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]
- 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,
- chemo-radiotherapy - the tumor is chemo- and radioresistant, the effect is vinblastine,
- imunoterapie (IFNα, IL-2) - since the 90s, effect on metastasis treatment, partial remission in 15% of patients (IL-2),
- 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.