1: Urological Malignancy - Renal Cell Carcinoma Flashcards
What is the most common cause of renal malignancy in adults
Renal cell carcinoma
In which gender is RCC more common
Males
What age does RCC typically onset
55-years
What are 3 causes of RCC
- Sporadic
- Von Hippel Lindau Syndrome
- Tuberous sclerosis
What is the inheritance pattern of von-hippel-lindau
Autosomal dominant
what type of renal cancer does von-hippel-lindau cancer cause
Clear cell renal cell carcinoma
what two neurological disorders does von-hippel-lindau cause
Cerebellar hemangiomas -SAH
Retinal hemangiomas - Vitreous haemorrhage
what is the inheritance pattern of tuberous sclerosis
Autosomal dominant
what are cutaneous features of tuberous sclerosis
- Ash-Leaf Spots (Under UV light)
- Shagreen patch - roughened skin over spine
- Angiofibromas over naso-labial folds
- Cafe au lait
what are neurological features of tuberous sclerosis
Epilepsy
Learning difficulties
Developmental delay
what are 3 risk factors for sporadic RCC
- Smoking
- Renal stones
- Acquire renal cysts
what is problem with RCC
Asymptomatic during early-stages
what is the triad of symptoms in RCC
Haematuria
Abdominal mass
Flank pain
when should RCC always be investigated for in males and why
Left varicocele.
Left testicular vein drains into left renal vein - meaning a mass (cancer) obstructive drainage can cause varicocele
what are 4 paraneoplastic syndromes of RCC
- PTHrp
- ACTH
- Renin
- EPO
- Stauffer syndrome
what does EPO cause
Polycythaemia
what does PTHrp cause
Hypercalcaemia
what is stauffer syndrome
Paraneoplastic hepatic dysfunction syndrome
what causes paraneoplastic hepatic dysfunction syndrome
Release of IL6
how does stauffer syndrome present clinically
Hepatosplenomegaly and cholestasis
what are renal cell carcinomas
adenocarcinomas that arise from the proximal convoluted tubule (PCT) of the kidney
what is the most common variant of renal cell carcinoma
clear-cell renal cell carcinoma
when should individuals be referred under 2WW for suspected renal carcinoma
> 45-years with:
- Unexplained macroscopic haematuria
- Haematuria persisting despite treatment for UTI
what is the main symptom that should ring alarm bells for RCC referral
> 45 and haematuria
what is the best investigation to diagnose RCC
CT-Abdomen
what may be seen on CXR in RCC
Cannonball metastases
when is a bone scan ordered in RCC
Raised ALP or bone pain
what treatment are RCC resistant to by nature
chemotherapy
if T1 what management is indicated for RCC
Partial nephrectomy
if above T1 what management is indicated for RCC
Radical nephrectomy
if unable to undergo nephrectomy, how is RCC managed
Cryotherapy or radio frequency ablation
how will those with mets be managed
IL2
Tyrosine Kinase inhibitors
what prognostic scoring system can be used in RCC
MAYO prognostic scoring system
