Ans. is 'b' ie. IVC involvement indicates inoperability A renal cell carcinoma that has spread to renal vein, IVC or even upto the thorax (hea) is operable. A preop 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 tit 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: i) Cigarette smoking ii) Obesity iii) Polycystic kidney ds iv) Tuberous sclerosis v) Von-Hippel lindau syndorme (Cerebellar hemangioblastoma, retinal angiomatosis and b/1 renal cell Ca) Histologically RCC is an adenocarcinoma. It has been reclassified into subtypes of which Clear Cell Ca is the MC type. Classical triad of RCC consists of Hematuria Flank pain Palpable flank mass Earliest and MC presenting feature is hematuria. Paraneoplastic syndormes i) Fever of unknown origin ii) Anemia iii) Erythrocytosis (d/t secretion of erythropoietin by RCC) (but anemia is a more common finding) iv) Hypeension v) Abnormal liver function (Stauffers syndrome ie non metastatic hepatic dysfunction) vi) Hypercalcemia vii) Neuromyopathy viii) Amyloidosis ix) Increased ESR (MC paraneoplastic syndrome) x) Dysfibrogenemia xi) Cushing's syndrome xii) Galactorrhoea xiii) 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.