Edit Article

Renal cell carcinoma

contributed by Dr Ruslan Esedov on November 7, 2009

System: Urogenital
Tag: kidney

Renal cell carcinoma (RCC) is malignant renal tumour. It is thought to be the 8th most commonest adult malignancy and accounts for 80 - 90 % of primary malignant adult renal neoplasms 4.

Demographics and clinical presentation

Patients are typically 50 - 70 years of age at presentation1-2, with a moderate male predilection of 2:1 2.

Presentation is classically described as the triad of:

  1. macroscopic hematuria : 60%
  2. flank pain : 40%
  3. palpable flank mass : 30 - 40%

This triad is however only found in 10-15% of patients1-2, and increasingly the diagnosis is being made on CT for assessment of haematuria alone or as an incidental finding. There majority of cases are sporadic. 

Paraneoplastic syndomes
Associations and risk factors

In some instances RCCs are associated with 2:

Risk factors include :

  • cigarette smoking 2
  • dialysis-related cystic disease 2
  • obesity

Pathology 

Arises from tubular epithelium. There are four histological sub types 

  • clear cell (conventional) : ≈ 70 %
  • papillary : ≈ 15 % ( commonest type to be bilateral and multi focal)
  • chromophobe : ≈ 5 % ; has best prognosis 5
  • collecting duct (Bellini duct) : ≈ < 1% ; has worst prognosis 5

Staging

Staging see RCC staging (TNM) and Robson staging

Radiographic features

CT

Can have variable appearances including calcific and cystic components. The clear cell sub type may show much stronger enhancement 5.

MRI

Content required. You too can contribute. Just register and click edit.

Treatment and prognosis

When feasible a radical nephrectomy is performed

Prognosis can be variable depending on sub type. The papillary variant carries the best prognosis while clear cell and collecting duct sub types carry the worst.

Content required. You too can contribute. Just register and click edit.

Differential diagnoses