Introduction
Kidney cancer constitutes about 3% of all malignancies in the adult
population.1 It is the 7th most
common cancer in men and the 10th most common cancer
in women.2 More than 400,000 new cases of Renal cell
carcinoma (RCC) were reported globally in 2018.3 Each
year, roughly 63,000 new RCC cases are diagnosed with 14,000 deaths in
the United States (U.S.).4 It is twice as common in
men as compared to women.5 The classic triad of
palpable flank pain, flank mass, and hematuria for RCC are usually seen
in advanced cases.6 RCC is associated with
coagulopathy and development of inferior vena cava (IVC) thrombus in
4–10% of cases, with approximately only 1% extending into the right
atrium.1 Metastasis is common to the lungs, liver,
lymph nodes, brain, bones and a significant predictor of prognosis in
RCC.7 With the increasing use of imaging, more than 70
% of all RCC being diagnosed as an incidental finding on imaging
studies.7 The most common histological type of RCC is
clear cell cancer (70-80%), followed by papillary renal cell cancer
(10-20%).7 It is more common in patients with
hypertension, hyperlipidemia, smoking, end-stage renal disease, acquired
cystic renal disease, kidney transplantation, and tuberous sclerosis
syndrome.8 More than 30 % of patients with RCC found
to have metastatic disease at the time of diagnosis.9The five-year survival with localized RCC is 92.1%, with the regional
disease is 65.4%, and with metastatic RCC is only
11.8%.10 A combination of cytoreductive nephrectomy
with systemic targeted therapies is currently being used for metastatic
RCC due to tumors’ highly immunogenic nature.11Radical surgical resection remains the definitive curative and
palliative treatment in patients with IVC thrombus propagating to the
right atrium without significant systemic
metastases.12 However, IVC thrombectomy is associated
with significant morbidity and mortality and requires careful patient
selection with a multidisciplinary care team approach for better
outcomes.12