The most common malignant neoplasm of the kidney is the hypernephroma or renal cell carcinoma. Which of the following statement(s) are true concerning renal neoplasms?

a. Renal cell carcinomas can produce a variety of hormone or hormone-like substances

d. Early control of the renal pedicle is an important aspect of surgical management of renal cell carcinoma

Renal cell carcinoma or hypernephroma account for approximately 2% of all cancers diagnosed annually. It is most common after the fifth decade of life and has a male to female ratio of approximately 2:1. No definite etiology has been identified, but a frequent genetic abnormality detected in renal cell cancer is the loss of heterozygosity of chromosome 3p. Multifocal bilateral tumors are associated with von Hippel-Lindau disease. Renal carcinomas can produce a variety of hormone or hormone-like substances (e.g., erythropoietin, renin, and parathormone) and may present with a variety of symptoms including anemia, hypertension, fever and erythrocytosis. Excretory uroraphy (IVP) provides a good renal image with superior detail of the collecting system. Renal masses such as benign cysts or renal cell carcinomas will both appear as “tumor deformities”, distorting the renal outline or the collecting system. Renal cysts are far more common than renal cell carcinoma and the diagnosis can be confirmed by renal ultrasound. Surgical excision remains the primary mode of treatment for renal cell carcinoma. Although the need for radical nephrectomy has recently been questioned, this procedure remains a gold standard against which less radical procedures must be judged. Radical nephrectomy is performed through an abdominal or a thoracoabdominal approach and involves early control of the renal artery and vein. The tumor, together with the kidney and the perirenal fat is excised within Gerota’s fascia which is not opened. Less radical approaches have been suggested for the treatment of smaller tumors, including partial nephrectomy. This approach is especially valuable for bilateral tumors or in patients with a solitary kidney or poor overall renal function.