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%