Karcinom ledviny

From WikiLectures

Longitudinal section of the kidney - carcinoma
Histological preparation of chromophobic renal carcinoma

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[edit | edit source]

  • 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

Histopathological grading[edit | edit source]


TNM classification[edit | edit source]

Template loop detected: Template:TNM

Clinical manifestations[edit | edit source]

  • 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[edit | edit source]

  • When an expansive kidney process is found:

Treatment[edit | edit source]

  1. Surgical – nephrectomy,
    • 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,
    • 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),
    • advanced carcinoma - resection of solitary metastasis, in massive hematuria embolization, in bone pain palliative radiation,
  2. chemo-radiotherapy - the tumor is chemo- and radioresistant, the effect is vinblastine,
  3. imunoterapie (IFNα, IL-2) - since the 90s, effect on metastasis treatment, partial remission in 15% of patients (IL-2),
  4. biologic therapy (since 2006) - sunitinib, sorafenib, doubled patient survival, angiogenesis inhibitors bevacizumab.

Tumor thrombus[edit | edit source]

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.

Links[edit | edit source]

Related articles[edit | edit source]

Source[edit | edit source]