Ptns with RCC can present with varieties of Sms related to the tumour itself (e.g., mass, pain), invasion of the UT (e.g., haematuria), paraneoplastic
KIDNEY CANCER
Clinical manifestation, evaluation, & staging of RCC (renal cell carcinoma).
List of abbreviations:
o RCC: renal cell carcinoma,
o CT: computed tomography.
o MRI: magnetic resonance imaging,
o Sns & Sms: signs & symptoms,
o IVC: Inferior vena cava,
o Ut: urinary tract.
o LL: lower limbs.
o LN: Lymph nodes
o DD: Differential diagnosis.
o MRI: magnetic resonance imaging.
Ptns with RCC can present with varieties of Sms related to the tumour itself (e.g., mass, pain), invasion of the UT (e.g., haematuria), paraneoplastic syndrome, or metastatic extensions. Moreover, RCC is more frequently incidentally diagnosed owing to the wide availability of imaging techniques worldwide for other purposes.
Sms & Sns: For ptns not diagnosed incidentally, Sns & Sms are generally attributed to the invasion of the anatomically related structures or the remote metastases.
1) The classically seen triad of RCC (flank pain, haematuria, and a palpable abdominal kidney mass) mostly observed in 9 % of ptns; if observed, it strongly denotes a locally invasive lesion.
2) Haematuria can be seen only if the tumour invades the collecting system. Study: haematuria was reported in almost 40 % of ptns. If intense, bleeding can induce clots formation with "colicky" discomfort. Clot formation cannot be developed with glomerular bleeding; so, the finding of clots is significant in ptns with unexplained haematuria.
3) Abdominal/loin mass observed with lower pole neoplasms, is mostly palpated in the thin adult. It is firm, homogeneous, not tender, & movable with respiration.
4) Scrotal varicocele mostly left sided, reported in 11 % of males with RCC. Varicocele typically cannot empty when ptn is recumbent. This observation should always raise suspicion of kidney neoplasm obstructing gonadal vein entering the renal vein.
5) IVC: affection > clinical findings: LL oedema, ascites, hepatic malfunction (Budd-Chiari syndrome), as well as pulmonary embolism.
6) Disseminated disease: Sns or Sms related to metastatic spread; most commonly including the lungs, LN, bone, liver, & brain. In this setting, Dgx can be established either via metastasis biopsy (if accessible) or reporting renal mass on CT abdomen.
Ptns with Sms, Sns, or other findings suggesting RCC should proceed into evaluation for the finding of a renal mass. CT abdomen or U/S can confirm mass finding, DD RCC from a benign cyst, and evaluating disease intensity. With the finding of solitary small renal mass, imaging testing cannot reliably DD benign kidney tumour from RCC. So, it is generally advised that lesions other than simple cyst to be surgically resected.
The tumour, node, metastasis (TNM) staging scheme that is based on the extension of the primary lesion and the presence/absence of regional LN affection or remote metastases can be applied for staging purposes for all variants of RCC. This staging system is correlating with ptn prognosis and providing crucial information for ptn therapy. Subjects believed to be at a higher risk for the evolution of RCC should be entitled for routine screening with abdominal US, CT, or MRI testing.
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