She was admitted for exploration with a view to bilateral native nephrectomy. However, the left renal tumour had invaded immediately in and around the aorta and the para-aortic nodes, and a frozen section biopsy confirmed that it was carcinoma in both the mass and the nodes. Histology suggested that it was either a squamous cell carcinoma or squamous differentiation within a transitional carcinoma of the kidney. Either way the tumour was inoperable.

The patient was referred to the Palliative Care Team who are improving her pain control with MST and oral morphine. Another option is radiotherapy and/or stopping immunosuppresisive therapy. However, the latter option would probably only hold the tumour for a short while longer and may result in the patient having to have dialysis.

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