+ General Considerations
- Renal pelvis TCC are pedunculated, multilobulated, and locally aggressive
- Metastatic rate of renal pelvic TCC is lower than renal carcinoma in dogs, but higher in cats
- Renal pelvic tumors may be associated with struvite calculi because of urothelial irritation by renal calculi resulting in squamous metaplasia and malignant transformation of the urothelium
- Prognostic factors in humans include multifocality, tumor grade and stage, DNA ploidy, and history of bladder TCC
DIAGNOSIS
+ CLINICAL SIGNS
- Clinical signs are non-specific such as abdominal enlargement and abdominal pain
- Urinary signs are uncommon
- Lameness caused by either skeletal metastases or hypertrophic osteopathy
+ Urinalysis and Urine Sediment Cytology
- Proteinuria is a common finding with renal tumors
- Hematuria is uncommon with renal carcinoma, but can be seen with HSA, hemangioma, and renal pelvis TCC
- Urine sediment cytology is rarely diagnostic for renal tumors
+ Blood Tests
- Hematology and serum biochemistry findings are usually normal or non-specific
- Mild-to-moderate normochromic, normocytic anemia can be caused by either hematuria or bone marrow suppression secondary to chronic disease
- Polycythemia is a reported paraneoplastic syndrome with renal tumors
- Uremia may result from obstruction of urinary outflow, bilateral renal tumors, or age-related renal failure
Imaging
+ General Considerations
- Survey abdominal and thoracic radiographs, contrast radiography, ultrasonography, CT, and MRI are imaging modalities used to identify the presence and extent of renal tumors
+ Survey Abdominal Radiography
- Survey abdominal radiographic findings: sublumbar lymph node enlargement, renomegaly, and skeletal metastases, especially lumbar vertebrae and pelvis
- Abdominal mass is identified in 81% and localized to the kidney in 54% of dogs with primary renal tumors
- Focal mineralization can be observed but difficult to differentiate tumor from renal calculi and GI opacities
+ Excretory Urography
- Excretory urographic findings: space occupying renal mass, variable opacification of the renal parenchyma, and distortion of the renal pelvis
- Excretory urography successfully identifies a renal mass in 96% dogs with primary renal tumors
+ Ultrasonography
- Ultrasonography results in earlier diagnosis and more successful treatment of renal neoplasia in humans
- Renal tumors, except for LSA, produce a mixed echogenicity with disruption of the normal renal architecture
- Renal LSA is usually hypoechoic
- Ultrasonography is also useful in detecting neoplastic involvement of regional lymph nodes and adjacent structures such as the adrenal glands ± caudal vena cava
+ Advanced Imaging
- CT scans are used for the diagnosis and local staging of renal neoplasia with a high correlation between CT findings and gross pathology
- MRI is preferred for identifying adjacent vascular and visceral invasion, especially if renal-sparing surgery is planned
- Other imaging techniques include caval venography and nuclear scintigraphy
+ Biopsy
- Biopsy is required for definitive diagnosis of renal tumors
- Biopsy techniques: FNA, needle biopsy, and wedge biopsy
- FNA and needle-core biopsy can be performed using a blind, ultrasound-guided, laparoscopic, or open technique
- Ultrasound-guided biopsy is a rapid, safe, and accurate technique for diagnosing focal and diffuse renal disease
- Blind percutaneous needle biopsy can be performed in cats where the kidney can be immobilized by palpation
- Percutaneous biopsy should be performed with bilateral renal lesions or suspected renal LSA
- Single procedure surgical biopsy, staging, and definitive treatment preferred for unilateral lesions
- Complications of needle biopsy: minor localized hemorrhage, microscopic hematuria, and tumor seeding
TREATMENT
+ Surgery
- Surgical management depends on behaviour of the tumor, presence of metastases and bilateral renal involvement, and invasion of the caudal vena cava and adjacent structures
- Nephroureterectomy is recommended for unilateral disease
+ Chemotherapy
- Non-steroidal anti-inflammatory drugs, such as piroxicam, meloxicam, and deracoxib, may have anticancer effects
- Chemotherapy drugs with known efficacy against TCC include cisplatin, carboplatin, doxorubicin, and mitoxantrone
RENAL TRANSITIONAL CELL CARCINOMA
T0 | No evidence of neoplasia |
T1 | Small tumor without deformation of the kidney - Primary Tumor |
T2 | Single tumor with deformation ± enlargement of the kidney |
T3 | Tumor invading perinephric structures ± pelvis or ureter ± renal blood vessels |
T4 | Tumor invading adjacent organs |
M0 | No evidence of metastasis |
M1 | Evidence of distant metastasis with site specified with (a) single metastasis, (b) multiple metastasis in 1 organ, and (c) multiple metastasis in ≥ 2 organs - Metastasis |
N0 | No evidence of regional lymph node involvement |
N1 | Ipsilateral regional lymph node involvement - Node |
N2 | Bilateral regional lymph node involvement |
N3 | Distant lymph node involvement |