The Continued Burden of Renal Cell Carcinoma in a Developing Country. Lessons Learnt or Not Learnt?

Abstract

Aims: To determine the incidence, gender distribution, presentation, management, histopathological features and outcome of renal cell carcinoma (RCC). Study Design: Retrospective study. Place and Duration of Study: University of Nigeria Teaching Hospital, Saint Mary’s Hospital, Royal Hospital, Mother of Christ Specialist Hospital and Eastside Hospital between January 2002 and December 2015. Methodology: We included 54 patients (29 men, 25 women; age range 19–67 years). Information abstracted included age, gender, presenting symptoms, imaging modality used, clinical stage of the disease and other relevant laboratory results. Histopathology results, duration of follow up, clinical outcome, use of targeted therapies and their duration. Results: The mean age was 37.61 ± 15.1 years Tumours were most frequent in the 4th decade of life, the male: female ratio was 1.16: 1. Smoking and obesity as risk factors were present in 7 patients (all male) and 2 patients respectively; familial-related RCC, as well as VHL-related RCC or long term dialysis-related RCC were absent. Loin mass in 54 patients (100%) and loin pain in 50 patients (92.5%) were the more common presentations. Right-sided tumours were slightly more common (28 patients, 51%). Late presentation was the bane, with onset-presentation interval being 3–34 months (mean 10). Commonest imaging modality was ultrasound (54 patients, 100%); intravenous urography (30 patients, 55.5%), and CT urography/ abdomen (24 patients, 44.4%). 8 patients were managed non-operatively, while 46 patients (85.2%) had radical nephrectomy. Clear cell and papillary carcinoma were the histologic patterns seen in 43/46 patients (93.4%) and 3/46 patients (6.5%) respectively. Follow up was short, mean 7 months (range 4-46 months). Conclusion: Late presentation, paucity of radiotherapy services, short duration of follow-up and prohibitive costs of targeted therapies were challenging. We recommend enlightenment and strengthening of the health system aimed at earlier detection.