Furthermore, tumor involvement of renal sinus and perinephric fat, involvement of renal vein and IVC, tumor extension into adjacent organs, and presence of nodal and distant metastases are critical information needed for treatment planning. Although partial nephrectomy may be the preferred curative option in many patients, active surveillance and local ablative therapies are being increasingly considered in carefully selected patients in the management of small localized T1 RCC [5]. Locally advanced T2 to T4 RCC and complex tumors not amenable for partial nephrectomy approach may benefit from radical nephrectomy. Metastatic disease at presentation varies with the patient series but typically occurs in approximately 1 in 10 patients [6,7]. The most common sites of distant metastases, in descending order, are the lungs, bone, retroperitoneal and mediastinal nodes, liver, brain, or multiple sites [8,9]. Radical nephrectomy with metastasectomy remains an option for carefully selected patients with oligo-metastases. Similarly, cytoreductive nephrectomy may be considered even in advanced stage RCC. However, many patients with advanced stage RCC present with multifocal metastatic disease, warranting a multidisciplinary approach. Better understanding of RCC tumor biology has paved the way for the development of numerous FDA-approved therapeutic options for advanced stage RCC including targeted therapy and immunotherapy. Imaging plays an important role in the staging of RCC [10]. In this document, we provide an update on the appropriate use of imaging examinations for initial staging of known RCC. Special Imaging Considerations CT urography (CTU) is an imaging study that is tailored to improve visualization of both the upper and lower urinary tracts.
Staging of Renal Cell Carcinoma. Furthermore, tumor involvement of renal sinus and perinephric fat, involvement of renal vein and IVC, tumor extension into adjacent organs, and presence of nodal and distant metastases are critical information needed for treatment planning. Although partial nephrectomy may be the preferred curative option in many patients, active surveillance and local ablative therapies are being increasingly considered in carefully selected patients in the management of small localized T1 RCC [5]. Locally advanced T2 to T4 RCC and complex tumors not amenable for partial nephrectomy approach may benefit from radical nephrectomy. Metastatic disease at presentation varies with the patient series but typically occurs in approximately 1 in 10 patients [6,7]. The most common sites of distant metastases, in descending order, are the lungs, bone, retroperitoneal and mediastinal nodes, liver, brain, or multiple sites [8,9]. Radical nephrectomy with metastasectomy remains an option for carefully selected patients with oligo-metastases. Similarly, cytoreductive nephrectomy may be considered even in advanced stage RCC. However, many patients with advanced stage RCC present with multifocal metastatic disease, warranting a multidisciplinary approach. Better understanding of RCC tumor biology has paved the way for the development of numerous FDA-approved therapeutic options for advanced stage RCC including targeted therapy and immunotherapy. Imaging plays an important role in the staging of RCC [10]. In this document, we provide an update on the appropriate use of imaging examinations for initial staging of known RCC. Special Imaging Considerations CT urography (CTU) is an imaging study that is tailored to improve visualization of both the upper and lower urinary tracts.