Question 4#

Which of the following statements about kidney cancer is FALSE?

a. Lesions are usually solid but can be cystic
b. May be sporadic or hereditary
c. Surgical debulking can improve survival in patients who present with metastatic disease
d. Patients are not curable (and therefore should not be operated on) if tumor thrombus extends proximally into the vena cava

Correct Answer is D


Renal tumors are usually solid, but they also can be cystic. Most cases of renal cell carcinoma (RCC) are sporadic, but many hereditary forms have been described. Up to 20 to 30% of patients may present with metastatic disease, in which case, surgical de bulking can improve survival, as shown in randomized controlled trials. Up to 10% of RCC invades the lumen of the renal vein or vena cava. The degree of venous extension directly impacts the surgical approach. Patients with thrombus below the level of the liver can be managed with crossclamping above and below the thrombus and extraction from a cavotomy at the insertion of the renal vein.