ADENOCARCINOMA OF THE KIDNEY
Prevention and Etiology
Cigarette smoking is a significant risk factor. Phenacetin-containing analgesics, when abused, also carry a significant risk for renal adenocarcinoma. Similarly, there may be an increased risk for those exposed to asbestos, petroleum products, cadmium and leather workers. Renal cell carcinoma also occurs in about 5% of patients with acquired cystic disease of the kidneys occurring in uremic patients on hemodialysis.
Treatment of Renal Cell Carcinoma Radical nephrectomy is the standard treatment for localized renal cell carcinoma. This approach is done through an abdominal incision to remove the affected kidney with regional lymph nodes and possibly the adrenal gland on that side. Extension of tumor into the veins such as the vena cava demands further dissection.
Surgical alternatives to radical nephrectomy for those with bilateral renal cell carcinoma, which may occur in as many as 3%, or in those that only have one kidney include partial nephrectomy, bench surgery, auto-transplantation and enucleation of multiple lesions. Preoperative renal artery embolization may have a limited role in those with very large tumors in which the renal artery may be difficult to approach early on for a radical nephrectomy. Preoperative irradiation is controversial. Radical nephrectomy may also be a reasonable palliative treatment despite spread of disease in those with significant discomfort and/or debilitation from bleeding and clot colic or paraneoplastic syndromes. Rare spontaneous regression of spread of the disease has been documented following a nephrectomy. In those presenting with a solitary metastasis, resection of the metastasis and a radical nephrectomy may be reasonable as a combined procedure.
METASTATIC RENAL CELL CARCINOMA
A. Radiation therapy
This may provide effective palliation of metastatic disease.
B. Hormonal therapy
Progesterones and other hormones may produce a marginal response.
Renal cell carcinoma is relatively chemotherapy resistant. D. Biological response modifiers. Interferon-alpha and interleukin-II may produce marginal response rates in controlling metastases.