Question

A tumor/mass lesion of the kidney extends into the IVC, with Gerota's fascia intact. All the following are true, EXCEPT

• A. IVC invasion is a contraindication for surgery
• B. Chest X-ray to rule out pulmonary metastases
• C. Pre-op radiotherapy is not indicated
• D. Pre-op biopsy is not indicated

Hint:

RCC with an IVC thrombus, but no spread outside Gerota's fascia, is still resectable with thrombectomy.

Answer 1

The Correct Option is A

Step 1: Read the clinical picture.
A kidney cancer has pushed a solid thrombus into the IVC, but the tumor is still wrapped inside Gerota's fascia, so it has not broken out locally. This is a classic renal cell carcinoma pattern.

Step 2: Recall how RCC behaves in veins.
RCC likes to grow as a column of tumor inside the renal vein and then the IVC, rather than spreading as separate deposits. Surgeons can often follow this column and pull it out in one piece, along with the kidney, even when it reaches high up the IVC.

Step 3: Test each claim.
Saying IVC invasion blocks surgery is wrong, because thrombectomy combined with radical nephrectomy is the accepted curative operation for exactly this situation.
Getting a chest X-ray makes sense, since the lung is the most common site RCC spreads to, and this needs to be checked before major surgery.
Skipping radiotherapy before surgery is correct, RCC does not shrink well with radiation, so it is not used to downstage the tumor.
Skipping a pre-op biopsy is also correct in typical cases, since imaging is usually enough to plan the operation and biopsy risks seeding the tumor along the needle track.

Step 4: Conclude.
The one wrong claim is that IVC invasion rules out surgery.
\[ \boxed{\text{IVC invasion is a contraindication for surgery, is FALSE}} \]