The first steps taken to diagnose this condition are consideration of the signs and symptoms, and a medical history (the detailed medical review of past health state) to evaluate any risk factors. Based on the symptoms presented, a range of biochemical tests (using blood and/or urine samples) may also be considered as part of the screening process to provide sufficient quantitative analysis of any differences in electrolytes, kidney and liver function, and blood clotting times. Upon physical examination, palpation of the abdomen may reveal the presence of a mass or an organ enlargement. Although this disease lacks characterization in the early stages of tumor development, considerations based on diverse clinical manifestations, as well as resistance to radiation and chemotherapy are important. The main diagnostic tools for detecting<unk>  are ultrasound, computed tomography (CT) scanning and magnetic resonance imaging (MRI) of the kidneys. Classification<unk>  <unk>  is not a single entity, but rather a collection of different types of tumours, each derived from the various parts of the nephron (epithelium or renal tubules) and possessing distinct genetic characteristics, histological features, and, to some extent, clinical phenotypes. Classification of the Common Histological Subtypes of<unk> <unk>  Subtype Frequency Genetic Abnormalities Characteristics Clear Cell<unk>  (CCRCC) Generally the cells have a clear cytoplasm, are surrounded by a distinct cell membrane and contain round and uniform nuclei. 60–70% * Alterations of chromosome 3p segments occurs in 70–90% of CCRCCs * Inactivation of von Hippel–Lindau (VHL) gene by mutation and promoter hypermethylation * Gain of chromosome 5q * Loss of chromosomes 8p, 9p, and 14q * In 2009–2010, five new frequently mutated genes were discovered in CCRCC; KDM6A/UTX, SETD2, KDM5C/JARID1C, and MLL2 * CCRCC is derived from the proximal convoluted tubule * Most commonly affects male patients in their sixties and seventies * Majority of CCRCC arise sporadically * Only 2 – 4% of the cases presenting as part of an inherited cancer syndrome Papillary<unk>  (PRCC) papillae covered with a single or double layer of small cuboid cells with scanty cytoplasm and Type 2 PRCC consist of papillae covered by large eosinophilic cells arranged in an irregular or pseudostratified manner. 10–15% * Trisomy of chromosomes 7 and 17, loss of chromosome Y in men in sporadic PRCC * Trisomy of chromosome 7 in hereditary PRCC * Gain of chromosomes 12, 16, and 20 * Rare mutations of Met proto-oncogene * PRCC is derived from the distal convoluted tubule * PRCCs most commonly affect males in their sixties and seventies * Less aggressive tumour than clear cell<unk> , with 5-year survival rates of 80% to 85%. * Majority of tumours occur sporadically, but some may develop in members of families with hereditary PRCC Chromophobe<unk>  (ChRCC) ChRCC consists of tumor cells with abundant eosinophilic cytoplasm (pale cells and eosinophilic cells with a perinuclear halo) and show mainly a solid structure. 3–5% * Loss of chromosomes Y, 1, 2, 6, 10, 13, 17, and 21 * ChRCC is derived from the cortical collecting duct * ChRCC has a much better prognosis than clear cell and papillary<unk> , with 5-year survival rate of greater than 90%. * Most cases arise sporadically, while some familial cases are associated with Birt–Hogg–Dube (BHD) syndrome Clinical, Pathological and Genetic Features of Uncommon<unk>  Subtypes Included in the 2004 WHO Classification of<unk>  Pathology<unk>  subtype Clinical features Cell/Tissue Characteristics Genetics Prognosis Multilocular Cystic<unk>  * Variant of CCRCC (5% of CCRCC) * Mean age 51 years (range 20–76) * Male:female = 2–3:1 Clear cytoplasm, small dark nuclei 3p deletion as observed in CCRCC * Favorable * No local or distant metastasis after complete surgical removal Carcinoma of the Collecting Ducts of Bellini * Less than 1% of all renal tumors; arising in the collecting ducts of Bellini * Mean age 55 years (range 40–70) * Male:female = 2:1 High-grade tumor cells with eosinophilic cytoplasm Variable results: LOH on chromosomes 1q, 6p, 8p,9p, 13q, 19q32 and 21q; c-erB2 amplification associated with unfavorable outcome * Poor prognosis * 1/3 presenting with metastasis * 2/3 patients succumb to the disease within 2 years of diagnosis Medullary Carcinoma * Exceedingly rare; almost exclusively in patients with sickle cell hemoglobinopathies or traits * Majority are African-Americans * Mean age 19 years (5–69) * Male:female = 2:1 Haemorrhage and necrosis, high-grade tumour cells with eosinophilic cytoplasm Not well defined * Highly aggressive * 95% presenting with metastasis * Often succumb to the disease within 6 months of diagnosis Xp11.2 Translocation Carcinoma * Predominantly affecting children and young adults * Accounts for 40% of<unk> s in this age group * Affects adult patients with a striking female predominance * May resemble PRCC * Clear and eosinophilic cells Chromosomal translocation involving TFE3 gene on Xp11.2 resulting in overexpression of the TFE3 protein * Present at advanced stage, but with indolent clinical course in children * Adult patients may pursue more aggressive course Mucinous Tubular Spindle Cell Carcinoma * Mean age 53 years (range 13–82) * Affects predominantly female patients (male:female = 1:4) incidental finding in most cases Tubules, extracellular mucin and spindle cells Not well defined; Losses involving chromosomes 1, 4, 6, 8, 9, 11, 13, 14, 15, 18, 22 reported; 3p alterations and gain of chromosome 7, and 17 not present * Favourable * Majority of patients remain disease free after surgical resection Post-Neuroblastoma<unk>  * Mean age of<unk>  diagnosis is 13.5 years (range 2–35) Eosinophilic cells with oncocytoid features (same as CCRCC) Not well defined; Loss of multiple chromosomal loci observed Similar to other common<unk>  subtypes Array-based karyotyping can be used to identify characteristic chromosomal aberrations in renal tumors with challenging morphology. Array-based karyotyping performs well on paraffin embedded tumours and is amenable to routine clinical use. See also Virtual Karyotype for CLIA certified laboratories offering array-based karyotyping of solid tumours. The 2004 World Health Organization (WHO) classification of genitourinary tumours recognizes over 40 subtypes of renal neoplasms. Since the publication of the latest iteration of the WHO classification in 2004, several novel renal tumour subtypes have been described: * Clear cell papillary<unk>  and Clear cell<unk>  with smooth muscle stroma * Mucinous tubular and spindle cell carcinoma (MTSCC) * Multilocular cystic clear cell<unk>  * Tubulocystic<unk>  * Thyroid-like follicular<unk>  * Acquired cystic kidney disease-associated<unk>  *<unk>  with t(6;11) translocation (TFEB) * Hybrid oncocytoma/chromophobe<unk>  * Hereditary leiomyomatosis and<unk> (HLRCC) Laboratory tests Laboratory tests are generally conducted when the patient presents with signs and symptoms that may be characteristic of kidney impairment. They are not primarily used to diagnose kidney cancer, due to its asymptomatic nature and are generally found incidentally during tests for other illnesses such as gallbladder disease. In other words, these cancers are not detected usually because they do not cause pain or discomfort when they are discovered. Laboratory analysis can provide an assessment on the overall health of the patient and can provide information in determining the staging and degree of metastasis to other parts of the body (if a renal lesion has been identified) before treatment is given. Urine analysis The presence of blood in urine is a common presumptive sign of<unk> . The haemoglobin of the blood causes the urine to be rusty, brown or red in colour. Alternatively, urinalysis can test for sugar, protein and bacteria which can also serve as indicators for cancer. A complete blood cell count can also provide additional information regarding the severity and spreading of the cancer. Complete blood cell count The CBC provides a quantified measure of the different cells in the whole blood sample from the patient. Such cells examined for in this test include red blood cells (erythrocytes), white blood cells (leukocytes) and platelets (thrombocytes). A common sign of<unk>  is anaemia whereby the patient exhibits deficiency in red blood cells. CBC tests are vital as a screening tool for examination the health of patient prior to surgery. Inconsistencies with platelet counts are also common amongst these cancer patients and further coagulation tests, including Erythrocyte Sedimentation Rate (ESR), Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT) should be considered. Blood chemistry Blood chemistry tests are conducted if<unk>  is suspected as cancer has the potential to elevate levels of particular chemicals in blood. For example, liver enzymes such as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are found to be at abnormally high levels. The staging of the cancer can also be determined by abnormal elevated levels of calcium, which suggests that the cancer may have metastasised to the bones. In this case, a doctor should be prompted for a CT scan. Blood chemistry tests also assess the overall function of the kidneys and can allow the doctor to decide upon further radiological tests. Radiology The characteristic appearance of<unk>  <unk>  is a solid
Renal cell carcinoma
Renal medullary carcinoma
Renal oncocytoma
Papillary renal cell carcinoma
Renal anaplastic sarcoma
Renal medullary fibroma
Clear cell renal cell carcinoma
Clear cell papillary renal cell carcinoma