Table 4 Summary table of local, nodal and haematogenous spread in renal cell carcinoma

Local spread

•Perinephric fat; ipsilateral adrenal; adjacent viscera (including muscles);

•Renal vein invasion (± IVC)

Lymph node spread

•Via lymphatics following the renal vessels to the ipsilateral para-aortic nodes; direct connections with the thoracic duct and mediastinum also exist

Haematogenous spread

•Common sites: lungs > bones, CNS, adrenals

Note

•Extension into renal vein occurs in 20% of patients at presentation; IVC involvement in 5–10%