Adult renal cell carcinoma in Lagos: Experience and challenges at the Lagos University Teaching Hospital

Introduction: Renal cell carcinoma (RCC), regarded as the most lethal of all urological tumors, is relatively uncommon. Recent reports from developed countries indicate a rising incidence, most likely from the increasing availability of imaging services leading to an increase in incidental diagnosis of early stage tumors, with consequently better prognosis. However, literature on RCC in sub-Saharan Africa is relatively sparse. Objectives: To determine the prevalence, presentation, pattern and outcome of RCC at the Lagos University Teaching Hospital. Methods: Information extracted from the records of 64 adult patients with RCC seen in our institution between January 2000 and December 2010 included the age and sex of the patient, clinical features, investigations, tumor stage, treatment, outcome of management and follow-up. Results: The mean patient age was 41.8 years (range 20–75 years) with a male:female ratio of 1:1.7. Flank mass, flank pain and hematuria were present in 90.6%, 86% and 40.6% of patients, respectively, while 36% of patients had the classical triad of loin pain, loin mass and hematuria. Only 1 patient (1.6%) had an incidental diagnosis.TNMtumor stages T3 and T4 accounted for 93.7% of patients, while the clear cell type accounted for 60% of histologically examined cases. Forty-five patients (70.3%) had surgical intervention. Of the T2 patients available for follow-up, 50% were alive at 48 months, while all inoperable T4 and M1 patients available for follow-up were dead within 1 year. Conclusion: RCC in our environment is characterized by a younger age at presentation, a female predominance and clinical presentation at an advanced clinical stage.