Renal cell carcinoma: Presentation, Evaluation and Operative management

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Matar,Awadalla Musa Abbakar
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This is a retrospective hospital-based study to determine the presentation and operative management of renal cell carcinoma. The records of Patients who presented to Urology Departments of Soba University Hospital and Ibn Sina Specialized Hospital in addition to Khartoum Radio-Isotope Center in the period from Jan. 2000 to Nov. 2003 were reviewed. Sixty patients were included in the study. The mean age was 55 years ± 15.6 standard deviation with male : female ratio of 1.6:1. The main presenting symptoms were flank pain (86.7%), haematuria (56.7%) and weight loss (46.7%). Thirty-five percent of patients presented with classical RCC triad (flank pain, haematuria, abdominal mass). Twenty-one percent of patients presented with metastatic disease. Common sites for metastasis were lungs (77%), bone (15.3%) and liver (7.7%). 7 Paraneoplastic syndromes including anaemia (29%), cachexia (33%), pyrexia (9%), hypertension (2%) and an ipsilateral varicocele in males (3%) were a frequent mode of presentation. The main curative surgical procedure was radical nephrectomy, which was performed in 35 patients (66%). In seventeen patients (32%) nothing could be done at laparatomy apart from a biopsy and in one patient (2%) even a biopsy was technically difficult to obtain because the tumour was highly vascular. The ipsilateral adrenal gland was removed in all radical nephrectomies. We concluded that RCC presents late. Part of this delay was attributable to lack of awareness regarding the seriousness of haematuria by general practitioners and paramedical personnel working in peripheral hospitals. The preoperative staging was inadequate and consequently the intraoperative decision of non-operability was inappropriately high.
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Renal cell carcinoma;Cigarette smoking;Obesity;Renal dialysis;Tuberous sclerosis