HJNO Mar/Apr 2022

54 MAR / APR 2022 I  HEALTHCARE JOURNAL OF NEW ORLEANS ONCOLOGY DIAL GUE COLUMN ONCOLOGY RENAL CELL CARCINOMAS (RCC), which originate within the renal cortex, constitute 80 to 85% of primary renal neoplasms. Other parenchymal epithelial tumors, such as on- cocytomas, collecting duct tumors, and re- nal sarcomas, are rare. Nephroblastoma, or Wilms tumor, is common in children (5 to 6% of all primary renal tumors). CLINICAL MANIFESTATIONS Patients with RCC can present with a range of symptoms; unfortunately, many patients are asymptomatic until the disease is ad- vanced. At presentation, approximately 25% of individuals either have distant metastases or advanced locoregional disease. The clas- sic triad of RCC (flank pain, hematuria, and a palpable abdominal renal mass) occurs in at most 9% of patients; when present, it strongly suggests locally advanced disease. evaluation for the presence of a renal mass. Incidental diagnosis of RCC is becoming more common due to the frequent use of abdominal computed tomography (CT) and/ or ultrasonography for evaluation of an unre- lated problem. The usual first test is abdomi- nal CT. Magnetic resonance imaging (MRI) may be useful when ultrasonography and/or CT are inconclusive or if iodinated contrast cannot be administered because of allergy or poor renal function. TISSUE DIAGNOSIS After the presumptive diagnosis has been made based upon imaging studies, the pa- tient must be evaluated for the extent of local involvement and the presence of metastatic disease prior to surgery. For patients with isolated solid renal masses, resection with either a partial or complete nephrectomy is Among patients with disseminated disease, signs or symptoms may be due to metastatic tumor; the most common sites of involve- ment include the lungs, lymph nodes, bone, liver, and brain. Hypercalcemia occurs in up to 15% of patients with advanced RCC. As with other tumors, patients with RCC may suffer from significant cachexia. Hepatic dysfunction is an uncommon occurrence in patients with RCC, which is called Stauffer syndrome when it occurs in the absence of liver metastases. Patients with RCC can present with or sub- sequently develop systemic symptoms or paraneoplastic syndromes. DIAGNOSTIC EVALUATION Patients with unexplained hematuria or other symptoms, signs, or findings sugges- tive of possible RCC must undergo imaging Overview of KIDNEY CANCER