الفهرس 
anatomy of the inferior vena cava.Only 14 pages are availabe for public view
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Abstract
Renal cell carcinoma is the most lethal urologic tumor accounting for 3% of adult malignancy and 85% of renal tumors. It has specific tendency for vascular invasion occurring in up to 10% of patients. Tumor venous extension has a negative prognostic impact on survival; however radical surgery is curative and associated with improved quality of life and survival. Diagnosis of venous involvement is made on clinical data and various imaging modalities rather than laboratory investigations. Different imaging modalities e.g. contrast enhanced spiral computed tomography and magnetic resonance imaging can characterize the mass, detect the thrombus and delineate the level of the thrombus. Management of patient who has renal tumor with vascular extension should be planned thoroughly, the decision should consider the performance status of the patient, the anatomical criteria of the mass (site, size and the relation to the surroundings), the status of the contralateral kidney and the thrombus level. There are several approaches e.g. open radical surgery and thrombectomy, laparoscopic radical surgery or in specific situations nephron sparing surgery may be considered. Wilms tumor is the most common primary malignant renal cancer in children representing 6%-7% of all children cancers. Intravascular extension occurs in 6% of patients with a 3-year survival of as high as 90% for patients with favorable pathology. Ultrasound is the initial diagnostic modality; CT and MRI are also used for better evaluation. Two different approaches for management are existing; preoperative chemotherapy that leads to down staging of the tumor together with possible disappearance of the thrombus followed by radical surgery. Another approach is the primary surgery followed by postoperative chemotherapy.