A renal cell carcinoma that has spread to renal vein, IVC or even upto the thorax (hea) is operable. A prep biopsy is not necessary as a RCC is the most common malignant neoplasm of kidney (90 - 95%) and any solid renal mass is considered to be RCC until unless proved otherwise. A chest x-ray should be done to rule out pulmonary metastasis as it will make the Ca of stage IV with worst prognosis and also decide the t/t plan. Radiotherapy, Chemotherapy or Hormonal therapy have little role in RCC t/t. More about Renal cell carcinoma Its the MC malignant neoplasm of kidney (90 - 95%) MC site of origin is prox. convoluted tubules RCC originates in the coex and tends to grow out into perinephric tissue. Usually situated at poles (commonly at upper pole) Male female ratio is 2 : 1 Age - 5th to 6th decade Risk factors: Cigarette smoking Obesity Polycystic kidney Tuberous sclerosis Von-Hippel lindau syndrome (Cerebellar hemangioblastoma, retinal angiomatosis and b/l renal cell Ca) Histologically RCC is an adenocarcinoma. It has been reclassified into subtypes of which Clear Cell Ca is the MC type. The classical triad of RCC consists of Hematuria Flank pain Palpable flank mass Earliest and MC presenting feature is hematuria. Paraneoplastic syndromes Fever of unknown origin Anemia Erythrocytosis (d/t secretion of erythropoietin by RCC) (but anemia is a more common finding) Hypeension Abnormal liver function (Stauffers syndrome ie non metastatic hepatic dysfunction) Hypercalcemia Neuromyopathy Amyloidosis Increased ESR (MC paraneoplastic syndrome) Dysfibrogenemia Cushing's syndrome Galactorrhoea Feminization and masculanization MC route of metastasis is hematogenous MC site of distant metastasis is lung (canon ball secondaries, secondaries may be pulsatile) Inv. of choice - CT scan. Ref : Bailey 25/e p1311