Comparison of excretory urography, angiography, ultrasound and computed tomography for T category staging of renal cell carcinoma

Renal cell carcinoma : clinical features and management

In 1999 it was estimated that renal cell carcinoma (RCC) would account for 29,990 new cancer cases diagnosed in the United States (61% in men and 39% in women), and lead to 11,600 deaths. RCC accounts for 2-3% of all malignancies in adults and causes 2.3% of all cancer deaths in the United States annually (1). Approx 4% of all RCC cases are bilateral at some point in the life of the patient. Data from over 10,000 cases of renal cancer entered in the Connecticut Tumor Registry suggests an increase in the incidence of renal cancer from 1935-1989; in women the incidence increased from 0.7 to 4.2 in 100,000, and in men from 1.6 to 9.6 in 100,000 (2). Factors implicated in the development of RCC include cigarette smoking, exposure to petroleum products, obesity, diuretic use, cadmium exposure, and ionizing radiation (3-9).

Continuing education: The emergence of thalidomide in treating advanced renal cell carcinoma

PURPOSE/OBJECTIVES

To review standard and investigational treatments in advanced renal cell carcinoma, with a focus on thalidomide.

DATA SOURCES

Published articles, conference proceedings, treatment guidelines, and textbooks.

DATA SYNTHESIS

The prognosis for advanced renal cell carcinoma when treated with standard regimens is poor; therefore, new treatments are needed.

CONCLUSIONS

Treatment with thalidomide, alone and in combination with other therapies, may improve survival for patients with advanced renal cell carcinoma.

IMPLICATIONS FOR NURSING

Proactive management of adverse effects associated with thalidomide, alone and in combination, may increase patient tolerance and compliance.

Pathologic findings at the time of nephrectomy for renal mass

BACKGROUND

Ultrasound (US) and computed tomography (CT) have improved the diagnosis of solid renal masses. Nevertheless, some patients still undergo exploration for a presumptive diagnosis of renal cell carcinoma (RCC) and are found to have other pathology. We report a contemporary series of non-RCC renal masses (both incidental and symptomatic) among nephrectomies performed for suspected RCC.

MATERIALS AND METHODS

All nephrectomies performed by the Urology Service at the Memorial Sloan-Kettering Cancer Center from July of 1989 through July of 1996 for a parenchymal renal mass were reviewed, and patients without a final diagnosis of RCC were identified. Cases were excluded if RCC was not suspected preoperatively. Presentation, preoperative radiographic evaluation, type of operation, and pathologic features were assessed.

RESULTS

Of the 636 nephrectomies performed, 108 patients (16.9%) had a diagnosis other than RCC.

CONCLUSIONS

Of patients undergoing nephrectomy for renal masses, 16.9% have other pathologic diagnoses. Sixty-six percent of these non-RCC masses are discovered incidentally, and the majority are treated with radical nephrectomy. Preoperative radiographic evaluation reflects both clinical presentation, with IVP used to evaluate symptomatic tumors, and diagnostic uncertainty, with multiple modalities used to evaluate cystic lesions. This information has important implications for preoperative counseling and surgical planning.