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Expanded, partially from material I've previously added to Wikipedia
==Evaluation==
Main parameters of tumors:
*'''Size'''. In case of mixed cystic and solid components, measure the maximal widths of both.
[[File:CT of angiomyolipoma, before and after radiocontrast.jpg|thumb|[[CT scan]] of a renal angiomyolipoma. It involves the [[renal cortex]], and has an attenuation of less than 20 HU on the [[Hounsfield scale]], which are typical characteristics.<ref name=Radiopaedia>{{cite web|url=https://radiopaedia.org/articles/renal-angiomyolipoma|title=Renal angiomyolipoma|author=Dr Yuranga Weerakkody and Dr Behrang Amini|website=[[Radiopaedia]]|accessdate=2019-08-02}}</ref>]]
*'''Attenuation'''. An attenuation of less than 20 HU is characteristic of an angiomyolipoma.<ref name=Radiopaedia/> Renal cell carcinomas and oncocytomas typically demonstrate intense heterogeneous enhancement on the parenchymal phase images and cannot be reliably differentiated from each other. Renal lymphoma on the other hand, will often have decreased enhancement when compared to the renal parenchyma on the parenchymal phase images.<ref name=Guite2013/>*Local spread, or '''staging''', which can follow the TNM staging system, where the size and extent of the tumour (T), involvement of lymph nodes (N) and metastases (M) are classified separately. The 1997 revision of the American Joint Committee on Cancer (AJCC) is described below:<ref name=cornellurology>[http://www.cornellurology.com/kidney/gi/rcc.shtml Kidney Cancer / General Information] {{webarchive|url=https://web.archive.org/web/20111101172045/http://www.cornellurology.com/kidney/gi/rcc.shtml |date=2011-11-01 }} at Weill Cornell Medical College, James Buchanan Brady Foundation, Department of Urology</ref>
{|class="wikitable"
| '''Stage I''' || Tumour of a diameter of 7 cm (approx. 2 3⁄4 inches) or smaller, and limited to the kidney. No lymph node involvement or metastases to distant organs.
| Distant metastases, such as in the lungs, bone, or brain.
|}
*'''Surgical complexity'''. The RENAL Nephrometry Scoring System is used to measure the complexity of kidney tumors for surgical excision, and is estimated by CT scan as follows:<ref name="ParsonsCanter2012">{{cite journal | vauthors = Parsons RB, Canter D, Kutikov A, Uzzo RG | title = RENAL nephrometry scoring system: the radiologist's perspective | journal = American Journal of Roentgenology | volume = 199 | issue = 3 | pages = W355–9 | date = September 2012 | pmid = 22915426 | doi = 10.2214/AJR.11.8355 }}</ref>
{|class="wikitable"
! !!colspan=3|Score
|-
! Component !! 1 point !! 2 points !! 3 points
|-
| '''R''' (radius, maximal diameter) || ≤ 4 cm || > 4 and < 7 cm || ≥ 7 cm
|-
| '''E''' (exophytic/endophytic) || ≥ 50% exophytic || < 50% exophytic || Completely endophytic
|-
| '''N''' (nearness to collecting system/renal sinus) || ≥ 7 mm || > 4 and < 7 mm || ≤ 4 mm
|-
| '''A''' (anterior/posterior locator) ||colspan=3| A descriptor of “a,” “p,” or “x” is assigned for tumour location.
|-
| '''L''' (location relative to polar lines) || Entirely below lower polar or above upper polar line || Mass crosses polar line || 50% of the mass is across polar line, or <br>mass is entirely between polar lines, or <br>mass crosses axial midline
|}
A higher score indicates a higher difficulty in removing the tumor surgically, potentially making radical (total) nephrectomy necessary. Specific guidelines vary internationally, but in [[Hong Kong]] data, patients that underwent partial nephrectomy had scores averaging 7, and those with radical nephrectomy had scores averaging 9.<ref name="WongCho2013">{{cite journal|last1=Wong|first1=MH|last2=Cho|first2=KY|last3=Ho|first3=KL|last4=Wong|first4=KW|last5=Lai|first5=CT|last6=Man|first6=CM|last7=Yiu|first7=MK|title=How can the R.E.N.A.L. nephrometry scoring system aid management of a solid renal mass?|journal=Hong Kong Medical Journal|year=2013|issn=10242708|doi=10.12809/hkmj133920}}</ref>
*'''General abdominal screening''', see [[CT of the abdomen and pelvis]].
==Report==
*Local spread
Most likely type or types of tumor if possible.
{|class="wikitable"
|+ Example
|
[[File:Corticomedullary phase CT in axial and coronal plane, and parenchymal phase, of renal cell carcinoma.jpg|300px|left]]
8 cm large inferolateral renal mass, abutting the left psoas major muscle (possible stage IV).
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