Treatments for Renal Cell Cancer
This is the histologic appearance of the clear cell carcinomas. It’s obvious why this tumor is called a clear cell carcinoma. You look at the morphology of the cells and the nuclei here. Compare that with this slide where there is a granular appearance. This is basically the same type of a tumor. So both this appearance and the clear cell appearance, that I just showed you, are considered to be the run-of-the-mill, garden variety, renal cell carcinoma. So that the tumors, the majority of the renal cell carcinomas that you see, can have either that clear cell appearance or this granular appearance. And as you see, the morphology of these cells is very similar, except that the cytoplasm stains pinkish. But the morphology of the nuclei is very similar, the morphology of the cells is very similar. There used to be a distinction between these two but these are really both classified as clear cell carcinomas. And are treated in the same fashion.
This is a histologic example of papillary carcinoma and you can see the papillary fronds of the tumor. And there is some debate as to whether papillary carcinomas represent a better prognosis or about the same prognosis as the more common clear cell carcinomas. This was from a report in 2006 where they found that in their review, papillary carcinomas tended to present at an earlier stage and the survival for the earlier stages was better than those for what they are calling conventional renal cell carcinomas. This was true not only for stage I but across stages as well, it seemed like survival was better. Like I said, there is some controversy about this but there are some authors who feel that the papillary carcinomas have a better prognosis.
This is simply a slide of a chromophobe renal cell carcinoma. I just included it for completeness. I don’t really have a lot to say about this minor variant. This is a transitional cell carcinoma which will arise in the renal pelvis. And the most important thing about this tumor is that you remember to treat it as if it was a bladder carcinoma, with respect to chemotherapy. These tumors I do not treat with immunotherapy but I do treat them with MVAC-type regimens. The tumor arises in the transitional epithelium in the pelvis so it makes a lot of logical sense and as well, as it turns out, clinical sense to treat these tumors in that fashion.