitors bevacizumab.

Tumor thrombus
Kidney cancer grows into the veins:


 * renal vein - nephrectomy,
 * inferior vena cava below the level of the diaphragm - cavotomy,
 * inferior vena cava above the level of the diaphragm - a two-cavity procedure with extracorporeal circulation and assisted by a cardiac surgeon.

Related articles

 * Clear cell renal cell carcinoma (histology slide)
 * Benign kidney tumors