Tumor Ginjal & Aspek Radiologisnya Word

Tumor Ginjal dan Aspek Radiologisnya Veny (406100115)
PENDAHULUAN
Insidens tumor ginjal menempati urutan ketiga dari tumor saluran kemih
setelah tumor kandung kemih dan prostat. Tumor ginjal merupakan tumor ginjal
sekunder di mana tumor primernya sering berasal dari tumor paru (20 %), tumor
payudara (12 %), tumor lambung (11 %) ataupun dari ginjal sisi lain (9 %) seperti
dilaporkan oleh kinner dkk.
elain dari tumor ganas ginjal metastasis, tumor ganas ginjal primer yang
sering ditemukan pada orang de!asa adalah karsinoma sel ginjal (Renal Cell
Carsinoma). edangkan pada anak, tumor ginjal ganas yang banyak dijumpai adalah
ne"roblastoma ( tumor #ilm$s).
%anyak "aktor yang diduga menjadi penyebab timbulnya tumor
ginjal.&erokok merupakan salah satu "aktor resiko yang menyebabkan tumor
ginjal.emakin lama merokok dan semakin muda seseorang mulai merokok,maka
semakin besar kemungkinan menderita tumor ginjal.
'rekuensi tumor ginjal jinak lebih tinggi daripada tumor ganas. Tumor jinak
jarang menimbulkan gejala klinik dan biasanya ditemukan se(ara kebetulan pada
bedah mayat. Tumor ganas sangat jahat, tidak hanya karena si"atnya yang ganas,
melainkan pula karena sering sukar untuk menegakkan diagnosis pada tingkat dini.
Tumor ganas ginjal yang sering adalah karsinoma sel ginjal, diikuti menurut
"rekuensinya oleh tumor #ilms dan tumor primer kalikses dan pel)is.
*roblem terbesar ahli bedah adalah menentukan apakah suatu tumor ginjal itu
berupa kista atau tumor ganas, karena hal ini penting artinya dalam menentukan
ren(ana pengobatan selanjutnya. %ila kelainan tersebut berupa kista, tindakan
pembedahan jarang dilakukan ke(uali apabila terdapat gejala+gejala yang serius.
,pabila berupa tumor ganas, tindakan pembedahan penting untuk men(egah
penyebaran tumor selanjutnya.
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"eriode #$!epem%er&'0(ko%er #010
-mumnya pada kasus+kasus tumor ginjal pemeriksaan radiologis yang
dilakukan adalah pemeriksaan plain )oo a%domen (%./), *nra Venous "yelogra)i
(I.0.*.) dan kadang+kadang dilakukan tomogram untuk menganalisa kelainan+
kelainan yang lebih lanjut.
Tetapi dengan melakukan pemeriksaan+pemeriksaan di atas kadang+kadang
belum dapat menemukan tanda+tanda klasik yang khas dari tumor ginjal se(ara
radiologis. -ntuk ini memerlukan suatu pemeriksaan radiologis yang lain yaitu
pemeriksaan arteriogra"i.
1hynn 2 3)ans (1940) mengemukakan bah!a kemampuan dan ketelitian
diagnosis untuk membedakan kista dan tumor ganas se(ara arteriogra"i adalah 95 %,
apalagi bila dilakukan tomogram pada "ase ne"rogram.
elain menganalisa penyakit+penyakit yang disebabkan oleh kelainan a.
renalis (reno)as(uler disease), arteriogra"i juga dapat menyokong, menganalisa, dan
mempelajari penyakit+penyakit parenkim ginjal.
esuai dengan perkembangan ilmu kedokteran maka belum lama ini juga
telah dikembangkan penatalaksanaan immunoterapi yang meliputi terapi yang berupa
alpha inter"eron dan interleukin+2 yang berman"aat untuk men(egah metastasis tumor
ganas ginjal.
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EMBRIOLOGI DAN ANATOMI GINJAL
*ada manusia terbentuk tiga sistem ginjal yang berbeda, agak saling tumpang
tindih, dengan urutan dari kranial ke kaudal selama kehidupan dalam kandungan,
yaitu6 prone"ros, mesone"ros, dan metane"ros. 7ang pertama rudimenter dan tidak
ber"ungsi6 yang kedua mungkin ber"ungsi dalam !aktu yang pendek dalam masa
janin a!al6 yang ketiga membentuk ginjal tetap.
&etane"ros atau ginjal tetap tampak pada minggu ke lima. atuan+satuan
ekskresinya berkembang dari mesoderm metane"ros dengan (ara yang sama seperti
pada sistem metane"ros. ,kan tetapi perkembangan sistem salurannya, berbeda dari
sistem ginjal lainnya.
istem *engumpul
%erkembang dari tunas ureter, suatu tonjol saluran mesone"ros di dekat
muaranya ke kloaka. Tunas ureter ini menembus jaringan metane"ros, yang menutup
ujung distalnya sebagai topi. elanjutnya tunas ini melebar membentuk piala ginjal
(pel)is renalis) primiti", dan terbagi menjadi bagian kranial dan kaudal, yang kelak
akan menjadi kalikes mayores. 8i bagian tepi terbentuk lebih banyak saluran hingga
akhir bulan ke lima. aluran generasi ke dua membesar dan menyerap masuk saluran
generasi ke tiga dan ke empat, sehingga terbentuklah kalikes minor piala ginjal. *ada
perkembangan selanjutnya, saluran pengumpul generasi ke lima dan seterusnya
sangat mamanjang dan menyebar dari kaliks minor membentuk piramida ginjal.
8engan demikian tunas ureter membentuk ureter, piala ginjal, kalikes mayor dan
minor dan kurang lebih 1+9 juta saluran pengumpul.
istem 3kskresi
Tiap+tiap saluran yang baru terbentuk, dibagian ujungnya ditutupi oleh topi
jaringan metane"rik. el topi jaringan ini membentuk gelembung ke(il yaitu )esikel
renalis yang selanjutnya akan membentuk saluran+saluran ke(il dengan berkas+berkas
kapiler yang dikenal sebagai glomeruli, membentuk ne"ron atau satuan ekskresi.
-jung proksimal masing+masing ne"ron membentuk simpai bou!man, yang di
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dalamnya berisi glomerulus. *emanjangan saluran ekskresi yang berlangsung terus
mengakibatkan pembentukkan tubulus kontortus proksimal, ansa henle, dan tubulus
kontortus distal. /leh karena itu, ginjal berkembang dari dua sumber yang berbeda :
(a) mesoderm metane"ros, yang membentuk saluran ekskresi dan (b) tunas ureter,
yang membentuk sistem pengumpul.
truktur ;injal
&emiliki kapsula "ibrosa sendiri dan dikelilingi oleh lemak perine"rik, dilapisi
oleh "asia renalis. *anjang tiap ginjal sekitar 10+12(m dan terdiri dari korteks di luar,
medulla di dalam, serta pel)is.
<ilus ginjal terletak di medial dan dari depan ke belakang merupakan tempat
le!at : ). =enalis, a. renalis, pel)is ureter, dan pembuluh lim"e, serta ner)us
)asomotor simpatis.
*el)is renalis terbagi menjadi dua atau tiga kalises mayor yang terbagi lagi
atas kalises minor yang menerima urin dari piramid medulla melalui papila.
*osisi ginjal terletak di retroperitoneum menempel ke dinding posterior
abdomen. 8inding kanan tingginya sekitar 1 (m diatas ginjal kiri.
*asokan darah : a. =enalis berasal dari aorta setinggi >2. bersama+sama, a.
=enalis mengarahkan 25% (urah jantung ke ginjal. Tiap a. renalis terbagi menjadi
lima aa. egmental pada hilus, yang pada gilirannya terbagi se(ara sekuensial
menjadi (abang+(abang lobaris, interlobaris, arkuata dan kortikal radial. ,. renalis
dekstra le!at di belakang I01. 0. =enalis sinistra panjang karena le!at di depan
aorta dan mengalir menuju I01. 8rainase lim"atik menuju ?;% paraaorta.
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KLASIFIKASI TUMOR GINJAL & RENAL PELVIS
Tumor ginjal terdiri dari 2 kelompok :
1. 7ang berasal dari korte@ (paren(hym), yang disebut : (orti(al tumor.
2. 7ang berasal dari renal pel)is dan (aly(es.
,. 1orti(al (paren(hymal) renal tumor
I. %enign (orti(al tumor
1. 3pithelial tumor (renal (el tumor 6 tumor yang berasal dari renal tubules)
adenoma :
*apillary tipe ((yst+adenoma)
,l)eolar type
Tubular type
2. &esen(hymal tumor (tumor jaringan ikat 6 tumor yang berasal dari
jaringan ikat pada renal (orte@A(apsul)
'ibroma
&yoma
>ipoma
&i@ed mesen(hymal tumors hamartoma (angiomyolipoma).
II. &alignant (orti(al (paren(hymal) tumor
1. 3pithelial tomur (renal (ell tumor 6 tumor yang berasal dari renal tubulus
yang mature).
,denokarsinoma (B(lear (ell (a6 granular (ell (a6 ;ra!itC$s
tumor6 hypernephroma).
2. &esen(hymal tumor (tumor jaringan ikat)
ar(oma
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9. 3mbryonal tumor (berasal dari embryoni( renal blastema)
#ilm$s tumor (Bembryional adeno (a6 mesoblasti( nephroma6
malignant nephroma).
D. Tumor yang menyerang (orte@ se(ara sekunder.
%. Tumor pel)is ginjal
I. %enign : non epithelial
II. &alignant :
1. 3pithelial tumor :
Transisional (ell epithelioma
Transisional (ell (ar(inoma
Euamous (ell epithelioma
Euamous (ell (ar(inoma
2. ,deno(ar(inoma (mu(inous adeno(ar(inoma)
9. Tumor se(under
D. .on epithelial mesen(hymal tumor6 sar(oma.
Tanda+tanda klasik dari tumor ginjal se(ara radiologis adalah :
1. &assa yang luas pada daerah ginjal dengan atau tanpa "ungsi ekskresi yang
menurun.
2. %entuk ginjal yang abnormal (ginjal melebar dan irreguler).
9. pa(e+o((upaying lesion pada parenkim ginjal.
D. ?alsi"ikasi pada parenkim.
5. >etak pel)iokali(es abnormal atau terdorong.
4. ?aliks memanjang dengan bentuk yang aneh.
F. *enyempitan atau (omplete obliterasi dari kaliks.
G. 8e"ormitas atau obstruksi dari uretropel)ik jun(tion.
9. *yele(tasis.
10. %entuk yang aneh dan irreguler dari pel)is.
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TUMOR JINAK GINJAL
Tumor jinak ginjal pada umumnya tidak memberikan keluhan yang spesi"ik
dan tidak jarang kasus ini tanpa keluhan. 8iagnosis tumor ditegakan setelah melihat
sediaan ginjal pasien yang telah dilakukan ne"rektomi karena alasan tertentu, dengan
demikian insidens yang pasti tumor ini tidak diketahui. 8iagnosis mungkin ditegakan
setelah pemeriksaan -ltrasonogra"i atau 1T (an massa tumor yang terlihat,
ditindaklanjuti dengan biopsi jarum halus.
Adenoma Ginjal
,denoma korteksAtubuler merupakan tumor ginjal yang paling banyak
ditemukan. %iasanya hanya ke(il, dan tidak menimbulkan gejala klinik. Tumor ini
adalah tumor sel glandular di daerah korteks ginjal, terdi"erensiasi se(ara baik dan
sukar dibedakan se(ara klinis dan histopatologis dari karsinoma sel ginjal stadium
a!al. %anyak klinisi menganggap bah!a tumor ini dapat berubah menjadi ganas dan
perlu dipantau se(ara teratur.
&akroskopik tampak sebagai suatu tonjolan pada korteks ber!arna kuning
kelabu, berbatas jelas dan seolah+olah bersimpai. ,da yang berpendapat bah!a
adenoma solid yang bergaris tengah lebih dari 9 (m sebaiknya dianggap ganas.
*endapat itu sering tidak benar. &ikroskopik tampak berbagai )arian. ?adang+
kadang terjadi generasi pada adenoma, terutama yang berjenis papiler, dengan atau
tanpa pembentukan kista. el+selnya berbentuk kuboid sampai poligonal, teratur dan
tidak menunjukan anaplasi. %atas+batas sel jelas dengan inti yang bulat, ke(il dan
terletak sentral.
itoplasma mengandung banyak granula, )akuol sebagian atau seluruhnya.
#alaupun makroskopik tampak berbatas jelas, namun pada pemeriksaan
mikroskopik tidak ditemukan simpai yang jelas.
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?adang+kadang, terutama pada adenoma papiler yang kistik ditemukan pula
perkapuran setempat. 8alam kalangan radiolog hal tersebut disebut dengan tumor
"+AR,-A../
Hama!oma Ginjal
,tau dikenal sebagai angiomiolipoma yaitu tumor jinak ginjal yang jarang
dijumpai namun mempunyai beberapa petunjuk atau tanda khusus. <amartoma ini
merupakan tumor jinak yang tumbuh perlahan+lahan dalam atau sekitar ginjal dan
didapatkan pada D5+G0 % kasus+kasus u%erous s0lerosis (penyaki 1ourne2ille3
epiloid). ,nehnya adalah jika didapatkan bersama u%erous s0lerosis3 hamartoma ini
biasanya bilateral dan asimtomatik.
?asus pertama dilaporkan terjadi pada tahun 19F5 oleh ?a)aney dan
'ielding. 8ari tiga puluh kasus, tujuh belas kasus pasien dilaporkan dengan
tubersklerosis dan empat belas pasien tidak dengan tubersklerosis.
E"idemiolo#i
Insidens tumor jenis ini terjadi pada 0,9 %+9 % dari seluruh tumor ginjal. -sia
rata+rata pada pertengahan usia D1 tahun. *erbandingan pada kelamin laki+laki dan
!anita adalah 1:2
.
Pa!olo#i dan Jeni$ Ti"e An#iomioli"oma
&engenai asal tumor ini belum ada kesepakatan pendapat. ,da sebagian
pendapat yang mengatakan bah!a tumor ini timbul akibat mutasi genetik yang
di!ariskan.
e(ara histologis, tumor ini mengandung unsur )askuler dan otot serta sel+sel
lemak. 8i anggap jinak !alaupun metastasenya ke kelenjar lim"e regional. *ada
pemeriksaaan patologi biasanya ditemukan komponen sel lemak, otot polos, dan
pembuluh darah. ?adang ditemukan juga pada lokasi ekstrarenal karena pertumbuhan
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yang multisentrik. Tumor sendiri berbentuk bundar atau o)al, tidak mempunyai
kapsul, dapat mendorong kapsul ginjal ke arah luar.
8ua tipe ,ngiomiolipoma yang dapat dideskripsikan adalah:
Isolated ,ngiomiolipoma
,ngiomiolipoma asso(iated dengan tubersklerosis
I$ola!ed An#iomioli"oma
Harang terjadi, timbul se(ara terpisah dan dilaporkan angka kejadiannya G0 %
dari tumor ginjal.
Terjadi pada usia sekitar 2F tahun+F2 tahun
8itemukan empat kali lebih banyak pada !anita dari pada pria.
ering ditemukan terjadi pada ginjal sebelah kanan dari pada ginjal sebelah
kiri.
An#iomioli"oma a$$o%ia!ed den#an !&'e$(leo$i$
8ilaporkan angka kejadiannya sekitar F0 % dari tumor ginjal ini.
Terjadi pada usia sekitar 1+1F tahun.
>esinya lebih besar dari pada isolated angiomiolipoma dan sering terjadi
bilateral serta multipel.
ering terjadi pada !anita muda dengan limpangiomiomatosis tanpa kelainan
stigmata lain dari tubersklerosis.
Gam'aan Klini$
;ejala+gejala yang dapat ditemukan adalah nyeri, adanya suatu massa pada
daerah ginjal (abdomen), hematuria, dan perdarahan retroperitoneal. .yeri yang
dirasakan oleh pasien dikarenakan terdapat tumor ke(il di pembuluh darah, yang
menghasilkan benjolan yang banyak di atas kulit. ,ngiomiolipoma kebanyakan
timbul tanpa gejala dan ditemukan se(ara tidak sengaja. %iasanya pada saat
pemeriksaan radiologi atau pada saat biopsi.
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;ambaran klinis :
40 % angiomiolipoma asimptomatik atau tidak menunjukkan gejala
G2 % pasien dengan ukuran tumor D (mAlebih
<anya 29 % dari pasien dengan tumor yang berukuran I D (m
*erkembangan terakhir dan muktahir dari -; abdomen, 1t (an dan &=I
meningkatkan pendekteksian kasus yang asimptomatik.
Dia#no$i$
8iagnostik ditentukan dengan ditemukannya massa pada ginjal yang pada
pyelogra"i intra)ena terlihat sebagai massa yang mendesak pada sistem pielum dan
kaliks. *ada pemeriksaan ultrasonogra"i dapat terlihat massa padat pada ginjal.
8engan arteriogra"i sulit membedakan tumor ini dengan tumor ganas karena
keduanya memberikan bayangan hiper)askularisasi. 8iagnosis juga dapat ditegakkan
dengan 1T+(an dan pemeriksaan biopsi aspirasi jarum halus. .e"rotomogram
memperlihatkan lesi tersebut padat atau kistik.
Radiolo#i$
)*Ra+
,ngiomiolipoma dengan ukuran yang sedang kemungkinan dapat dinilai
dengan plain abdominal radiogra"i atau intra)enous urogram. ,pabila
planatonogra"ik images diperoleh sebelum masuknya kontras ke intra)ena dan jika
kuantitas dari lemak lebih mendominasi pada tumor tersebut gambaran radiolusen
makin jelas.
uatu angiomyolipoma multiple yang besar, pada pasien dengan
tuberosklerosis pada pemeriksaan dengan intra)enous urogram dapat dilihat distorsi
dari renal (olle(ting system. 8imana tidak dapat dibedakan dengan penyakit ginjal
polikistik. Teknik ini tidak (ukup sensiti" untuk memperlihatkan lemak dan tumor.
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,T S%an
Tanda dari angiomyolipoma pada pemeriksaan 1T (an menampilkan
gambaran lemak. .ilai dari negati)e attenuation 15 (lima belas) <u sampai dengan
100 (seratus) <u. %iasanya kelihatan jaringan adiposa neoplasma mungkin
mempunyai )ariasi, (ampuran lemak dan otot, tetapi jarang yang solid. ?alsi"ikasi
jarang terlihat pada tumor. 1T (an memiliki keakuratan yang tinggi dalam
karekteristiknya dan mendiagnosis lesi.
MRI
8engan pemeriksaan &=I, ,ngiomyolipoma dapat lebih memperlihatkan
karakteristik yang jelas, karena adanya gambaran dari lemak diantara tumor
(khususnya setelah selesai menggunakan teknik "at+suppression). .amun &=I bukan
saran pemeriksaan spesi"ik yang mengutungkan. Imaging pada potongan(oronal dan
sagital, dapat memperlihatkan gambaran asal mula lesi tumor yaitu dari (orte@ ginjal,
lebih baik daripada batasan peritoneum karena liposar(oma dapat menggantikan
ginjal tapi jarang menyerang parenkim ginjal. >esi yang berisi lemak berhubungan
dengan (orte@ sub(apsular. ekarang ini karena adanya perluasan (omputed
tomography dapat menjadi pilihan untuk mendeteksi lemak dalam tumor ginjal.
USG
8engan pemeriksaan -;, ,ngiomyolipoma merupakan tumor ginjal yang
sangat e(hogeni( dan dapat menyebabkan timbulnya bayangan akustik tumor (orti(al
yang bulat atau o)al, karena angiomyolipoma mempunyai intensitas yang e(hogeni(,
tumor dengan diameter yang ke(ilpun dapat terindenti"ikasi. ,rea dengan sedikit
e(hogeni( di dalam tumor dihubungkan dengan adanya suatu perdarahan atau
pelebaran dari (ali@+(ali@ ginjal. *engurangan e(hogeni( dari angiomyolipoma,
pikirkan untuk menghubungkan ke komponen yang ke(il dan komponen otot yang
lebih menonjol. 8opple -; dapat digunakan untuk mendeteksi komplikasi dari
pembuluh )ena ginjal. Tanda e(hogeni( pada suatu massa di ginjal tidak patognomi(
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untuk suatu tumor angiomyolipoma, termasuk juga (arsinoma (ell ginjal, dapat juga
hypere(hoi(.
An#io#a"-+
95 % dari angiomyolipoma hiper)as(ular, dengan pembesaran interlobar dan
arteri interlobar. ,rteri intra tumor iregular dan an(urisma. 0ena pooling dan
memberi gambaran onion peel appearan(e. %iasanya tidak ada shuting arteri )ena.
unburst appearan(e pada (appitlary nephrogram. /nion skin appearan(e pada
pembuluh darah peri"er.
Pena!ala($anaan
Tumor dengan ukuran kurang dari D (m yang biasanya tanpa keluhan tidak
memerlukan tindakan operasi namun perlu dipantau. Hika dibiarkan dan tidak diterapi
akan berakibat menjadi ganas apabila tumbuh dan terus membesar. Tumor yang telah
menjadi ganas akan bermetastase ke paru+paru. -ntuk alasan inilah penemuan dan
identi"ikasi dari tumor jinak ginjal ini penting se(ara dini ditemukan. Hika ukuran
tumor lebih dari D (m dan terdapat keluhan, pengobatan yang bisa dilakukan dapat
berupa embolisasi pada (abang arteri renalis atau dilakukan ne"rektomi parsial.
8engan kemajuan dibidang (ross se(tional amaging, diagnostik dapat
ditegakkan tanpa harus melakukan pembedahan. kebanyakan tumor dapat
dikendalikan se(ara konser)ati", terutama yang asimptomatik.
*ada kasus yang akut dan hebat di mana metode konser)ati" gagal, radikal
ne"rektomi mungkin merupakan satu+satunya (ara. *arsial ne"rektomi dapat menjadi
pilihan yang ideal untuk massa dengan diameter yang lebih ke(il yaitu kurang dari 9
(m dan memungkinkan juga untuk massa tumor yang berdiameter lebih ke(il dari 5
(m. &ungkin juga lebih baik untuk melepaskan atau menghilangkan massa yang sulit
ditentukan batasnya. 3mbolisasi arteri ginjal dapat digunakan untuk mengontrol atau
mengendalikan perdarahan.
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Po#no$i$
*ada kasus yang jarang, suatu maligna dapat menjadi suatu (arsinoma. ?asus
yang bukan maligna dapat berkembang menjadi gagal ginjal dan perdarahan yang
masi" se(ara progresi".
Dia#no$i$ Di..een$ial
=enal (ell (arsinoma
Teratoma
/n(o(ytoma
Janthogranulomatous pyelonephritis
#ilm$s tumor
=enal lipoma
=enal dan reboperitoreal iposar(oma.
On(o$i!oma Ginjal
&erupakan tumor yang berasal dari onkositA sel epitel besar dengan granula
halus dalam sitoplasmanya dengan si"at sitoplasma eosino"ilik. /nkositoma dapat
terjadi pada berbagai tempat, seperti pada kelenjar ludah, tiroid, dsb. /nkositoma
terdapat pada 9+5 % kasus+kasus dengan tumor ginjal.
Tumor ini mempunyai kapsul yang baik sekali dan jarang sekali tumor ini
mengadakan penetrasi ke kapsul tumor itu. <al ini berbeda sekali dari karsinoma sel
ginjal dengan pseudokapsul yang hampir selalu mengalami penetrsi tumor. Tumor
biasanya soliter dan umumnya mengenai ginjal unilateral.
e(ara histologis tumor dibagi dalam beberapa stadium:
tadium I : el+sel sama tersusun beraturan dengan inti bundar dan dalam
sitoplasmanya dan granular eosino"ilik.
tadium II : Terdiri dari sel+sel dengan inti yang tak sama besar, bentuk dan
susunannya.
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tadium III: el dengan inti yang tak beraturan dan atipik dan di sana+sini terdapat
sel yang dalam keadaan mitosis.
8iagnosa onkositoma tergolong sukar karena tidak terdapat keluhan atau
gejala yang spesi"ik untuk tumor ini. Tidak juga terdapat gambaran yang khas pada
pemeriksaan pielogra"i intra)ena, ultrasonogra"i maupun 1T s(anning. %eberapa
laporan menunjukkan bah!a onkositoma dihubungkan dengan beberapa penyakit
keganasan lain seperti mieloma multipel dan tumor paru. ?elemahan tentang
diagnostik tumor ini masih sering terjadi !alau telah dilakukan aspirasi biopsi dengan
jarum halus. &engingat gambaran mitosis pada tumor stadium tiga, orang melakukan
ne"rektomi radikal sebagai tindakan terapi pada onkositoma ini.
Leiom+oma
Tonjolan ke(il subkapsuler dan mungkin berasal dari jaringan otot polos
simpai.
Fi'oma
Tampak sebagai tonjolan putih ke(il (0,9+1 (m) pada medula.
Heman#ioma
Harang ditemukan. 8apat menyebabkan hematuria sedang atau keras.
%iasanya jenis ka)ernosum.
;ambaran roentgen minimal. Tumor ini dapat mengadakan impresi ringan
pada in"undibulum dari kaliks, meregang susunan tersebut, seolah+olah
memperlihatkan penyakit polikistik.
R! Royal Taruma
TUMOR GANAS GINJAL
TUMOR /ILM0S 1NEPHROBLASTOMA2
La!a Bela(an#
8apat disebut juga adenomyosar0oma3 em%ryoma3 0ar0inosar0oma3
em%rional mi6ed umor. Tumor #ilm$s jarang ditemukan pada !aktu lahir atau
bulan+bulan pertama kelahiran. Tendensi spesial timbul pada pasien tipe non "amiliai
atau ani0idia kongenital, jarangpada pasien dengan hemihipertro"i atau sindrom
1e0k7i8&9iedeman.
Telah dilaporkan ada hubungan dengan ginjal tapak kuda dan penyakit ginjal
kistik dan dengan pasien pseudoherma"rodit dan ne"ritis progresi" (sindrom 8rosh).
Tumor ini berasal dari kongenital yang timbul dalam parenkim ginjal, mungkin dari
sisa+sisa blastoma ne"rogen dan biasanya dari "okus tunggal, kadang+kadang lebih
dari satu area. Tumor #ilm$s biasanya dikelilingi oleh jaringan pseudokapsul yang
memisahkannya dari kompresi parenkim ginjal normal.
<istologi tampak tidak uni"orm. Tumor terdiri atas sel+sel poligonal,
seringkali tersusun dalam bentuk pseudotubular dan pseudoglomerular. Tumor ganas,
anaplasi sel+sel, "okal atau di"us tipe sel sarkoma dan rabdoid tumor #ilm$s
hemoragi, nekrosis, dan kalsi"ikasi (mikroskopik). ;ambaran khas histologisnya
adalah glomerulus yang primiti" atau aborti" dengan ruang bo!man yang terbentuk
kurang baik dan tubulus yang aborti", seluruhnya terkurung dalam stroma sel spindel.
8iagnostik histologis terletak pada pengenalan tubulus primiti" dalam stroma sel
spindel dan serabut otot bergaris adalah bukti yang sangat menunjang.
.e"roblastoma dapat menembus kapsula renalis dan menyebar ke kelenjar
retroperitoneal dan jaringan sekitarnya (anak ginjal, hepar, dan dia"ragma). 8apat
pula menyebar melalui )ena renalis ke )ena (a)a in"erior dan atrium kanan. 8alam
ginjal menyebar ke pel)is renalis dan jarang ke ureter dan buli+buli. &etastasis jauh
R! Royal Taruma
adalah ke paru+paru, hati, otak dan organ lain. 8iagnostik ditegakkan dengan
Intra)ena pielogra"i, ultrasonogra"i, dan (omputed tomogra"i.
Tumor #ilm$s adalah tumor ganas ginjal yang sering dijumpai pada anak+
anak dengan usia rata+rata (median) 2 tahun 11 bulan, terdapat pula pada orang
de!asa muda atau de!asa, dan "rekuensinya sama untuk kedua jenis kelamin. Tumor
ini diduga merupakan kelainan ba!aan mengingat adanya (ampuran unsur+unsur
embrional,dan dapat dijumpai bersamaan dengan kelainan kongenital lainnya. Tumor
ini besar dan mengandung banyak daerah nekrosis dan perdarahan. <al ini jelas
tampak pada 0ompued omograp8y dan ultrasonogra"i. Tidak ada gambaran spesi"ik
pada lesi ini. -ntuk membedakannya dengan hiperne"roma, berbeda dengan apa yang
didapat pada anak, maka pada orang de!asa tumor ini berbatas tegas dan seringkali
meluas ke retroperitoneum. Compued omograp8y atau ultrasonogra"i memegang
peranan penting dalam menentukan tumor ginjal.
Gam'aan (lini$
*enderita biasanya datang dengan keluhan berkenaan dengan besarnya tumor
yang luar biasa. %iasanya sudah dapat teraba massa abdomen, yang dapat meluas
mele!ati garis tengah dan turun ke pel)is. 7ang jarang, penderita datang dengan
demam (10+20 %) dan nyeri abdomen (20+90 %) dengan hematuri, atau kadang+
kadang dengan obstruksi abdomen akibat tekanan tumor. edangkan kurang na"su
makan, mual, dan muntah pada 15 % penderita. <ipertensi dapat dijumpai pada 40
% penderita. Tanda+tanda sekunder karena penekanan tumor yang besar seperti udem
kaki dan )ari(o(ele juga dapat dijumpai.
La'oa!oi&m
*ada pemeriksaan urine dapat dijumpai adanya hematuri. ,nemia dapat
ditemukan khususnya bila terjadi perdarahan ke dalam tumor.
R! Royal Taruma
*emeriksaan kadar )anilmandeli( a(id (0&,) dilakukan untuk membedakan
dengan neuroblastoma, dimana kadar 0&, normalpada tumor #ilm$s dan
meningkat pada neuroblastoma.
Radiolo#i
Fo!o Polo$ A'domen
8apat dijumpai adanya massa tumor jaringan lunak dan pendesakan organ+
organ abdomen lainnya oleh massa tumor ini. ?alsi"ikasi dapat ditemukan pada
sekitar 10 % kasus, biasanya berupa titik+titik atau (in(in.
Ul!a$ono#a.i
*en(itraan ginjal dapat dilakukan dengan ultrasonogra"i yang dapat
menemukan tumor padat pada ginjal, yang pada anak kemungkinan paling besar
tumor #ilm$s.
Pielo#a.i in!a3ena
. &enunjukan perubahan bayangan ginjal dan gambaran pel)iokaliks dan
sekaligus memberi kesan mengenai "aal ginjal, juga dapat ditemuka tanda khas yaitu
pendesakan (olle(ting system ke arah kranial oleh massa intrarenal. *emeriksaan ini
juga dapat menilai "ungsi ginjal kontralateral
,T S%an
8apat memberi gambaran pembesaran ginjal dan sekaligus menunjukan
pembesaran kelenjar regional atau in"iltrasi tumor ke jaringan sekitarnya.
Fo!o Toa($
?arena tingginya insidens metastasis ke paru+paru maka pemeriksaan ini
!ajib dilakukan pada penderita ini.
Pemei($aan Pen&njan# Lain
*emeriksaan &=I tidak menambah banyak keterangan untuk jenis tumor ini.
%iopsi jarum yang hanya dibenarkan apabila tumor sangat besar sehingga
diperkirakan akan sukar untuk mengangkat seluruh tumor. *ungsi dilakukan sekedar
Kepanieraan Radiologi 1$
R! Royal Taruma
untuk mendapatkan sediaan patologik untuk kepastian diagnostik dan menentukan
radiasi atau terapi sitostatik prabedah untuk menge(ilkan tumor.
Pena!ala($anaan
Tujuan pengobatan tumor #ilm$s ialah mengusahakan penyembuhan dengan
kemungkinan komplikasi dan morbiditas serendah mungkin. 8engan terapi
kombinasi (pembedahan, radioterapi, dan kemoterapi) dapat diharapkan hasil yang
memuaskan.
*engobatan pilihan untuk tumor #ilm$s adalah ne"rektomi dan deseksi
kelenjar lim"e bersama dengan kapsul ;erota yang intak. *emberian radioterapi
biasanya dilakukan pada stadium yang lanjut.
Po#no$i$
'aktor yang mempengaruhi harapan hidup pada penyakit ini adalah jenis
histologi, keterlibatan kelenjar lim"e dan stadium.
*ada umumnya baik dengan kombinasi radioterapi, ne"rektomi, dan
kemoterapi, hasil yang diperoleh baik. ,ngka kelangsungan hidup dua tahun setinggi
90 % dan kelangsungan hidup dua tahun biasanya berarti kesembuhan. <asil ini luar
biasa karena banyak penderita dengan metastasis di paru, ditemukan pada saat
diagnosis, menghilang dengan pengobatan teurapeutik.
Dia#no$!i( Bandin#
<idrone"rosis, kista ginjal dan neuroblastoma intrarenal. *ada neuroblastoma,
yang juga biasanya ditemukan pada anak, tidak terlihat kelainan bentuk pielum dan
kaliks pada pielogram intra)ena, dan kadar katekolamin meninggi. arkoma ginjal
sangat jarang ditemukan.
<idrone"rosis dan kista ginjal biasanya dapat dengan mudah dibedakan
dengan ultrasonogra"i atau 1T (an, sedangkan lesi neuroblastoma biasanya
menyebrang garis tengah dan (olle(ting system biasanya akan terdesak ke arah
kaudal (dengan melakukan pemeriksaan kadar 0&, dan pielogra"i intra)ena).
R! Royal Taruma
Ka$inoma Sel Ginjal
La!a Bela(an#
8ilaporkan pertama kali oleh ;ra!itC pada tahun 1GG9 sehingga dikenal juga
dengan nama tumor ;ra!itC. ?arsinoma sel ginjal sering juga disebut hiperne"roma,
karsinoma al)eolar dan 0lear 0ell 0arsinoma/ <al ini terjadi akibat perbedaan
pendapat para peneliti yentang kelainan histogenesis yang mendasari penyakit ini.
?ontro)ersi pendapat tentang asal tumor ini berakhir setelah peneliti /berling dengan
menggunakan mikroskop elektron mendapatkan bah!a karsinoma berasal dari sel
tubulus proksimal. /leh karena tumor ganas ini berasal dari sel+sel epitel tubulus
proksimal, maka nama yang tepat adalah renal 0ell 0arsinoma atau adeno0arsinoma
ginjal.
;ejala klinis tumor ini sangat ber)ariasi mulai dari keadaan ringan seperti
hematuri asimtomatik sampai keadaan klinis berat terutama setelah ada metastasis ke
paru dan tulang.dalam hal ini dapat terjadi keluhan metastasis lebih dominan sedang
tumor ginjalnya sendiri hanya memberikan keluhan subyekti" yang ringan.
?arsinoma sel ginjal yang ke(il tetapi sudah menimbulkan metastasis jauh pada
beberapa alat tubuh pasien (paru dan tulang) menyebabkan orang kadang+kadang
menyebut tumor ini sebagai inernis umor/ 8ari kasus+kasus yang datang dengan
sesak na"as serta hemoptisis atau dengan nyeri dan destruksi tulang karena metastasis
tumor, ternyata 90 % tumor asalnya adalah karsinoma sel ginjal.
E"idemiolo#i
&enurut 3&&3T hypernephroma merupakan G5 % dari semua renal tumor.
8i negara maju seperti ,merika erikat laporan kesehatan menunjukan terdapat
sekitar 90.000 kasus baru pada tahun 1994 dan diperkirakan pada tahun 2000 jumlah
ini meningkat mendekati angka 100.000 orang. 8i 8enmark jumlah kasus ini lebih
ke(il tapi menetap sekitar 500 orang setiap tahunnya dan merupakan tumor ganas
R! Royal Taruma
yang ke sembilan dari semua keganasan. 8ata nasional penyakit ini belum tersedia,
namun diperkirakan (ukup banyak pasien yang terkena tumor ini.
-sia yang paling sering terkena tumor ini adalah antara 50 dan 40 tahun,
namun dapat ditemui pada usia kurang dari D0 tahun. &erupakan 9% dari tumor
ganas pada orang de!asa, insidens pada lelaki dua atau tiga kali lebih sering dijumpai
dari pada perempuan. Tidak terdapat perbedaan insidens antara pasien kulit hitam dan
pasien kulit putih.
#alau jarang terjadi, karsinoma sel ginjal dapat mengenai kedua ginjal.
>okasi lesi pertama tumor dapat terjadi di pool ba!ah ginjal. Tumor mungkin dapat
mulai di daerah korteks ginjal ataupun pada bagian medula.
Pa!olo#i dan Pa!o#ene$i$
*enampakan makroskopik biasanya ber!arna kekuningan atau ber!arna orange
karena mengandung jaringan lemak di daerah korteks sehingga menonjol di
permukaan ginjal. -kuran tumor bisa ke(il, tetapi bisa juga mengisi seluruh rongga
retroperitoneal. *otongan permukaan pada tumor yang lebih ke(il tampak homogen,
sedang tumor yang lebih besar biasanya disertai kista sekunder di dalamnya dengan
perdarahan dan daerah nekrosis serta sekali+sekali ditemukan adanya kalsi"ikasi di
daerah peri"er. e(ara histopatologi karsinoma sel ginjal ini dapat digolongkan
kepada bentuk 0lear 0ell ype (25 %), granular ype (25 %), sar0omaoid 0ell ype (2
%). %entuk yang paling sering di jumpai adalah bentuk mi6ed ype (DG %)
Tumor dari daerah korteks (enderung untuk meluas ke daerah jaringan di sekitar
ginjal. Tumor sendiri mempunyai pseudo kapsul yang terdiri dari jaringan parenkim
yang tertekan serta jaringan "ibrous dan sel+sel in"lamasi. In"iltrasi tumor ke arah luar
menimbulkan tonjolanAbulging atau massa yang dapat dipakai sebagai tanda
diagnostik pada pemeriksaan -; atau CT !0anning.
?eluhan klinis tumor turut ditentukan oleh besarnya tumor dan in)asi terhadap
jaringan sekitar seperti kelenjar getah bening serta in)asi ke dalam pembuluh darah
Kepanieraan Radiologi #0
R! Royal Taruma
terutama ke dalam )ena renalis dan pada gilirannya memberikan keluhan dan gejala
metastasis tumor tersebu
E!iolo#i dan Fa(!o Ri$i(o
*enyebab pasti dari tumor ganas ini belum diketahui, !alaupun se(ara
eksperimen dilaporkan adanya hubungan dengan (y(asin, a"lato@in, antibiotika, Cat+
Cat kimia (timah dan (admium), radiasi dan )irus. %aru+baru ini juga dilaporkan
bah!a pada penderita+penderita dengan hemodialise kronis dijumpai adanya kista
ginjal dan kadang+kadang terdapat tumor ganas ginjal. .amun demikan hubungan
yang pasti belumlah diketahui.
*endapat lain mengatakan ada peranan "aktor genetik. <al ini diperkuat oleh
kenyataan bah!a insidensi karsinoma sel ginjal meningkat pada pasien dengan kista
ginjal dan kelompok keluarga dengan ri!ayat penyakit tumor ginjal. 'aktor risiko
lain yang juga berpengaruh yaitu lingkungan pekerjaan, kejadian tumor ini lebih
tinggi pada kelompok pekerja tukang sepatu, tukang (at, pekerja yang terpajan bahan
kimia. *eningkatan insidensi tumor ginjal juga terjadi pada kelompok sosioekonomi
kurang, kegemukan, peminum kopi jangka lama, penggunaan diuretik kronis. *eran
"aktor+"aktor risiko di atas disimpulkan dari studi retrospekti" jumlah besar dari
pasien+pasien yang meninggal karena karsinoma ginjal.
Gam'aan Klini$
%iasanya sepertiga kasus tanpa tanda+tanda gejala klinis. Tanda dan gejala
tumor ;ra!itC dapat ber)ariasi. Trias klasik, yaitu hematuria makroskopik, nyeri
pinggang, dan massa di daerah ginjal. ?etiga gejala ini didapatkan pada 10+15 %
pasien. ?alau ditemukan massa di daerah ginjal biasanya tumor sudah lanjut. <al ini
juga berarti ramalan tentang hasil pengobatan tidak begitu baik. <ematuria
merupakan tanda yang paling sering ditemukan (40 %) tidak selalu tanpa rasa nyeri.
.yeri timbul karena peregangan simpai ginjal, adanya bekuan darah yang turun
melalui ureter yang menimbulkan kolik ureter. &assa di daerah ginjal merupakan
R! Royal Taruma
keluhan kedua setelah hematuria. ?arsinoma sel ginjal adalah tumor yang
memberikan ma(am+ma(am mani"estasi klinis sehingga tidak mudah untuk
mendeteksi tumor ini pada "ase a!al.
,nemia dan tanda metastasis jauh di paru, seperti batuk dan nyeri pada
metastasis tulang, ditemukan pada penyakit yang sudah lanjut. Tidak jarang gejala
atau tanda metastasis tulang merupakan mani"estasi pertama.
%iasanya ditemukan gejala dan tanda sistemik berupa kelemahan, malaise
umum, anoreksia, dan berat badan menurun. 8emam tidak jarang didapat. ?adang
dijumpai neuromiopati berupa nyeri otot. ?adang ditemukan tanda sindrom
paraneoplastik, seperti eritrositosis, hiperkalsemia, hipertensi dan kelainan hati tanpa
tanda metastasis tapi disertai gangguan "ungsi hati. ;angguan "aal hati sebagai bagian
dari gambaran karsinoma ini dapat membaik setelah dilakukan ne"rektomi dan
dikenal sindroma tau""er$s. elain dari kelainan di atas bisa mun(ul klinis penting
yang mungkin dapat terjadi dalam bentuk sindrom 1ushing, hipoglikemia, dan
ginekomasti.
?elainan laboratoris yang menyertai penyakit ini dapat berupa anemia
normositer karena terjadi sebagai akibat perdarahan akut, hematuria dan peningkatan
ke(epatan sedimentasi eritrosit. ?elainan tulang yang sering merupakan metastasis
tumor diikuti oleh hiperkalsemia yang terjadi akibat peningkatan hormon paratiroid
ataupun sebagai lesi osteolitik yang merupakan bagian dari kegiatan metastasis itu
sendiri.
=esiko untuk bermetastasis ditentukan oleh ukuran dan penyebaran dari tumor
primernya. %erikut di ba!ah ini tabel mengenai hal tersebut:
T&mo Me!a$!a$i$
-kuran I F (m I 5 %
-kuran K F (m 25 %
&enyebar sampai di luar ginjal K 50 %
&engenai nodus lim"atikus F0+90 %
A$"e( Radiolo#i
Kepanieraan Radiologi ##
R! Royal Taruma
Fo!o "olo$ A'domen dan P+elo#a.i In!a3ena
*emeriksaan radiologi pertama adalah "oto polos abdomen, di mana dapat
dijumpai adanya pembesaran bayangan ginjal yang homogen dengan kalsi"ikasi linier
atau terlokalisir pada bagian ginjal tertentu. elanjutnya, pada pemeriksaan pyelogra"i
intra)ena dapat ditemukan adanya perubahan bentuk pada (olle(ting sistem yang
merupakan tanda utama adanya tumor dalam ginjal. ,pabila ginjal yang terkena tidak
ber"ungsi pada pemeriksaan ini, perlu dilakukan pemeriksaan retrograd pyelogra"i
untuk melihat perubahan bentuk tersebut.
?etepatan dengan (ara "oto polos abdomen dan pyelogra"i intra)ena hanya
sekitar F5 % dan karena itu masih diperlukan pemeriksaan kon"irmasi lainnya.
Ul!a$ono#a.i
,pabila terdapat keraguan antara kista ginjal dan tumor padat ginjal, maka
pemeriksaan yang tersederhana dan murah adalah pemeriksaan ini.
%ersi"at non in)asi", tidak terlalu mahal dan hampir tidak mempunyai dampak
sampingan. -ltrasonogra"i dapat juga digunakan sebagai penuntun dalam melakukan
biopsi aspirasi memakai jarum halus. ;ambaran radiologis petanda karsinoma sel
ginjal adalah didapatkannya massa tanpa internal e(ho kista sederhana dengan
transmisi homogen dan adanya gambaran dinding di bagian posterior.
?etepatan diagnosis dengan (ara ultrasonogra"i (-;) (ukup tinggi dan
dilaporkan kira+kira 95 %.
,T S%an
-ntuk tambahan ketepatan dalam membedakan antara kista dengan tumor
padat, dapat dilakukan pemeriksaan 1T (an. .ilai tambahan dari pemeriksaan ini
adalah ketepatan dalam melakukan staging. *emeriksaan ini dapat juga dilakukan
untuk melihat adanya sisa tumor setelah pembedahan atau adanya rekurensi tumor
pas(a bedah.
Kepanieraan Radiologi #'
R! Royal Taruma
?etepatan diagnosisnya akan lebih tinggi lagi jika 1T (an dikerjakan
bersamaan dengan media kontras. #alau lebih mahal biayanya tindakan diagnostik
ini bersi"at non in)asi". 8ugaan karsinoma sel ginjal ditandai oleh massa hipoekoik
yang lebih jelas dari jaringan ginjal sekitarnya.
?etepatan diagnostik dengan melakukan (ara 1T (an dilaporkan dapat
men(apai sekitar 9G %.
An#io#a.i Ginjal
&erupakan suatu tindakan diagnostik tergolong in)asi" dan mempunyai
banyak komplikasi seperti perdarahan, timbulnya emboli, terjadi aneurisma pada
tempat suntikan. ?omplikasi yang lebih berat timbul apabila menderita alergi
terhadap bahan kontras.
,danya tumor pada pemeriksaan ini ditunjukkan oleh adanya neo)askularisasi
dan "istula arterio)enosa. 8engan arteriogra"i ginjal dapat diketahui adanya in)asi
tumor ke arah )ena ka)a dan )ena renalis. #alau agak mahal dan mempunyai
beberapa risiko, pemeriksaan ini masih dipertahankan pada pasien yang mempunyai
hanya satu ginjal (setelah ne"rektomi atau satu ginjal atro"i) sebagai pedoman untuk
pengobatan atau tindakan ne"rektomi parsial.
*ada arteriogra"i tampak :
8alam "ase arteriogram :
+ a. renalis biasanya melebar dan (abang+(abangnya terdorong oleh desakan
tumor.
+ Terdapat mio)askularisasi yang tipis seperti bentuk tidak teratur, berbelok+
belok, kaliber yang berbeda+beda.
+ ?adang+kadang terjadi anastomosis dan membentuk ,0 "istula sehingga
terjadi aneurisma+aneurisma ke(il dalam
"ase nephrogram :
R! Royal Taruma
+ 8ensitas kontras meninggi karena pembentukan pembuluh darah yang
berlebihan.
+ ?adang+kadang densitas sangat berkurang karena terjadi "ibrosis tumor atau
trombosis )ena yang memperdarahi tumor tersebut.
Pemei($aan Radionuclide Imaging
*emeriksaan ini menjadi penting untuk pasien yang alergi terhadap bahan
kontras sehingga tidak dapat dilakukan pyelogra"i intra)ena atan 1T (an memakai
bahan kontras.
alah satu keuntungan yang dapat diperoleh adalah dapat dibuat diagnosis
metastasis jarak jauh seperti metastasis ke tulang, paru, dan otak. %iaya pemeriksaan
relati" mahal, namun diperlukan dalam upaya penatalaksanaan pasien. 8i samping
ne"rektomi mungkin diperlukan obat+obat seperti inter"eron dan interleukin untuk
menekan metastasis.
S!adi&m Ka$inoma Sel Ginjal
ebagai patokan, di pakai (ara stadium yang dianjurkan oleh -I11 yaitu:
T1 : Tumor berukuran L 2,5 (m, masih terbatas dalam ginjal.
T2 : Tumor berukuran K 2,5 (m, masih terbatas dalam ginjal.
T9 : Tumor sudah tumbuh ke luar dari kapsul ginjal atau mengenai )ena renalis
tetapi masih belum menembus kapsul ;erota.
TD : Tumor sudah tumbuh keluar dari kapsul ;erota.
Pena!ala($anaan
8alam penatalaksanaan karsinoma sel ginjal dapat dilakukan tindakan operati"
dan pemberian terapi medikamentosa se(ara sistemik. <asil pengobatan dan jenis
tindakan yang akan dilaksanakan tergantung pada stadium tumor serta ada atau
tidaknya metastasis jauh.
R! Royal Taruma
*engobatan pilihan untuk tumor yang belum menunjukan tanda+tanda
metastasis adalah radikal ne"rektomi yaitu pengangkatan en %lok ginjal beserta
tumornya dan kapsul gerota se(ara intak. Tindakan ini dapat dilakukan melalui
sayatan torakoabdominal atau transabdominal, dan sebelum melakukan pengangkatan
ginjal, didahului dengan kontrol terhadap pembuluh (arteriA)ena) ginjal. *ada
pembedahan ini, dapat sekaligus dilakukan pengangkatan kelenjar suprarenal dan
kelenjar getah bening, tetapi perlu atau tidaknya kedua hal ini dilakukan masih
diperdebatkan.
,pabila sudah ada metastasis maka pengobatan yang dianjurkan adalah
ne"rektomi dengan harapan akan memperpanjang harapan hidup, mengurangi lesi
metastasis, meninggikan e"ekti"itas pengobatan tambahan lainnya, mengurangi
keluhan setempat dan mengurangi pengaruh keji!aan terhadap adanya keganasan.
.amun demikian, karena angka mortalitas operasi pada tumor yang sudah ada
metastasis relati" tinggi, maka operasi ini hanya dianjurkan bila harapan hidup
diperkirakan akan lebih dari 4 bulan. Tindakan lainnya adalah embolisasi arteri
renalis, sedangkan radioterapi dapat diberikan sebagai pengobatan paliati" untuk
keluhan sakit akibat metastasis ke tulang.
*emeriksaan pada )ollo7 up meliputi pemeriksaan "isik untuk mendeteksi
adanya rekurensi setempat, pembesaran kelenjar lim"e abdominal dan tanda+tanda
metastasis lainnya. >aboratorium darah dilakukan untuk menilai "ungsi hepar dan
ginjal. *emeriksaan "oto toraks diperlukan untuk melihat ada tidaknya metastasis ke
paru+paru.
%elum lama ini juga telah dikembangkan penatalaksanaan immunoterapi yang
meliputi terapi dengan antibody, )aksin (a yang berupa alpha inter"eron dan
interleukin+2. ?edua tipe imunoterapi tersebut berman"aat dan sangat responsi" untuk
mengatasi penyebaran dari metastasis tumor ganas ginjal tipe Renal 0ell 0arsinoma/
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Po#no$i$
%anyak "aktor yang mempengaruhi prognosa pada penyakit ini seperti:
keadaan klinis, usia pasien, stadium perkembangan, derajat penyebaran, derajat
keganasan, derajat histologi dan ukuran tumor, laju endap darah, kelamin penderita
dan "asilitas pengobatan yang tersedia.
?arsinoma sel ginjal yang masih terlokalisasi dan tidak memperlihatkan
tanda+tanda metastasis, dengan ne"rektomi radikal jika diikuti pemberian inter"eron
diperkirakan memberikan hasil yang lebih baik. ?endala ysng ditemukan sehari+hari
terjadi adalah bah!a pasien datang dalam stadium lanjut dan telah ada metastasis
jauh. %anyak pasien yang dira!at kurang mampu membeli obat mahal, termasuk
inter"eron sebagai obat anti kanker di masa depan.
e(ara umum persentase harapan hidup lima tahun adalah F9 % untuk
stadium 1, D0 % untuk stadium 2, 2D % untuk stadium 9 dan G % untuk stadium D.
Dia#no$i$ 'andin#
<idrone"rosis, tuberkulosis ginjal dan ginjal polikistik atau setiap pembesaran
ginjalAadanya massa dalam ginjal yang disebabkan oleh tumor jinak. <al ini biasanya
dapat dibedakan dengan pemeriksaan -;, arteriogra"i dan 1T (an
Kepanieraan Radiologi #$
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T&mo Pel3i$ Ginjal
&erupakan 5+10 % dari pada tumor ginjal primer. %iasanya lebih
(epatmenimbulkan gejala klinik, karena letaknya pada pel)is. 'ragmentasi tumor
dapat menyebabkan hematuria. ering pula menyebabkan obstruksi pada saluran
kemih, sehingga menimbulkan hidrone"rosis. In"iltrasi ke dinding pel)is dan kalises
sering ditemukan. 8emikian pula )ena renalis sering terkena,karena itu !alaupun
ke(il dan kelihatannya jinak, prognosisnya kurang baik.
%erbagai tumor yang dapat ditemukan pada pel)is ginjal sama dengan tumor
kandung kemih.
Sa(oma
arkoma ginjal sangat jarang ditemukan.
T&mo Me!a$!a$i$ 1T&mo Se(&nde2
?arena )olume peredaran darah sangat besar, tidak mengherankan bah!apada
ginjal sering ditemukan metastasis, baik dari karsinoma maupun sarkoma.juga ada
ke(enderungan yang khas dari pada suatu tumor ginjal ganas untuk bermetastasis ke
ginjal yang lain.
&engenai mekanismepenyebrangan belum ada keterangan yang
jelas.dianggap bah!a hal itu dapat terjadi melalui aliran lim"atik kekelenjar paraaorta
dan lalu retrograd menyebrang ke ginjal yang berhadapan.
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RESUME
?eganasan ginjal merupakan kejadian tersering ketiga yang dijumpai dalam
bidang urologi. *enyakit ini pada umumnya tidak menimbulkan keluhan atau gejala
sehingga sering didiagnosa pada stadium lanjut.
ebagai (ontoh, tumor ganas ginjal umumnya tidak menimbulkan keluhan
atau gejala sampai dirabanya massa tumor baik oleh penderita sendiri atau oleh
dokter pemeriksa. &assa tumor ini dapat dikelirukan dengan kista ginjal,
hidrone"rosis, atau bahkan pembesaran lim"e.
Tumor ganas ginjal yang sering adalah karsinoma sel ginjal, diikuti menurut
"rekuensinya oleh tumor #ilms dan tumor primer kalikses dan pel)is.
*emeriksaan radiologis merupakan (ara pemeriksaan sekaligus (ara e)aluasi,
yang memegang peranan penting di samping pemeriksaan laboratorium, dan
pemeriksaan klinis lainnya.
*emeriksaan radiologis yang bisa dilakukan adalah sebagai berikut:
'oto polos abdomen
'oto toraks
-ltrasonogra"i (-;)
Intra)ena *yelogra"i (I0*)
&=I
1T (an
,ngiogra"i, dsb.
*enatalaksanaan berupa pengobatan atau kombinasi pengobatan yang sesuai
dengan kemajuan jaman dan kemajuan sistem kesehatan masyarakat dalam bidang
kedokteran serta pembedahan dapat mengatasi penyakit ini pada hampir semua.
%elum lama ini juga telah dikembangkan penatalaksanaan immunoterapi yang
meliputi terapi dengan antibody, )aksin (a yang berupa alpha inter"eron dan
interleukin+2. ?edua tipe imunoterapi tersebut berman"aat untuk mengatasi
penyebaran dari metastasis tumor ganas ginjal tipe Renal 0ell 0arsinoma/
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%anyak "aktor yang mempengaruhi prognosis pada penyakit ini seperti:
keadaan klinis, usia pasien, stadium perkembangan, derajat penyebaran, keterlibatan
kelenjar lim"e, derajat keganasan, derajat histologi dan ukuran tumor, kelamin
penderita dan "asilitas pengobatan yang tersedia.
Kepanieraan Radiologi '0
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DAFTAR PUSTAKA
%udjang, .. =adiologi 8iagnostik. 3d : =asad. , ?artoleksono. , 3kayuda.
*enerbit: %alai *enerbit '?+-I, Hakarta. 1995. 2F9+2GD.
8jad"ar. H, 8harmaeiCar yabani. . %uku ,jar Ilmu *enyakit 8alam. Hilid II. 3disi
ketiga. *enerbit: %alai *enerbit '?-I, Hakarta. 2001. 99G+D02.
'rik. #, ;oering. -. =oentgenologi( ,natomy. Translated by >.;.=igler, *. spiegler.
19G0. 59+54.
<agen M ,nseri, andra, >. Te@tbook o" 8iagnosti( -ltrasonography. *enerbit: 10
.osby 1ompany, -,. 2
nd
edition. 19G9. 192+20F.
?umpulan ?uliah Ilmu %edah. 3ditor: =eksoprodjo .. *enerbit: %inarupa ,ksara.
Hakarta. 1995: 1F9+1FF.
=obbins and ?umar. %uku ,jar *atologi II. 3disi D. *enerbit: %uku ?edokteran
3;1. Hakarta. 1995. 215+21F.
jamsuhidayat, Hong #.d.. %uku ,jar Ilmu %edah. 3disi 2. *enerbit: %uku
?edokteran 3;1, Hakarta. 2005. FFD+FF9.
utton, 8a)id. %uku ,jar =adiologi untuk &ahasis!a ?edokteran. 3d: sutarto, .
*enerbit: <ipokrates. 1995. 49+G0.
http:AA!!!.emedi(ine.(om
http:AA!!!.!ho.intA
http:AAintl+radiographi(s.rsnajnls.orgA
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>,&*I=,.
;ambar skematik perkembangan satuan ekskresi metane"ros
Kepanieraan Radiologi '#
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,ngiomyolipoma (J+=ay)
Kepanieraan Radiologi ''
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,ngiomyolipoma (J+=ay)
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=in(ian pembesaran tinggi dari pola sel jernih karsinoma sel ginjal
<iperne"roma memperlihatkan kelainan bentuk yang aneh dan peregangan kalises
ginjal.
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=enal sel karsinoma ultrasonogra"i
?elainan patologi dalam pembuluh darah (angiogra"i)

olitary 'ibrous tumor
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&akula densa dan Hu@tagromerulus
1T+(an Tumor
#ilm$s Tumor
Kepanieraan Radiologi '$
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KIDNE4 ,AN,ER
?idney (an(er strikes more than 94,000 ,meri(ans e)ery year, and kills o)er 12,400
adults and (hildren. ,bout hal" o" ne! (ases diagnosed in adults are lo(aliCed, or
limited to the kidney itsel". ,nother 25% ha)e ad)an(ed disease at diagnosis, and
25% !ill ha)e regional disease. -ltimately, 50% o" kidney (an(er patients !ill
e@perien(e metastases (tumor spread).
In the 19G0s, up to G0% o" people had ad)an(ed kidney (an(er !hen diagnosed.
Today, thanks to ad)an(ed dete(tion methods, only about D0% o" patients present
!ith ad)an(ed disease at diagnosis. -n"ortunately, the risk o" metastasis is dire(tly
related to the siCe o" the primary tumor:

The most signi"i(ant risk "a(tor "or kidney (an(er is smoking, but men are more than
t!i(e as likely to get kidney (an(er than !omen. In addition to smoking, other risk
"a(tors in(lude age (most (ases o((ur a"ter age 50)6 obesity6 on+the+job e@posure to
asbestos, (admium and (oke (used in making steel)6 high blood pressure6 longterm
kidney dialysis and )on <ippel >indau syndrome.
The most (ommon type o" kidney (an(er is enal %ell %a%inoma 1R,,25
!hi(h in(ludes (lear (ell, papillary, (hromophobe and (olle(ting du(t (an(er types.
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T&mo
,-an%e o.
Me!a$!a$i$
I F (m. in siCe I 5%
K F(m. in siCe 25%
spread outside kidney K 50%
lymph node
in)ol)ement
F0+90%
1lear (ell (ar(inoma a((ounts "or G0% o" all =11 (ases, and most treatments are
"o(used on this type. /ilm$0 !&mo is a (hildhood (an(er, making up 95% o"
pediatri( kidney (an(er (ases.
S+m"!om$ o. Kidne+ ,an%e
8ue to the lo(ation o" the kidneys, people o"ten donNt e@perien(e any symptoms until
the tumor has gro!n Euite large. The most (ommon symptom is blood in the urine
(hematuria), but the presen(e o" blood doesnNt ne(essarily mean itNs (an(er. /ther
symptoms o" kidney (an(er may in(lude:
, lump or mass in the kidney area
=e(urrent "e)er
=apid !eight loss
>ingering dull a(he or pain in the side, abdomen or lo!er ba(k
'eeling "atigued or in poor health
De!e%!ion & Dia#no$i$
=enal (ell (ar(inomas (an be )ery hard to dete(t in the early stages. /"ten, people
ha)e no symptoms at all until the tumor be(omes large enough to be "elt, or (auses a
dull, a(hing pain in the ba(k or side.
There are se)eral tests used to dete(t and stage kidney (an(er:
Ima#in# $!&die$ su(h as a 1T s(an, ultrasound, &=I or intra)enous pyelogram
(I0*). 1T s(ans are )ery use"ul "or dete(ting kidney tumors. I0*, !hi(h in)ol)es
inje(ting a dye that sho!s up on an J+ray as it tra)els through the urinary system, (an
also be help"ul in diagnosing kidney (an(er. These imaging studies (an also be used
"or disease staging to help on(ologists determine the appropriate treatment.
Fine Needle A$"ia!ion ('.,) in)ol)es the insertion o" a long, thin needle into the
kidney to take a tiny sample o" tissue (biopsy) "or e@amination under a mi(ros(ope.
'., is generally used i" other tests ha)e "ailed to pro)e the presen(e o" a tumor.
S&#e+
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urgery to treat kidney (an(er is (alled nephre(tomy. 8epending on the tumor siCe,
lo(ation and stage, the surgi(al on(ologist may (hoose to remo)e the entire kidney
(radi(al nephre(tomy) or just the portion a""e(ted by (an(er (partial nephre(tomy).
'or ad)an(ed or metastati( kidney (an(er, surgery (an play a role along !ith other
treatments. The prognosis is poor "or metastati( disease, but &. 8. ,nderson is
studying radi(al nephre(tomy (ombined !ith inter"eron therapy to impro)e out(omes
"or these patients.
Radi%al Ne"-e%!om+
=adi(al nephre(tomy in)ol)es remo)al o" the entire kidney. There are t!o types o"
radi(al nephre(tomy:
S!andad o 6o"en6 $&#e+7 a "our+ to "i)e+in(h in(ision is made in the lo!er
ba(k. The surgeon remo)es the entire kidney through the in(ision.
La"ao$%o"i% Radi%al Ne"-e%!om+ 1LRN27 a small in(ision is made to insert a
laparos(ope, a thin tube !ith a (amera that allo!s the surgeon to )ie! the treatment
"ield on a monitor. /ther tiny in(isions are made "or miniature surgi(al instruments to
remo)e the kidney. >aparos(opi( radi(al nephre(tomy (>=.) is Eui(kly be(oming
the Ogold standardO surgi(al treatment in the -nited tates "or properly sele(ted
kidney (an(er patients. Its bene"its in(lude a shorter hospital stay (three days )s. one
!eek), shorter re(o)ery time and less blood loss than !ith open surgery.
Pa!ial Ne"-e%!om+
In a partial nephre(tomy, only the (an(erous portion o" the kidney is remo)ed, along
!ith a margin o" healthy tissue. *re+treatment imaging is used to determine !hat !ill
be remo)ed, and ultrasound is used to look "or additional tumors during surgery.
,s !ith radi(al nephre(tomy, this pro(edure (an be done by traditional or
laparos(opi( methods. >aparos(opi( partial nephre(tomy (>*.) is still (onsidered
de)elopmental, and data (olle(ted by &. 8. ,nderson surgeons sho! only a slight
ad)antage o)er standard te(hniEues.
1andidates "or partial nephre(tomy are (hosen based on "a)orable tumor lo(ation, (o+
e@isting health problems that may a""e(t the treatment out(ome and the patientNs
desire to sa)e his or her kidney. *artial nephre(tomy is best "or tumors "our
(entimeters or less in siCe. =e(urren(e rates "or both types o" partial nephre(tomy are
about 5%.
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Ene#+ A'la!i3e Te%-ni8&e$
,nother minimally in)asi)e surgery te(hniEue uses either heat or (old energy
to treat tumors in pla(e, !ithout ha)ing to remo)e the kidney.
,+oa'la!ion "reeCes the tumor to +150 degrees (entigrade !ith a long, thin
probe inserted into the tumor. Intensi)e "ollo!+up !ith J+rays or other imaging
pro(edures is reEuired to ensure that the tumor has been destroyed. 1ryoablation
is ideal "or smaller kidney tumors in patients (onsidered at high risk "or surgery.
Radio.e8&en%+ A'la!ion 1RFA2 is similar to (ryoablation, but heat is used to kill
the tumor instead o" (old. =', does ha)e good potential "or appropriate patients.
Radia!ion T-ea"+
=adiation has a limited role in the treatment o" kidney (an(er. ?idney tumors are not
)ery sensiti)e to radiation, but healthy kidneys are, so radiation as a "rontline
treatment is not )iable.
In some (ases, radiation may be used as a palliati)e treatment, to ease pain and other
symptoms o" ad)an(ed kidney (an(er that has spread to bone or other areas o" the
body.
,-emo!-ea"+
1hemotherapy is generally ine""e(ti)e against kidney tumors, but may ha)e a role in
the treatment o" metastati( tumors that ha)e spread to the lung, bones, brain or lymph
nodes. In these (ases, (hemotherapy !ould be (ombined !ith surgery or other
lo(aliCed therapy. , (ombination o" gem(itabine and (ape(itabine to treat metastati(
renal (ell (ar(inoma has been studied in se)eral (lini(al trials, and other
(hemotherapy agents may also be analyCed "or their e""e(ti)eness in treating
metastases.
Imm&no!-ea"+
In re(ent years, a signi"i(ant amount o" (an(er resear(h has been de)oted to
immunotherapy, !hi(h uses the bodyNs o!n de"ense me(hanisms to "ight (an(er. ,ll
(ells ha)e protein markers, (alled antigens, on their sur"a(es that identi"y them as
either OnormalO or O"oreign.O The presen(e o" "oreign antigens (su(h as (an(er (ells)
pro)okes a sophisti(ated (hemi(al rea(tion in)ol)ing lympho(ytes and other (ells that
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de"end the body against disease. ome o" these de"ender (ells produ(e antibodies,
!hi(h seek out and destroy spe(i"i( antigens.
Immunotherapies are designed to manipulate the antigenAantibody immune response
by targeting antigens on spe(i"i( types o" tumor (ells. ,s resear(hers identi"y more o"
these tumor+spe(i"i( antigens, they are !orking to de)elop therapeuti( agents that
target only those (ells.
There are t!o basi( types o" immunotherapy:
An!i'od+ !-ea"+ targets spe(i"i( antigens. =itu@imab and <er(eptin are e@amples
o" antibody therapies (urrently appro)ed "or treatment o" (ertain types o" lymphoma
and breast (an(er, respe(ti)ely.
,an%e 3a%%ine$ are designed to atta(k antigens that e@ist spe(i"i(ally on (an(er
(ells. <o!e)er, many o" these proteins are also e@pressed on normal (ells. &. 8.
,nderson resear(hers are trying to re+tea(h the immune system to re(ogniCe and
eliminate tumor antigens !ithout a""e(ting normal (ells. 1an(er )a((ines ha)e yet to
re(ei)e appro)al "rom the 'ood and 8rug ,dministration, but se)eral are being tested
in (lini(al trials.
Imm&no!-ea"+ & Kidne+ ,an%e
=enal (ell (ar(inoma (=11) is )ery responsi)e to immunotherapy, !hi(h has be(ome
the standard o" (are "or metastati( disease. T!o types o" immunotherapy are used to
treat metastati( =11:
In!e.eon*al"-a is a protein produ(ed by !hite blood (ells in response to a )iral
in"e(tion. It in(reases antigens on the sur"a(e o" (an(er (ells, making them more
sus(eptible to atta(k by the immune system. Inter"eron is an outpatient treatment
administered )ia inje(tion, !hi(h patients (an do themsel)es. ide e""e(ts o"
inter"eron therapy in(lude "lu+like symptoms ("e)er, mus(le a(hes, heada(he, nasal
(ongestion), depression, "atigue and nausea.
In!ele&(in*9 1IL*92 is a protein that stimulates the gro!th o" immune (ells and
a(ti)ates them to destroy tumor (ells. <igh+dose I>+2 therapy is administered
intra)enously, and treatment reEuires a "i)e+day hospital stay. ide e""e(ts in(lude
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hypotension (lo! blood pressure), "lu+like symptoms ("e)er, mus(le a(hes, heada(he,
nasal (ongestion), de(reased urine produ(tion, nausea and diarrhea.
%oth o" these therapies ha)e only a general, non+targeted e""e(t on the immune
system, and their intense side e""e(ts are not !ell+tolerated by many patients. %oth
therapies ha)e about a 15% response rate, but those !ho do respond do so Euite
dramati(ally. %e(ause kidney tumors are not sensiti)e to radiation, immunotherapy
may be(ome a more )iable treatment !ith more study.
Ta#e!ed T-ea"+
?idney tumors are )ery )as(ular (blood )essel+ri(h). They rely on a pro(ess (alled
angiogenesis to (reate their o!n net!ork o" blood )essels, enabling them to thri)e
and gro!. These blood )essels ha)e uniEue (hara(teristi(s that may make them
)ulnerable to drugs designed spe(i"i(ally to target them !ithout harming normal
blood )essels.
, number o" Oanti+angiogeni(O (ompounds are being de)eloped to take ad)antage o"
the pro(ess. These treatments in(lude be)a(iCumab (,)astin
T&
), %,7 D9+9004
(ora"enib) and -0112DG. ,ll o" these agents are (urrently in large, late+phase
(lini(al trials, and results "rom these trials !ill be a)ailable by 2004. These are
merely e@amples o" a gro!ing "ield o" treatments that target )ulnerabilities spe(i"i( to
the tumor, !ith lo!er side e""e(ts than traditional (hemotherapies or
immunotherapies.
/-a! i$ %an%e:
1an(er is a disease o" the bodyNs (ells. /ur bodies are al!ays making ne! (ells: so
!e (an gro!, to repla(e !orn+out (ells, or to heal damaged (ells a"ter an injury. This
pro(ess is (ontrolled by (ertain genes. ,ll (an(ers are (aused by (hanges to these
genes. 1hanges usually happen during our li"etime, although a small number o"
people inherit a (hanged gene "rom a parent.
.ormally, (ells gro! and multiply in an orderly !ay. <o!e)er, (hanged genes (an
(ause them to beha)e abnormally. They may gro! into a lump. These lumps (an be
benign (not (an(erous) or malignant ((an(er(ous).
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%enign lumps do not spread to other parts o" the body.
, malignant lump (more (ommonly (alled a malignant tumour) is made up o" (an(er
(ells. #hen it "irst de)elops, this malignant tumour may be (on"ined to its original
site. I" these (ells are not treated they may spread into surrounding tissue and to other
parts o" the body. #hen these (ells rea(h a ne! site they may (ontinue to gro! and
"orm another tumour at that site. This is (alled a se(ondary (an(er or metastasis.
'or a (an(er to gro! bigger than the head o" a pin, it must gro! its o!n blood
)essels. This is (alled angiogenesis.
T-e Kidne+
The kidneys are t!o kidney bean+shaped organs about the siCe o" a "ist. They are near
the middle o" the ba(k, at either side o" the ba(kbone. The kidneys are part o" the
urinary system. They remo)e !aste produ(ts "rom the blood. This !aste, in the "orm
o" urine, is (arried "rom the kidneys to the bladder by tubes (alled ureters. The
bladder stores the urine until it is "ull. Then it empties through a tube (alled the
urethra.
The kidneys also make hormones. These hormones trigger the making o" red blood
(ells, (ontrol blood pressure and (ontrol the bodyNs (al(ium le)els.
I" one kidney is damaged or diseased, the other healthy kidney is usually able to take
up the e@tra !ork. , person is able to li)e Euite normally !ith just one kidney.
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Kidne+ ,an%e
?idney (an(er o((urs !hen (an(er (ells gro! in part o" a kidney.
&ost kidney (an(ers are renal (ell (ar(inomas. In renal (ell (ar(inoma, (an(er (ells
gro! in the lining o" a kidney. =arely, both kidneys (an be a""e(ted at the same time.
, less (ommon type o" kidney (an(er begins at the point !here the kidney joins the
ureter: this is (alled transitional (ell (ar(inoma. =enal sar(oma is another rare "orm o"
kidney (an(er.
I" the (an(er is not treated early on, it may spread to other parts o" the body. I" the
(an(er is "ound a"ter it has spread, treatment is more di""i(ult, and the outlook "or
sur)i)al is not as good.
ymptoms, diagnosis and treatment "or all "orms o" adult kidney (an(er are similar.
,a&$e$ o. (idne+ %an%e
The e@a(t (auses o" kidney (an(er are not kno!n. <o!e)er, se)eral "a(tors are
kno!n to in(rease the risk o" kidney (an(er.
moking. -p to one third o" all kidney (an(ers are thought to be due to
smoking.
/)eruse o" painkillers (ontaining phena(etin. This (hemi(al is not used in
modern painkillers. <o!e)er, people !ho took painkillers (ontaining
phena(etin in large amounts, be"ore it !as banned, may be a""e(ted.
3@posure to asbestos or (admium. This applies to some people !ho !ere
e@posed to these substan(es in their jobsPin(luding (onstru(tion !orkers,
do(k !orkers, painters and printers.
*eople !ith a "amily history o" kidney (an(er. This may be be(ause there are
abnormalities in their genes. 8i""erent geneti( abnormalities may also (ause
t!o rare "orms o" kidney (an(er: )on <ippel+>indau syndrome and tuberous
s(lerosis.
&en are more likely to de)elop kidney (an(er than !omen.
Ho; %an I .ind o&! i. I -a3e (idne+ %an%e:
ymptoms
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8o(tors and other health pro"essionals !ho treat kidney (an(er
<o! kidney (an(er is diagnosed
o -ltrasound s(an
o Intra)enous pyelogram (I0*)
o 1hest @+ray
o 1T s(an
o &agneti( resonan(e imaging (&=I)
o =adioisotope bone s(an
o -rine test
o %lood test
o 1ystos(opy
NtagingN (an(er
S+m"!om$
&ost kidney (an(ers are "ound !hen a do(tor is (he(king "or something else, be(ause
in its early stages kidney (an(ers usually does not produ(e symptoms.
#hen they o((ur, symptoms o" kidney (an(er (an in(lude:
blood in the urine (haematuria)
pain or a dull a(he in the side or lo!er ba(k that is not due to an injury
a lump in the abdomen
(onstant tiredness
rapid, une@plained !eight loss
"e)er not (aused by a (old or "lu.
&ost o" these symptoms (an be (aused by other illnesses. <o!e)er, i" you ha)e any
o" these symptoms, you must see your do(tor.
Do%!o$ and o!-e -eal!- "o.e$$ional$ ;-o !ea! (idne+
%an%e
7our do(tor !ill e@amine you and re"er you "or tests to see i" ha)e (an(er. This (an
be a !orrying and tiring time, espe(ially i" you need se)eral tests.
I" the tests sho! you ha)e or may ha)e (an(er, your do(tor !ill re"er you to a
spe(ialist !ho may ask you to ha)e more tests. I" you ha)e (an(er, one or more
spe(ialists !ill ad)ise you about treatment options.
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pe(ialists and other health pro"essionals !ho (are "or people !ith kidney (an(er
in(lude:
urologists: !ho spe(ialise in diseases o" and surgery to the urinary system
medi(al on(ologists: !ho are responsible "or (hemotherapy and other medi(al
treatments
radiation on(ologists: !ho are responsible "or radiotherapy
nurses: !ho !ill help you through all stages o" your (an(er e@perien(e
dietitians: !ho !ill re(ommend the best diets to "ollo!
so(ial !orkers, physiotherapists and o((upational therapists: !ho !ill ad)ise
you on support ser)i(es and help you to get ba(k to normal a(ti)ities.
Ho; (idne+ %an%e i$ dia#no$ed
I" your do(tor thinks you might ha)e kidney (an(er, some o" the "ollo!ing tests !ill
be re(ommended.
Ul!a$o&nd $%an
In this test, sound !a)es are used to (reate a pi(ture o" the inside o" your body.
%e"ore your test you may be asked to drink plenty o" "luids so that your bladder is "ull
and a (lear pi(ture (an be seen. /n(e you are lying on your ba(k, a spe(ial gel is
spread o)er your abdomen.
, small de)i(e, like a mi(rophone, is passed o)er the area. The e(hoes are turned into
a pi(ture by a (omputer.
The s(an is painless and takes about "i"teen to t!enty minutes.
In!a3eno&$ "+elo#am 1IVP2
This type o" @+ray sho!s up anything unusual in the kidneys, bladder and the rest o"
the urinary system. ,n I0* (an be done in a hospital @+ray department or at a spe(ial
(lini(.
, dye is inje(ted into a )ein, usually in your arm, and tra)els through the bloodstream
to the kidneys. The do(tor (an !at(h the dye mo)e around the body on an @+ray
s(reen and pi(k up anything unusual, like a tumour or kidney damage (aused by a
tumour.
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The dye (an make you "eel hot and "lushed "or a "e! minutes, but this "eeling
gradually goes a!ay. 7ou may "eel some dis(om"ort in your abdomen, but only "or a
!hile.
7ou should be able to go home as soon as the test is o)er. It takes about an hour.
,-e$! <*a+
, (hest @+ray uses lo! doses o" radiation to look "or any unusual areas in the (hest. It
takes only a "e! minutes and is painless and sa"e. I" (an(er has been diagnosed, a
(hest @+ray (an sho! i" (an(er has spread to your lungs or to bones in your (hest.
,T $%an
, 1T s(an is a spe(ial type o" @+ray that gi)es a three+dimensional pi(ture o" the
organs and other stru(tures (in(luding any tumours) in your body.
1T s(ans are usually done at a hospital or a radiology (lini(. It takes about thirty to
"orty minutes. The test is painless.
7ou may be asked to drink a liEuid dye that helps outline the bo!el. 7ou !ill also
ha)e an inje(tion o" a dye that helps outline the kidneys, ureters and bladder. 7ou
!ill be asked to lie on a table !hile the 1T s(anner, !hi(h is large and round like a
doughnut, slo!ly mo)es around you. &ost people are able to go home as soon as
their s(an is o)er. There is a small possibility o" the intra)enous dye (ausing an
allergi( rea(tion.
Ma#ne!i% e$onan%e ima#in# 1MRI2
This test is like a 1T s(an, but it uses magnetism to build up pi(tures o" your body. It
may be able to pro)ide more details than a 1T s(an.
>ike a 1T s(an, &=I is painless, and the magnetism is harmless. 7ou !ill be asked to
lie still on a table inside a large metal tube, !hi(h is open at both ends. The test may
take up to an hour. The tube makes some people "eel (laustrophobi( (a"raid o" being
in a small spa(e). 7ou may be able to take someone into the room !ith you to keep
you (ompany. The ma(hinery (an be Euite noisy.
The test takes about thirty minutes.
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Radioi$o!o"e 'one $%an
, radioisotope s(an may be done to see i" any (an(er (ells ha)e spread to the bones.
'or this test, a small amount o" a radioa(ti)e dye is inje(ted into a )ein, usually in the
arm. It is normal to !ait "or the dye to mo)e through the body and then lodge in the
bones be"ore the images are taken. This (an take three to "our hours. 7ou !ill be
s(anned by a ma(hine !hi(h dete(ts tiny amounts o" radioa(ti)ity, espe(ially in the
bones.
The do(tor (an tell i" the (an(er has spread, as a larger amount o" radioa(ti)ity is
"ound in areas o" bone !hi(h ha)e (an(er (ells. This (auses a dark spot to appear on
the bone s(an. The s(an is also used to see i" the other kidney, not a""e(ted by (an(er,
is healthy.
The amount o" radiation used is small, and the radiation goes "rom your body !ithin a
"e! hours. 7ou !ill be ad)ised to a)oid (onta(t !ith pregnant !omen and young
(hildren "or the rest o" the day, and drink plenty o" "luids.
This test is not re(ommended "or pregnant or breast+"eeding !omen.
Uine !e$!
, urine test looks "or blood and signs o" in"e(tion in your urine. , urine test (an
sometimes "ind (an(er (ells "rom the kidney, ureter or bladder.
Blood !e$!
The do(tor !ill ask "or a blood sample to (he(k your general health and blood (ount
(the number o" di""erent blood (ells in your blood). Too "e! or too many red blood
(ells (an be a sign o" kidney (an(er. <igh le)els o" li)er enCymes and blood (al(ium
le)els are also symptoms o" kidney (an(er.
,+$!o$%o"+
I" you ha)e blood in your urine, the do(tor may re(ommend a (ystos(opy.
The (ystos(opy is done by a urologist. In many (ases, it is done under lo(al
anaestheti(. The test is (arried out using a small, "le@ible teles(ope (alled a
(ystos(ope. This is gently passed through the urethra and into the bladder. Through
the (ystos(ope, the do(tor (an e@amine the urethra and bladder. It may be possible to
see !here the bleeding is (oming "rom.
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S!a#in# %an%e
The tests des(ribed abo)e sho! !hether you ha)e (an(er. They !ill also sho! !here
the primary (an(er is and !hether the (an(er (ells ha)e spread to other parts o" your
body. This helps your do(tors stage the disease so they (an !ork out the best
treatment "or you.
The staging system used "or kidney (an(er is kno!n as the T.& system (TBtumour,
.Bnodes, &Bmetastases).
T "ollo!ed by a number bet!een 1 and D sho!s ho! "ar the (an(er has spread
into the kidney and nearby tissues. , higher number a"ter the T ("or e@ample
T9 or TD) means it has spread through the kidney into the surrounding tissues.
N plus a number "rom 0 to 2 des(ribes !hether the (an(er has spread to lymph
nodes near the kidney. <igher numbers are used !hen more than one group o"
nodes are a""e(ted by the (an(er.
M "ollo!ed by 1 sho!s that the (an(er has spread to other organs or to lymph
nodes that are not near the kidney. &0 (an(ers ha)e not spread in this !ay.
8o(tors put together this in"ormation to !ork out the stage o" the (an(er, "rom tage
1 (I) to tage D (I0). 'or e@ample, a (an(er assessed as T1, .0, &0 (tumour
(ontained !ithin the kidney, lymph nodes not a""e(ted and no metastasis) !ould be
(alled a tage 1 (I) (an(er.
,sk your do(tor to e@plain the stage o" your (an(er in a !ay you (an understand. This
!ill help you to (hoose the best treatment "or your o!n situation.
Tea!men! .o (idne+ %an%e
urgery
o ,"ter the operation
,rterial embolisation
=adiotherapy
o ide e""e(ts o" radiotherapy
1hemotherapy
Immunotherapy
*alliati)e treatment
*rognosis
The type o" treatment you (hoose !ill depend on the stage o" your (an(er, your age,
your general health and !hat you !ant. 7our spe(ialist !ill go o)er your treatment
options !ith you.
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Treatments "or kidney (an(er in(lude surgery, (hemotherapy and radiotherapy. 7ou
may be ad)ised to ha)e one or more o" these treatments.
S&#e+
urgery is not possible "or all people !ith kidney (an(er. I" surgery is possible, the
type re(ommended !ill depend on your general health and the stage o" your (an(er.
The most (ommon surgery is to remo)e the !hole kidney. This is (alled a radi(al
nephre(tomy. /ther surrounding tissues may be remo)ed at the same time, i" they are
"ound to ha)e (an(er, too.
,nother type o" surgery is to remo)e only part o" the kidney. This is (alled a partial
nephre(tomy. This is the best (hoi(e "or people !ho ha)e (an(er in both kidneys or
only one kidney that !orks. It is also done "or some patients !ith small tumours (less
than D (m).
7ou !ill usually ha)e a general anaestheti(. , (ut is made at the side o" your
abdomen !here the diseased kidney is lo(ated. ometimes this (an be done using
laparos(opy. #ith )ery large (an(ers, the (ut may be bigger and go "rom the (hest
into the abdomen, through the rib(age.
A.!e !-e o"ea!ion
#hen you !ake up "rom the operation you !ill ha)e se)eral tubes in pla(e. 7ou !ill
ha)e an intra)enous drip to gi)e you "luid and medi(ines. 7ou may ha)e tubes to
drain a!ay "luid "rom the operation site.
7ou may need a urinary (atheter "or a "e! days a"ter surgery. This is inserted in your
urethra !ith the tip in the bladder and the other end atta(hed to a bag that (olle(ts
urine. It is not pain"ul.
7ou !ill ha)e pain or dis(om"ort in the areas !here organs !ere remo)ed and you
!ill ha)e stit(hes. 7ou may ha)e an anaestheti( inje(ted into the area around the
spine: this method o" pain relie" is kno!n as an NepiduralN and (an be )ery e""e(ti)e. I"
you ha)e pain or dis(om"ort, ask "or medi(ations to help (ontrol the symptoms.
7ou !ill be in hospital "or about a !eek. 7ou may see a physiotherapist, !ho !ill
e@plain ho! you may begin e@er(ising again.
A!eial em'oli$a!ion
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This is sometimes re(ommended "or people !ho ha)e medi(al problems that mean
they (annot ha)e surgery to remo)e the kidney. It blo(ks the artery that "eeds the
diseased kidney. This (auses the kidney and the tumour in it to die (tumours need a
blood supply to sur)i)e).
, )ery small tube (alled a (atheter is inserted through a blood )essel in the groin and
passed up into the kidney. This is done using @+ray. &aterial is inje(ted through the
(atheter to blo(k the artery. *eople !ho re(o)er "rom their medi(al problems
sometimes ha)e the kidney remo)ed later. 3mbolisation is also used to relie)e
symptoms (su(h as bleeding) i" a person has a (an(er that (annot be operated on.
Radio!-ea"+
=adiotherapy uses radiation, usually @+rays, to kill (an(er (ells. These @+rays (an be
targeted e@a(tly onto (an(er sites in your body. Treatment is (are"ully planned to do
as little harm as possible to your normal body tissues.
=adiotherapy may be used instead o" surgery to treat kidney (an(er. This is
parti(ularly the (ase !ith people !ho ha)e se(ondary (an(ers that (annot be treated
!ith surgery. In these people, radiotherapy (an relie)e pain and dis(om"ort (aused by
the gro!ing se(ondary (an(er. In most (ases, radiotherapy is not re(ommended to
treat primary kidney (an(er.
The treatment is gi)en in the radiotherapy department. The (ourse is usually gi)en
daily "rom &onday to 'riday. The total number o" treatments and duration o" your
treatment !ill depend on the type and siCe o" the (an(er. ometimes only a (ouple o"
treatments are ne(essary, or you may ha)e many treatments o)er a number o" !eeks.
Side e..e%!$ o. adio!-ea"+
=adiotherapy (an (ause temporary side e""e(ts in(luding nausea (!hi(h (an be helped
by medi(ation), loss o" appetite and tiredness.
kin in the treatment area may be(ome irritated a"ter t!o or three !eeks o" treatment.
7ou !ill need to take (are !ashing and a)oid sha)ing the area or !earing (lothing
that rubs. 1he(k !ith your do(tor or nurse be"ore using any tal(s and lotions. ,sk a
member o" your radiotherapy treatment team about ho! to deal !ith any side e""e(ts.
1oping !ith radiotherapy pro)ides "urther in"ormation.
,-emo!-ea"+
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This is the treatment o" (an(er !ith anti+(an(er drugs. The aim is to kill all (an(er
(ells !hile doing the least possible damage to normal (ells. The drugs !ork by
stopping (an(er (ells "rom gro!ing and reprodu(ing themsel)es.
1hemotherapy is usually gi)en by inje(tion into a )ein.
1hemotherapy is not as e""e(ti)e in treating kidney (an(er as it is "or some other
(an(ers, so it is not o"ten used. <o!e)er, resear(hers are looking "or better types o"
(hemotherapy and there may be a ne! or e@perimental treatment a)ailable "or you to
try, "or e@ample, by taking part in a (lini(al trial. ,sk your do(tor i" you !ould like
more in"ormation.
1oping !ith (hemotherapy pro)ides more in"ormation.
Imm&no!-ea"+
Immunotherapy (or biologi(al therapy) is the use o" substan(es that are naturally
made !ithin the body to help the immune system to "ight disease. Inter"eron and
interleukin ha)e been used to treat some kidney (an(ers. #hile they are NnaturalN
substan(es, they (an (ause se)ere side e""e(ts. Immunotherapy is not a standard
treatment in ,ustralia "or kidney (an(er, but is a)ailable in some (entres. 7ou may be
eligible to join a (lini(al trial o" immunotherapy "or kidney (an(er. 8is(uss this !ith
your do(tor i" you !ish.
Pallia!i3e !ea!men!
*alliati)e treatment relie)es or soothes symptoms o" illness, in(luding pain. It is
a)ailable "or people !ith (an(er, !hate)er their stage o" (an(er treatment. It is a )ery
important type o" treatment "or people !ith ad)an(ed (an(er, !ho (annot be (ured
but (an e@pe(t to li)e !ithout undue pain and distress.
*alliati)e (are in(ludes pain relie" using painkilling drugs and other measures su(h as
radiotherapy. *ain (an usually be !ell (ontrolled !ith drugsPby mouth, skin pat(hes
or sometimes inje(tion. There is no need to "ear de)eloping drug dependen(y.
'or "urther in"ormation, (onta(t the 1an(er <elpline on 19 11 20 or *alliati)e 1are
0i(toria on (09) 9442 94DD.
Po#no$i$
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&ost kidney (an(ers (an be e""e(ti)ely (ured i" they are "ound early, be"ore they ha)e
spread.
7ou !ill need to talk !ith your do(tor about your o!n prognosis. 7our medi(al
history is uniEue, so you !ill need to dis(uss !ith your do(tor !hat you (an e@pe(t
and the treatment options that are best "or you.
REVIE/ OF PEDIATRI, RENAL NEOPLASMS
Jo-n Hi%($
Te<a$ ,-ilden=$ Ho$"i!al5 Ho&$!on5 T)
MALIGNANT RHABDOID TUMOR OF KIDNE4
I.83J
3pidemiology
*athology
,n(illary In)estigations
1ytogeneti(s
Mali#nan! R-a'doid T&mo o. Kidne+7 E"idemiolo#+
/riginally 1onsidered O=habdomyosar(omatoidO 0ariant
o" #ilms Tumor (abundant eosinophili( (ytoplasm)
+ >a(k o" &yo"ilaments (1ross+striations)
+ >a(k o" &yo"ibroblasti( 8i""erentiation
+ >a(k o" &yoglobin, ,(tin, 8esmin, &us(le &arkers
-n(ertain 3tiology
,sso(iation !ith *rimiti)e .euroepithelial Tumors o"
*osterior and &iddle 1ranial 'ossa in 15%
&edian ,ge 11 months
90% o" 1ases I9 years o" age
/ldest 1ase G.5 years o" age
;ender =atio 1.5& : 1.0'
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<yper(al(emia !ith 3le)ated *arathormone >e)els
.o ,sso(iated yndromes
hort, -nrelenting 1lini(al 1ourse:
=esistant to 1hemotherapy and =adiotherapy
-sually, 8ie o" 8isease #ithin 1 year o" 8iagnosis
&etastasiCe #idely )ia <ematogenous and >ymphati( =outes
Mali#nan! R-a'doid T&mo o. Kidne+7 Pa!-olo#+
<istopathologi( *atterns:
(lerosing
'ibroti(
/steosar(omatoid
1hondroid
3pithelioid
Trabe(ular
&u(oid
,l)eolar
tori"orm
*seudoglandular
pindled
%road 'as(i(ular
&y@oid
*eri(ytomatous
tori"orm
*alisading
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>ymphomatoid
olid
<istio(ytoid

Mali#nan! R-a'doid T&mo o. Kidne+7
Li#-! mi%o$%o"+ 1A2 and Ul!a$!&%!&e 1B2
Fi#&e >A7 T&mo %ell$ ae
%-aa%!ei?ed '+ e%%en!i% n&%lei5
"ominen! n&%leoli and eo$ino"-ili%
%+!o"la$mi% in%l&$ion$@
Fi#&e >B7 ,+!o"la$mi% in!emedia!e
.ilamen! ;-il$ ae dia#no$!i% o. !-e
-a'doid "-eno!+"e@
Mali#nan! R-a'doid T&mo o. Kidne+7 An%illa+ In3e$!i#a!ion$
Immuno(yto(hemistry:
*ositi)e: 1ytokeratin, 3&,, 0imentin
0ariably *ositi)e: .eural &arkers, 8esmin, ,(tin
-ltrastru(ture:
Tightly #horled ,ggregates o" Intermediate 'ilaments
*rimiti)e 1ell Hun(tions
Tono"ilaments
'lo! 1ytometry: -sually 8iploid
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Mali#nan! R-a'doid T&mo o. Kidne+7 ,+!o#ene!i%$
1ytogeneti( ,bnormalities:
1hromosome 22(E11.2)
1hromosome 22 &onosomy and *artial 8eletions
Translo(ation
t(11622) and t(1G622)(E216E11.2)
1hromosome 22 del(22)(E11)
%reakpoint 1luster =egion 8i""erent "rom 3!ings ar(oma
'amily o" Tumors
Kidne+ ,an%e7 S+m"!om$5 ,a&$e$5 Dia#no$i$ and Tea!men!
?idney (an(er in(iden(e rates in the -nited tates ha)e risen dramati(ally sin(e the
1950s. They ha)e risen o)er 124 per(ent, translating into o)er 90,000 ne! (ases a
year. 8eath rates ha)e risen by 94.5 per(ent, (ausing appro@imately 11,900 deaths a
year.
The rise in in(iden(e rates may be e@plained at least in part by better diagnosti( tools:
thanks to 1T s(ans, ultrasounds and other tools, kidney (an(er is diagnosed !ith
greater "reEuen(y than it !as in the past. 3arly dete(tion o" the disease has also
helped impro)e "i)e+year sur)i)al rates. #hile the 1950s sa! a)erage sur)i)al rates
o" 9D per(ent, by 1994 the a)erage "i)e+year sur)i)al rate had risen to 42 per(ent.
A'o&! 4o& Kidne+$
7our kidneys are t!in organs that play important roles in the urinary system, the
produ(tion o" red blood (ells, and the (ontrol o" blood pressure. =ed+bro!n and
appro@imately the siCe o" a "ist, they are lo(ated at the ba(k o" the abdominal (a)ity.
Their main "un(tion is to "ilter e@(ess "luids, salt and !aste produ(ts "rom the body.
Kidne+ ,an%e S!a!i$!i%$:
It makes up three per(ent o" all (an(er (ases.
ItNs the eighth most (ommon malignan(y in men.
ItNs the tenth most (ommon malignan(y in !omen.
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Renal ,ell ,a%inoma
This site "o(uses on renal (ell (ar(inoma (=11), the most (ommon "orm o" kidney
(an(er. =enal (ell (ar(inoma a((ounts "or up to 95 per(ent o" all (ases. The kidneys
(ontain millions o" tiny "ilters (alled nephrons. .ephrons in turn (ontain small tubes
(alled tubules. =11 usually starts in the (ells that line the tubules.
Smo(in# and En3ionmen!al Ri$( .a%!o$
moking is one o" the key risk "a(tors "or malignant renal tumors. moking doubles
the risk o" kidney (an(er. The more you smoke, the greater the risk. Quitting smoking
de(reases risk le)els.
In addition to (igarette smoke, a number o" o((upational and en)ironmental haCards
in(rease the risk o" renal tumors. *eople !ho !ork !ith asbestos or petroleum
produ(ts in(rease the possibility that they !ill (ontra(t the disease.
In(iden(e rates are also higher among steel plant (oal o)en !orkers. 3@posure to
hea)y metals su(h as lead and (admium may also raise risk le)els.
or high blood pressure, has been linked Euite (on)in(ingly to =11. 3""orts to study
the (onne(tions among obesity, high "at diets and =11 are in(on(lusi)e, but some
e)iden(e appears to indi(ate that a (onne(tion may e)entually be established. 7ou
(an "ind out more about the (onne(tion bet!een e@(ess "at and (an(er risks at /besity
and 1an(er.
Gende and A#e
,d)an(ing age appears to be (orrelated to the (han(e o" de)eloping renal tumors.
&ost (ases o" renal (ell (ar(inoma o((ur bet!een the ages o" "i"ty and se)enty, !ith
an a)erage age at diagnosis o" 44. ;ender also plays a signi"i(ant role. &en are t!i(e
as likely as !omen to de)elop kidney (an(er.
Heedi!a+ Fa%!o$
, "amily history o" =11 may alert some indi)iduals to the possibility o" de)eloping
the disease, but heredity does not appear to play a large role. =are geneti( mutations
(an in(rease the (han(e o" =11. *eople li)ing !ith u%erous s0lerosis and 2on
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:ippel ,indau disease may de)elop it. 0on <ippel >indau disease (auses tumors in
the kidneys, eyes, spine and brain, and has an in(iden(e rate one in e)ery 94,000
births.
Medi%al Fa%!o$
The use or, more properly, the o2er&use o" phena(etin or a(etaminophen+(ontaining
analgesi(s has been linked to in(reased (han(es o" de)eloping kidney tumors.
In)estigations into this (laim are ongoing.
The long+term uses o" dialysis ma(hines by people !ith renal "ailure (arries !ith it a
slightly in(reased (han(e o" de)eloping =11.
/ilm$ T&mo and ,-ilden
#ilms tumor is a "orm o" pediatri( kidney (an(er. *ediatri( treatment options di""er
"rom those reEuired "or adult =11. 7ou (an "ind out more about this (hildhood
disease on this siteNs #ilmsN tumor page.
KIDNE4 ,AN,ER
O3e3ie;

1ar(inoma o" the kidney a""e(ts some 2F,000 indi)iduals in the -nited tates ea(h
year. -ntil re(ently, little attention !as paid to the geneti(s and histology o" renal
(ar(inomas. In the past 10 years major ad)an(es ha)e been made in the understanding
o" the geneti( basis o" human kidney (an(er and it$s treatment.

/-a! i$ a Kidne+:

/ne o" a pair o" organs in the abdomen. There are 2 kidneys, one on ea(h side o" the
ba(kbone, abo)e the !aist. The kidneys o" an adult are about 5 in(hes long and 9
in(hes !ide and are shaped like a kidney bean. The kidneys (lean the blood and
produ(e urine to rid the body o" !aste. The urine (olle(ts in the middle o" ea(h
kidney in a large (a)ity (alled the renal pel)is. -rine drains "rom ea(h kidney through
a long tube (alled the urethra, into the bladder, !here it is stored until it is passed
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"rom the body through the urethra. ?idneys also play a role in blood pressure
regulation.

/-a! i$ Kidne+ ,an%e:

1an(er that "orms in tissues o" the kidneys. ?idney (an(er in(ludes renal (ell
(ar(inoma ((an(er that "orms in the lining o" )ery small tubes in the kidney that "ilter
the blood and remo)e !aste produ(ts) and renal pel)is (ar(inoma ((an(er that "orms
in the (enter o" the kidney !here urine (olle(ts).

Ri$( Fa%!o$

tudies ha)e sho!n that (ertain li"estyle or geneti( "a(tors in(rease the risk o"
de)eloping kidney (an(er:
1igarette smoking
<igh blood pressure
8iets high in saturated "ats
, "amily history o" kidney (an(er
/besity and la(k o" e@er(ise
ome pro"essions !ere people are e@posed to asbestos or (admium may
in(rease a risk o" getting the disease.
S+m"!om$

?idney (an(er usually sho!s no symptoms in the early stages. #hen symptoms
appear, the tumor may ha)e gro!n "airly large. The most ob)ious symptom to
re(ogniCe is blood in your urine. /ther symptoms may in(lude the "ollo!ing:
-nusual lo! ba(k pain
'atigue
#eight loss
'e)er that is not due to a (old or "lu
!elling o" the ankles and legs (due to an impaired ability to rid the body o"
liEuid !aste)
,lthough in many (ases, these possible kidney (an(er symptoms (an be attributed to
other reasons rather than (an(er, "or e@ample in"e(tion, it is important to see your
do(tor. It$s essential to determine i" these symptoms are the result o" kidney (an(er or
(aused by another disease.

S%eenin#

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?idney (an(er is less (ommon in the -nited tates than many other (an(ers, su(h as
those o" the breast, lung, or prostate. There"ore apparently healthy people usually
don$t ha)e regular e@aminations "or this (an(er. <o!e)er, those people that are at a
high risk o" a kidney (an(er may bene"it "rom s(reening "or early signs o" the disease.
I" the (an(er is dete(ted early, be"ore the symptoms ha)e o((urred, there are more
(han(es to su((ess"ully (ure it, (ommonly by surgery alone.
Ke+ Poin!$7

1ar(inoma o" the kidney a""e(ts some 2F,000 indi)iduals in the -nited tates ea(h
year. ?idney is one o" a pair o" organs in the abdomen. There are 2 kidneys, one on
ea(h side o" the ba(kbone, abo)e the !aist.

=isk 'a(tors: studies ha)e sho!n that (ertain "a(tors in(rease the risk o" de)eloping
kidney (an(er.

ymptoms: as most (an(ers kidney (an(er usually sho!s no symptoms in the early
stages. I" you noti(ed any o" kidney (an(er symptoms you immediatelly see your
do(tor.

(reening: i" the (an(er is dete(ted early, be"ore the symptoms ha)e o((urred, there
are more (han(es to su((ess"ully (ure it, (ommonly by surgery alone.
/-a! Heal!-+ Feline Kidne+$ Do
The kidneys are essentially a "iltration system "or the body, not unlike those used to
keep a s!imming pool (lean. %ut !here a pool "ilter remo)es lea)es and algae "rom
!ater, the kidneys remo)e to@i( !aste produ(ts (su(h as urea and (reatinine) !hi(h
a((umulate in the blood o" mammals as their "ood is (on)erted into energy.

<o!e)er, the kidneys are not just simple "ilters. TheyNre highly (omple@ organs
!hi(h also regulate blood (omposition and pressure.

&ost notably, they (ontrol the amount o" ele(trolytes in the blood (potassium,
magnesium and (al(ium, !hi(h regulate heart (ontra(tions6 sodium, !hi(h regulates
the amount o" !ater in the blood6 phosphorous, a (onstituent o" bones and teeth).

The kidneys also produ(e a substan(e (alled erythropoietin (!hi(h stimulates the
bone marro! to produ(e red blood (ells).

'inally, they produ(e an enCyme (alled renin, !hi(h maintains and (ontrols blood
pressure.
R! Royal Taruma

,ny "ailure o" the kidneys has a kno(k on e""e(t on e)ery other organ in the body,
making them e)ery bit as important to your (ats !ellbeing as, say, their heart or
lungs.

<o!e)er, !here heart or lung "ailure tends to ha)e more immediately noti(eable
e""e(ts, the kidneys ha)e a (onsiderable amount o" o)er(apa(ity. 7ou probably kno!
that most people (an sur)i)e !ith only one kidney. In "a(t, it is not until F5% o"
kidney "un(tion has been lost through disease that out!ard (lini(al symptoms start to
be seen.
R! Royal Taruma
Kidne+ %an%e
Provided by:
Last Updated: 02/10/2006
In!od&%!ion
7our kidneys are t!o bean+shaped organs, ea(h about the siCe o" your "ist. TheyNre
lo(ated behind your abdomen, one on ea(h side o" your spine. >ike other major
organs in the body, the kidneys (an sometimes de)elop (an(er. In adults, the most
(ommon type o" kidney (an(er is renal (ell (ar(inoma (renal adeno(ar(inoma),
!hi(h begins in the (ells that line the small tubes !ithin your kidneys. 1hildren are
more likely to de)elop a kind o" kidney (an(er (alled #ilmsN tumor.
?idney (an(er seldom (auses problems in its early stages. %ut as a tumor gro!s,
you may noti(e blood in your urine or e@perien(e unintentional !eight loss or ba(k
pain that doesnNt go a!ay. ?idney (an(er (ells may also spread (metastasiCe)
outside your kidneys to nearby organs as !ell as to more distant sites in the body.
7et i" kidney (an(er is dete(ted and treated early, the (han(es "or a "ull re(o)ery
are good.
Si#n$ and $+m"!om$
?idney (an(er rarely (auses signs or symptoms in its early stages. In the later
stages, the most (ommon sign o" both renal (ell and transitional (ell (an(ers is
blood in the urine (hematuria). 7ou may noti(e the blood !hen you urinate, or your
do(tor may dete(t it by urinalysis, a test that spe(i"i(ally (he(ks the (ontents o"
your urine. /ther possible signs and symptoms may in(lude:
, pain in the ba(k just belo! the ribs that doesnNt go a!ay
, mass in the area o" the kidneys thatNs dis(o)ered during an e@amination
#eight loss
'atigue
Intermittent "e)er
*ain in other parts o" the body i" the (an(er has metastasiCed
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#ilmsN tumor usually has no symptoms, and do(tors are likely to dis(o)er this
(ondition !hen e@amining a (hildNs abdomen.
,a&$e$
7our kidneys are part o" the urinary system, !hi(h remo)es !aste and e@(ess "luid
and ele(trolytes "rom your blood, (ontrols the produ(tion o" red blood (ells, and
regulates your blood pressure. Inside ea(h kidney are more than a million small
"iltering units (alled nephrons. ,s blood (ir(ulates through your kidneys, the
nephrons "ilter out !aste produ(ts as !ell as unneeded minerals and !ater. This
liEuid !aste P urine P "lo!s through t!o narro! tubes (ureters) into your
bladder, !here itNs stored until itNs eliminated "rom your body through another tube,
the urethra.
=enal (ell (ar(inoma, !hi(h a((ounts "or most kidney (an(ers, usually begins in
the (ells that line the small tubes (tubules) that make up a part o" ea(h nephron. In
most (ases, renal (ell tumors gro! as a single mass, but you may ha)e more than
one tumor in a kidney or de)elop tumors in both kidneys.
, "ar less (ommon type o" kidney (an(er, transitional (ell (ar(inoma, de)elops in
the tissue that "orms the tubes (onne(ting the kidneys to the bladder. Transitional
(ell (ar(inomas (an also begin in the ureters themsel)es or in the bladder. , rare
"orm o" kidney (an(er, renal sar(oma, begins in the (onne(ti)e tissue o" the kidney.
Hust !hat (auses kidney (ells to be(ome (an(erous isnNt (lear. %ut resear(hers ha)e
identi"ied (ertain "a(tors that appear to in(rease the risk o" de)eloping both renal
and transitional (ell kidney (an(ers.
R! Royal Taruma
The kidneys, ureters, bladder and urethra are the tubes and organs that "orm your
urinary system. 7our kidneys produ(e urine by "iltering !aste and "luid "rom your
blood.
R! Royal Taruma
7our urinary system, !hi(h in(ludes your kidneys, ureters, bladder and urethra, is
responsible "or remo)ing !aste "rom your body through urine. 7our kidneys,
lo(ated in your upper posterior abdomen, produ(e urine by "iltering !aste and "luid
"rom your blood.
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The kidneys are t!o bean+shaped organs near the middle o" your ba(k. They
(leanse your blood, help (ontrol blood pressure and regulate the produ(tion o" red
blood (ells.
Ri$( .a%!o$
The risk o" renal (ell (ar(inoma in(reases !ith age6 most kidney (an(ers o((ur in
people 40 and older. &en are more than t!i(e as likely as are !omen to de)elop
renal (ell (ar(inoma, and bla(k men ha)e a slightly higher risk than !hite men do.
/ther risk "a(tors "or renal (ell (ar(inoma in(lude:
Smo(in#@ mokers, espe(ially those !ho smoke pipes or (igars, are at greater
risk than nonsmokers are. The risk in(reases the longer you smoke and
de(reases a"ter you Euit, although it takes years to rea(h the same risk le)el as
someone !ho has ne)er smoked.
O'e$i!+@ , strong link bet!een e@(ess !eight and renal (ell (ar(inoma e@ists
in both men and !omen. In "a(t, obesity may a((ount "or as many as one+third
o" renal (ell (ar(inomas.
Hi#- 'lood "e$$&e 1-+"e!en$ion2@ <a)ing high blood pressure makes it
more likely youNll de)elop renal (ell (ar(inoma, and the risk in(reases "urther
i" youNre also o)er!eight. ,lthough treating high blood pressure appears to
redu(e this risk, diureti( medi(ations used to treat hypertension a(tually may
(ontribute to kidney (an(er.
En3ionmen!al !o<in$@ 1oal o)en !orkers in steel plants ha)e high rates o"
kidney (an(er. o do people !ho are e@posed to (admium, to organi( sol)ents
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su(h as tri(hloroethylene and to asbestos, a "ireproo"ing material that has also
been linked to lung (an(er.
Dial+$i$@ *eople !ho re(ei)e long+term dialysis to treat (hroni( renal "ailure
are at greater risk o" de)eloping kidney (an(er, possibly be(ause renal "ailure
depresses the immune system. *eople !ho ha)e a kidney transplant and
re(ei)e immunosuppressant drugs also are more likely to de)elop kidney
(an(er.
Radia!ion@ In some (ases, e@posure to radiation may in(rease your risk o"
kidney (an(er.
Von Hi""el*Linda& di$ea$e@ *eople !ith this inherited disorder are likely to
de)elop se)eral kinds o" tumors, in(luding, in some (ases, renal (ell
(ar(inoma.
Heedi!a+ "a"illa+ enal %ell %a%inoma@ <a)ing this inherited (ondition
makes it more likely youNll de)elop one or more renal (ell (ar(inomas, but
unlike people !ith 0on <ippel+>indau disease, youNre not at unusually high
risk o" other types o" tumors.
=isk "a(tors "or transitional (ell (ar(inoma in(lude:
,i#ae!!e $mo(in#@ This is the leading risk "a(tor "or transitional (ell
(ar(inomas. , history o" smoking (an Euadruple your risk o" this type o"
(an(er.
E<"o$&e !o ind&$!ial %-emi%al$@ These in(lude hea)y metals, asbestos and
aniline dyes.
Bladde %an%e@ *eople !ho ha)e bladder (an(er are more likely to de)elop
transitional (ell (ar(inoma o" the ureter or kidney as !ell as additional bladder
(an(ers. ,nd ha)ing transitional (ell kidney (an(er makes it more likely youNll
de)elop bladder (an(er.
P-ena%e!in@ ,lthough no longer a)ailable in the -nited tates, the analgesi(
medi(ation phena(etin has been kno!n to (ause kidney (an(er in some
people.
/-en !o $ee( medi%al ad3i%e
R! Royal Taruma
ee your do(tor right a!ay i" you noti(e blood in your urine. In most (ases, this
doesnNt mean you ha)e kidney (an(er. %lood in the urine may be a sign o" many
(onditions, in(luding a renal (yst P a non(an(erous lesion o" the kidney thatNs
(ommon in people older than 50 P bladder or kidney stones, prostate problems,
urinary tra(t in"e(tions or glomerulonephritis, a kidney disease that a""e(ts the
kidneysN "iltering "un(tion. In rare (ases, you may e)en noti(e blood in your urine
a"ter strenuous e@er(ise su(h as a marathon run.
I" you think you may be at risk o" de)eloping kidney (an(er, dis(uss your (on(erns
!ith your do(tor. <e or she may suggest !ays to redu(e your risk and (an s(hedule
regular (he(kups. #hen kidney (an(er is diagnosed early, itNs easier to treat and
your (han(es o" sur)i)al are good. /n(e (an(er has spread, ho!e)er, treatment is
more di""i(ult and the prognosis is less positi)e.
S%eenin# and dia#no$i$
In addition to taking a (omplete medi(al history and per"orming a physi(al e@am,
your do(tor !ill likely re(ommend blood and urine tests. I" your do(tor suspe(ts a
problem or i" you are at high risk o" kidney (an(er, you may also ha)e one or more
o" the "ollo!ing tests to (he(k "or gro!ths or tumors:
In!a3eno&$ "+elo#am 1IVP2@ In this test, a (ontrast dye is inje(ted into a
)ein in your arm. , series o" J+rays is taken as the dye mo)es through your
kidneys, ureters and bladder.
Ul!a$o&nd e<amina!ion@ ,n ultrasound isnNt an J+ray. Instead, it uses high+
"reEuen(y sound !a)es to generate images o" your internal organs, su(h as
your kidneys and bladder, on a (omputer s(reen.
,om"&!ei?ed !omo#a"-+ 1,T2 o ma#ne!i% e$onan%e ima#in# 1MRI2
$%an@ 1T s(ans use (omputers to (reate more detailed images than those
produ(ed by (on)entional J+rays. &=I s(ans use magneti( "ields and radio
!a)es to generate (ross+se(tional pi(tures o" your body.
Bio"$+@ In this test, a sample o" tissue is remo)ed and e@amined under a
mi(ros(ope. ItNs the only !ay to (on"irm the presen(e o" (an(er. %iopsies are
(ommonly per"ormed on tumors that de)elop in a ureter or in the kidney
pel)is P the area at the (enter o" the kidneys !here urine (olle(ts. , solid
kidney tumor, on the other hand, is o"ten remo)ed !ithout a biopsy be(ause
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these tumors are almost al!ays (an(erous and be(ause a needle biopsy may
spread (an(er (ells outside the biopsied kidney.
Te$!$ .o !an$i!ional %ell %an%e
I" the results o" an I0* suggest transitional (ell (an(er, your do(tor !ill likely
re(ommend a test that e@amines your bladder "or signs o" (an(er ((ystos(opy). In
this pro(edure, a long, narro! tube (alled a (ystos(ope is inserted through your
urethra into your bladder. The tube (arries a light sour(e and spe(ial lens, !hi(h
allo! your do(tor to inspe(t both your urethra and bladder. The (ystos(ope (an
also be used to remo)e a small tissue sample "rom a tumor. In some (ases, a
mi(ros(opi( e@amination o" the sediment in your urine may also help identi"y
(an(er (ells.
Te$!$ !o de!emine ;-e!-e %an%e -a$ $"ead
I" your do(tor "inds signs o" kidney (an(er, the ne@t step is to determine !hether
the (an(er has spread. This usually means more tests, in(luding additional blood
tests, an ultrasound o" your li)er, a 1T s(an, a (hest J+ray or a bone s(an. , bone
s(an is a test in !hi(h youNre gi)en a small amount o" a radioa(ti)e material thatNs
then taken up by your bones. Tumors absorb e)en more o" this material and sho!
up as a bla(k area !hen a spe(ial (amera s(ans your body.
Se%ond o"inion$
I" youN)e re(ei)ed a diagnosis o" kidney (an(er, you may !ant to seek a se(ond
opinion. ometimes your insuran(e (ompany may e)en reEuire you to do so. In that
(ase, your (urrent do(tor may be able to re(ommend other spe(ialists. In addition,
the 1an(er In"ormation er)i(e at (G00) D+1,.13=, or (G00) D22+429F, (an
pro)ide in"ormation on treatment (enters. 7ou (an also get a list o" do(tors "rom
your lo(al hospital or a nearby medi(al s(hool.
Tea!men!
Together, you and your treatment team P !hi(h may in(lude a surgeon, a do(tor
!ho spe(ialiCes in disorders o" the urinary organs (urologist), a (an(er spe(ialist
(on(ologist) and an on(ologist !ho spe(ialiCes in treating (an(er !ith radiation
(radiation on(ologist) P !ill dis(uss all o" your options. The best approa(h "or you
may depend on a number o" "a(tors, in(luding your general health, the kind o"
kidney (an(er you ha)e and !hether the (an(er has spread.
Kepanieraan Radiologi $0
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Renal %ell %a%inoma
Treatments "or renal (ell (ar(inoma in(lude:
S&#i%al emo3al@ -ntil re(ently, the standard treatment "or (an(er that
!as (on"ined to the kidney !as surgi(al remo)al o" the entire kidney
(radi(al or simple nephre(tomy). In a radi(al nephre(tomy, surgeons
remo)e the kidney along !ith the adrenal gland that sits atop the kidney, a
border o" normal tissue and adja(ent lymph nodes. , simple nephre(tomy
in)ol)es remo)ing the entire kidney, although not the adrenal gland or
lymph nodes. %ut studies sho! that remo)ing just the tumor (nephron+
sparing surgery), rather than the !hole kidney, results in sur)i)al rates
similar to those o" more radi(al pro(edures. In addition, people !ho ha)e
nephron+sparing surgery appear less likely to de)elop (hroni( kidney "ailure
and are more likely to enjoy a better Euality o" li"e than do those !ho ha)e
the !hole kidney remo)ed.
ometimes surgeons may (hoose to remo)e the entire kidney be(ause o" the
e@tent and the lo(ation o" the tumor. In that (ase, laparos(opi( nephre(tomy
may o""er ad)antages o)er traditional open surgery be(ause it typi(ally
results in less postoperati)e pain, "aster re(o)ery time and less s(arring. In a
laparos(opi( pro(edure, a tiny (amera is inserted into your body through a
small in(ision. The (amera transmits )ideo images that allo! your surgeon
to see the kidney in great detail. The surgeon inserts surgi(al instruments
through t!o or three additional small in(isions and per"orms the operation.
The re(o)ery time and side e""e(ts o" any type o" kidney surgery !ill )ary,
but itNs likely youNll "eel tired and !eak "or a time, e)en !ith laparos(opi(
nephre(tomy.
A!eial em'oli?a!ion@ In this pro(edure, a radiologist inje(ts a spe(ial
material into the main blood )essel leading to the kidney. %y (logging this
)essel, the tumor is depri)ed o" o@ygen and other nutrients. ,rterial
emboliCation may be used be"ore an operation or to relie)e pain and bleeding
!hen an operation isnNt possible. ide e""e(ts may in(lude temporary nausea,
)omiting or pain.
Radia!ion !-ea"+@ This therapy uses radiation to kill (an(er (ells. ItNs
usually used to relie)e pain !hen kidney (an(er has spread to the bones. In
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general, youNll re(ei)e radiation treatment at a (lini( or hospital on an
outpatient basis P o"ten "i)e days a !eek "or se)eral !eeks. The e""e(ts o"
radiation are (umulati)e, and you may be(ome )ery tired in the last "e!
!eeks o" treatment. The skin in the treated area may be(ome red, tender or
it(hy, and you also ha)e other side e""e(ts, su(h as nausea and )omiting.
Imm&no!-ea"+@ This treatment uses your bodyNs immune system to "ight
(an(er. ,n on(ologist may administer a substan(e kno!n as a biologi(al
response modi"ier, su(h as inter"eron or interleukin+2. .ormally produ(ed by
the body, these substan(es are also made in laboratories. tudies sho! that
people may do better !hen theyNre treated !ith both inter"eron and surgery,
rather than !ith inter"eron alone. %iologi(al response modi"iers (an ha)e
serious side e""e(ts, in(luding (hills, "e)er, nausea, )omiting and loss o"
appetite. 7ou may bruise easily a"ter treatment and "eel e@tremely tired.
Interleukin+2 and inter"eron therapies (an also a""e(t li)er and kidney
"un(tion. These side e""e(ts are o"ten se)ere, but usually disappear on(e
treatment is stopped.
,-emo!-ea"+@ This therapy, !hi(h uses drugs to atta(k rapidly di)iding
(ells, hasnNt pro)ed parti(ularly use"ul "or renal (ell (ar(inoma.
Tan$i!ional %ell %an%e
To treat transitional (ell (an(er in its early stages, surgeons remo)e an area
surrounding the tumor !hile trying to sa)e the kidney itsel". I" the tumor is too
large or too (entrally lo(ated, the kidney and ureter may need to be remo)ed along
!ith the portion o" the bladder thatNs (onne(ted to the ureter. This helps de(rease
the risk o" (an(er (ells spreading to the bladder. 1hemotherapy is o"ten used to
treat transitional (ell (an(er that has spread.
/ilm$= !&mo
Treatment "or (hildren !ith #ilmsN tumor depends on the (hildNs age and o)erall
health, the type o" tumor and !hether the (an(er has spread. In many (ases,
treatment may in(lude surgi(al remo)al o" the tumor "ollo!ed by (hemotherapy or
radiation.
,lini%al !ial$
I" kidney (an(er has spread, standard treatments are seldom e""e(ti)e. 'or that
reason, you may (hoose to parti(ipate in a (lini(al trial. These trials test the
Kepanieraan Radiologi $#
R! Royal Taruma
e""e(ti)eness and side e""e(ts o" ne! treatments. Those !ho take part ha)e a
(han(e to re(ei)e a treatment that may be promising but not yet !idely a)ailable. I"
youNre interested in (lini(al trials, talk to your do(tor. 7ou (an also (onta(t the
.ational 1an(er Institute "or detailed in"ormation, or )isit the (lini(al trials page on
its #eb site.
Pe3en!ion
,lthough the "ollo!ing steps may not pre)ent kidney (an(er, they (an help redu(e
your (an(er risk and keep you healthier o)erall:
A&i! $mo(in#@ mokers are nearly t!i(e as likely to de)elop kidney (an(er as
nonsmokers are. Talk to your do(tor about the best !ays to stop smoking.
Ea! moe .&i!$ and 3e#e!a'le$@ In the past, some studies ha)e sho!n that a
diet ri(h in "ruits and )egetables may help prote(t against kidney (an(er. ,
2005 !edish study looked at !hi(h types o" produ(e might o""er the most
bene"its. The study "ound an o)erall asso(iation bet!een (onsumption o"
"ruits and )egetables and a lo!er risk o" kidney (an(er. 'urther, the study
"ound the strongest asso(iation !as "or study parti(ipants eating bananas and
root )egetables, in(luding beets and (arrots.
S!a+ "-+$i%all+ a%!i3e@ ,n a(ti)e li"estyle redu(es your risk o" kidney (an(er
and helps you lo!er your blood pressure and maintain a healthy !eight. ,im
"or at least 90 minutes o" e@er(ise on most days. I" you ha)enNt been a(ti)e
be"ore, start out slo!ly, and gradually in(rease the amount o" time you
e@er(ise. Try to in(lude !eight+bearing e@er(ises, su(h as !alking, jogging or
dan(ing as !ell as some strength+training e@er(ises in your routine. trength
training has been "ound to redu(e stress e)en more than aerobi( e@er(ise does,
and it has the added bene"it o" helping keep your bones strong.
Main!ain a -eal!-+ ;ei#-!@ There is a (lear link bet!een !eighing more
than is healthy "or you and kidney (an(er.
Red&%e o a3oid e<"o$&e !o en3ionmen!al !o<in$@ I" you must !ork !ith
to@i( (hemi(als, take spe(ial pre(autions su(h as !earing a mask and hea)y
glo)es.
Red&%e -i#- 'lood "e$$&e@ I" you ha)e, or think you may ha)e, high blood
pressure P !hi(h has been linked to renal (ell (ar(inoma in men P talk to
your do(tor. 8iet and e@er(ise (an (ontrol high blood pressure in many (ases.
Kepanieraan Radiologi $'
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Sel.*%ae
3ating !ell, managing stress and e@er(ising are !ays to promote your o)erall
health and (ope !ith any "orm o" (an(er.
Ea!in# ;ell
;ood nutrition is espe(ially important "or people undergoing (an(er treatment. %ut
eating !ell (an be di""i(ult, espe(ially i" your treatment in(ludes (hemotherapy or
radiation treatment. 7ou may "eel nauseated or lose your appetite, and "oods may
seem tasteless. 7ou may "ind that the last thing you !ant to do is plan meals.
3)en so, eating !ell during (an(er treatment (an help you maintain your stamina
and your ability to (ope !ith the side e""e(ts o" treatments. ;ood nutrition may also
help you pre)ent in"e(tions and remain more a(ti)e.
=emember these strategies "or eating !ell !hen you donNt "eel !ell:
Ea! "o!ein*i%- .ood$@ 'oods high in protein (an help build and repair body
tissues. 1hoi(es in(lude eggs, yogurt, (ottage (heese, peanut butter, poultry
and "ish. ?idney beans, (hi(kpeas and bla(k+eyed peas also are good sour(es
o" protein, espe(ially !hen (ombined !ith ri(e, (orn or bread.
Kee" an o"en mind a'o&! !-e .ood$ +o& mi#-! ea!@ 'oods that are
unappealing today might taste better to you ne@t !eek.
/-en +o& do .eel ;ell5 ma(e !-e mo$! o. i!@ 3at as many healthy "oods as
you (an. *repare meals that you (an easily "reeCe and reheat. ,lso look "or
lo!+"at "roCen dinners and other prepared "oods.
Gi3e meal$ a "lea$an! a!mo$"-ee@ #hene)er possible, eat at a table set
!ith attra(ti)e dishes and "lo!ers.
Pa%( %aloie$ in!o !-e .ood$ +o& ea!@ 'or e@ample, spread butter, jam or
honey on bread. prinkle "oods !ith (hopped nuts.
Ea! $malle amo&n!$ o. .ood moe .e8&en!l+@ I" you (anNt "a(e the thought
o" a large meal, try eating small amounts o" "ood more o"ten. ?eep "ruits and
)egetables handy "or sna(king.
Mana#in# $!e$$
&ethods "or redu(ing physi(al tension (an help you manage stress. /ne simple and
po!er"ul te(hniEue is to simply (lose your eyes and noti(e your breathing. *ay
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attention to ea(h inhalation and e@halation. 7our breathing !ill be(ome slo!er and
deeper, promoting rela@ation. ,nother te(hniEue is to lie do!n, (lose your eyes and
mentally s(an your entire body "or any points o" tension.
E<e%i$e
In addition, a(ti)ities that reEuire repetiti)e mo)ements, su(h as running and
s!imming, (an produ(e a mental state similar to meditation. o (an yoga and other
stret(hing e@er(ises.
7our do(tor may ha)e more spe(i"i( suggestions about ho! to best (are "or
yoursel" be"ore, during and a"ter treatment "or kidney (an(er.
R 199G+2004 &ayo 'oundation "or &edi(al 3du(ation and =esear(h (&'&3=).
,ll rights reser)ed. , single (opy o" these materials may be reprinted "or
non(ommer(ial personal use only. O&ayo,O O&ayo 1lini(,O O&ayo1lini(.(om,O
O&ayo 1lini( <ealth In"ormation,O O=eliable in"ormation "or a healthier li"eO and
the triple+shield &ayo logo are trademarks o" &ayo 'oundation "or &edi(al
3du(ation and =esear(h. Terms o" use.
=enal (ell (ar(inoma (=11) is the most (ommon primary renal malignant neoplasm
in adults.It a((ounts "or appro@imately 90% o" renal tumors and 2% o" all adult
malignan(ies. =11 is more (ommon in men than in !omen (ratio, 1.4:1), and it most
o"ten o((urs in patients aged 55+GD years. ,ppro@imately 5F,F40 ne! (ases o" =11
and 12,9G0 deaths are e@pe(ted to ha)e o((urred in the -nited tates in 2009. /ne
"ourth to one third o" patients present !ith metastati( disease. In only appro@imately
2% o" (ases are bilateral tumors seen at presentation. In re(ent years tumors are being
dis(o)ered at an earlier stage, possibly due to in(reased use o" medi(al imaging in
general.
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=isk "a(tors in(lude in(reased age6 male se@6 smoking6 (admium, benCene,
tri(hloroethylene, and asbestos e@posure6 e@(essi)e !eight6 (hroni( dialysis use6 and
se)eral geneti( syndromes ("amilial =11, hereditary papillary =11, )on <ippel+
>indau syndrome, and tuberous s(lerosis).
1,2
,a$e B@ La#e enal %ell %a%inoma@ T-ee*min&!e !omo#am@
,a$e B@ La#e enal %ell %a%inoma@ Dela+ed in!a3eno&$ &o#a"-i% ima#e@
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,a$e B@ La#e enal %ell %a%inoma@ ,on!a$!*en-an%ed %om"&!ed !omo#a"-+
1,T2 $%an@
Re%en! $!&die$
/li)a et al (ompared the (hara(teristi(s on &=I o" papillary renal (ell tumors and
(lear (ell tumors and noted that they had a similar appearan(e and signal intensity
ratio on T1+!eighted images, but on T2+!eighted images, most papillary tumors !ere
hypointense and most (lear (ell tumors !ere hyperintense. , tumor T2 signal
intensity ratio o" 0.44 or less had a spe(i"i(ity o" 100% and a sensiti)ity o" 5D% "or
papillary tumors.
9
,((ording to ;uCCo et al, multidete(tor 1T !ith 9+dimensional mapping is e""e(ti)e
in a((urately (hara(teriCing the le)el o" )enous thrombus in patients !ith renal (ell
(ar(inoma. #hen e@(luding patients !ith segmental )enous in)ol)ement only, the
(on(ordan(e rate bet!een multidete(tor 1T and pathologi( "indings !as GD%, and
multidete(tor 1T predi(ted the le)el o" tumor thrombus in 24 o" 2F patients (94%).
The in)estigators noted that in patients !ith renal (ell (ar(inoma in !hom
multidete(tor 1T "ails to dete(t tumor thrombus, it is unlikely that a tumor thrombus
!ill be "ound at surgery that !ould (hange the surgi(al approa(h.
D
Taouli et al (ompared di""usion+!eighted &=I !ith (ontrast+enhan(ed &=I to
(ompare the ability to diagnose renal lesions. They "ound that although di""usion+
!eighted images (an be used to (hara(teriCe renal lesions (eg, di""erentiate solid
tumors "rom on(o(ytomas and (hara(teriCe histologi( subtype), su(h images are less
a((urate than (ontrast+enhan(ed images. The area under the (ur)e (,-1), sensiti)ity,
and spe(i"i(ity o" di""usion+!eighted imaging !ere 0.G54, G4%, and G0%,
respe(ti)ely, !hereas the ,-1, sensiti)ity, and spe(i"i(ity o" (ontrast+enhan(ed &=
imaging !ere 0.9DD, 100%, and G9%, respe(ti)ely.
5
Kepanieraan Radiologi $$
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Pa!-o"-+$iolo#+
=11s arise "rom the tubular epithelium and are usually based in the renal (orte@.
e)eral pathologi( subtypes ha)e been des(ribed, in(luding the (lear (ell, papillary,
granular (ell, (hromophobe (ell, sar(omatoid, and (olle(ting du(t subtypes. These
tumors )ary "rom being nearly (ompletely (ysti( to being (ompletely solid. The
imaging "eatures re"le(t this heterogeneity. %ilateral =11s are (ommon in )on
<ippel+>indau syndrome, tuberous s(lerosis, and (hroni( dialysis6 ho!e)er, bilateral
=11s o((ur in only appro@imately 2% o" (ases. =11s are multi(entri( in as many as
25% o" patients.
pread by means o" dire(t lo(al in)asion o" adja(ent stru(tures, su(h as the adrenal
glands, li)er, spleen, (olon or pan(reas, (an o((ur. >o(al regional lymph node
metastases are also (ommon. =11s ha)e a propensity to e@tend into the renal )ein
and, subseEuently, into the in"erior )ena (a)a. The lungs are the most (ommon sites
o" distant metastases. >i)er, bone, adrenal gland, and kidney metastases may also
o((ur. Typi(ally, skeletal metastases are purely lyti(.
=11s (an be staged by using the ,meri(an Hoint 1ommittee on 1an(er T.& (T
umor, N ode, M etastases) (lassi"i(ation, as "ollo!s:
tage 1 =11s are F (m or smaller and (on"ined to the kidney.
tage 2 =11s are larger than F (m but still organ (on"ined.
tage 9 tumors e@tend into the renal )ein or )ena (a)a, in)ol)e the ipsilateral
adrenal gland andAor perinephri( "at, or ha)e spread to one lo(al lymph node.
tage D tumors e@tend beyond the ;erota "as(ia, to more than one lo(al node
or ha)e distant metastases.
=e(ent literature has Euestioned !hether the (uto"" in siCe "or stage 1 and 2 tumors
should be 5 (m instead o" F (m.
Fe8&en%+
Uni!ed S!a!e$
=11 a((ounts "or appro@imately 2% o" adult malignan(ies, !ith about 5F,F40 ne!
(ases and 12,9G0 deaths e@pe(ted to ha)e o((urred in the -nited tates in 2009.
mall =11s are "ound at autopsy in as many as 22% o" (ases.
Mo!ali!+CMo'idi!+
The prognosis o" patients !ith =11 depends on its stage at diagnosis.
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The prognosis is !orst "or patients !ith metastati( disease at presentation and
best "or patients !ith small masses (on"ined to the kidney.
The siCe o" the primary lesion also a""e(ts the prognosis be(ause larger lesions
tend to be higher grade and metastasiCe more "reEuently. *oorly marginated or
ne(roti( lesions also tend to be o" higher grade.
I" rese(tion is attempted, the 5+ and 10+year sur)i)al rates "or stage T1 (an(ers
are 95% and 91%, respe(ti)ely. 'or T2 (an(ers, the 5+ and 10+year sur)i)al
rates are G0% and F0%, respe(ti)ely. -nrese(table =11s are asso(iated !ith a
5+year sur)i)al rate o" less than 20%.
Ra%e
.o signi"i(ant di""eren(es in in(iden(e based on ra(e are reported.
Se<
=11 is more (ommon in men than in !omen, !ith a male+to+"emale ratio o"
appro@imately 1.4:1.
A#e
The in(iden(e peaks in patients aged 55+GD years, but the age distribution is broad.
=11 rarely o((urs in young (hildren and is un(ommon in adults younger than D5
years.
Ana!om+
The kidney is a retroperitoneal stru(ture surrounded by a "ibrous (apsule and
en(losed in the perirenal spa(e !ith the adrenal gland and "at. In the general
population, F0%+G0% o" indi)iduals ha)e single renal arteries to ea(h kidney. The
remaining population has multiple renal arteries. &ultiple renal )eins are rarer,
o((urring in appro@imately 10% o" patients. The )as(ular anatomy be(omes
important !hene)er minimally in)asi)e surgery or nephron+sparing surgery is
(onsidered be(ause (ontrol o" potentially bleeding )essels is paramount.
Pe$en!a!ion
1lini(ally, patients present !ith hematuria, "lank pain, or (less "reEuently than in the
past) a "lank mass. 1urrently, nearly hal" o" =11s are dis(o)ered in(identally during
imaging "or indi(ations other than the assessment o" =11. In one series, 0.9% o" all
1T s(ans demonstrated in(idental =11. In(idental dete(tion has also in(reased on
ultrasound (-) images. /((asionally, patients present !ith systemi( symptoms su(h
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as "e)er, nausea, anore@ia, and !eight loss. =arely, patients ha)e symptoms related to
humoral "a(tors su(h as parathyroid hormone, prola(tin, erythropoietin, or renin.
4,F
Pe.eed E<amina!ion
,lthough a )ariety o" e@aminations (ultrasound S-T, magneti( resonan(e imaging
S&=IT, angiography) (an be used in the !orkup o" patients !ith suspe(ted =11, the
pre"erred method o" imaging these patients is dedi(ated renal (omputed tomography
(1T). In most (ases, this single e@amination (an be used to dete(t and stage =11 and
to pro)ide in"ormation "or surgi(al planning !ithout additional imaging.
D,G,9
In the "e! patients in !hom the 1T "indings are eEui)o(al, &=I or - (an be use"ul.
=e(ent literature suggests a use "or (ontrast+enhan(ed 8oppler - "or lesions that
sho! eEui)o(al enhan(ement at 1T. ,ngiography is rarely used in the !orkup o"
suggested =11, but it (an pro)ide in"ormation about the origin o" the tumor in
troublesome (ases. ,t present, no a((epted proto(ol has been de)eloped "or =11
s(reening among asymptomati( indi)iduals in the general population. *atients !ith a
hereditary predisposition "or =11 should be periodi(ally e@amined by using
dedi(ated renal 1T.
,a$e 9@ La#e enal %ell %a%inoma@ Dela+ed !omo#am@
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,a$e 9@ La#e enal %ell %a%inoma@ Sono#am@
,a$e 9@ La#e enal %ell %a%inoma@ ,on!a$!*en-an%ed ,T $%an@
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,a$e >@ Small le.! enal %ell %a%inoma i$ $&'!le on !-i$ in!a3eno&$ &o#a"-i%
ima#e@
,a$e >@ Small enal %ell %a%inoma@ Tomo#am@
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,a$e >@ Small enal %ell %a%inoma@ ,on!a$!*en-an%ed ,T $%an@
Limi!a!ion$ o. Te%-ni8&e$
The primary limitation o" 1T is the (hara(teriCation o" hypoattenuation in masses
smaller than G+10 mm, in !hi(h pseudoenhan(ement may be a problem. In these
(ases, - may be o" some use in (hara(teriCing the lesions as (ysts. In addition,
spread to regional lymph nodes in the absen(e o" lymph node enlargement (an be
missed. I" (ontrast material (annot be intra)enously administered, 1T is a poor (hoi(e
"or e)aluating renal masses. &=I should be per"ormed instead.
The primary limitations o" - in(lude problems related to in(omplete staging (bones,
lungs, regional nodes) and to the dete(tion o" small nonM(ontour+de"orming masses.
In addition, large patients are not good (andidates "or - be(ause o" te(hni(al
di""i(ulties in obtaining adeEuate images.
&=I is limited by patient (ooperation be(ause &=I is more sensiti)e to motion
arti"a(t than 1T. <o!e)er, ad)an(es in te(hniEues "or limiting motion, as !ell as
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te(hniEues that allo! "ree breathing, may ob)iate these limitations. <o!e)er, &=I is
still more e@pensi)e and less readily a)ailable than 1T. 'urthermore, patients !ith
pa(emakers, those !ith (ertain types o" medi(al implants, and those !ith se)ere
(laustrophobia are e@(luded "rom undergoing &=I.
Pa!ien! Ed&%a!ion7 'or e@(ellent patient edu(ation resour(es, )isit e&edi(ineNs
1an(er and Tumors 1enter. ,lso, see e&edi(ineNs patient edu(ation arti(le =enal 1ell
1an(er.
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