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2nd Year - Urinary Diseases > 6.1. Cancer - Renal Adenocarcinoma > Flashcards

6.1. Cancer - Renal Adenocarcinoma Flashcards

1
Q

What is the most common Renal Cell Malignancy?

A

Renal Adenocarcinoma

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2
Q

Where do most Renal Adenocarcinoma’s occur?

A

The Proximal Tubules

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3
Q

What are the 4 Differentiated Histological sub-types of Renal Adenocarcinoma?

A
  1. Clear Cell Carcinoma - 85%
  2. Papillary Carcinoma - 10%
  3. Chromophobe Carcinoma - 4%
  4. Bellini-type Ductal Carcinoma - 1%
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4
Q

What are the main Risk Factors of Renal Adenocarcinoma?

A
  1. Family History
  2. Lifestyle
  3. Renal Damage
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5
Q

How is Family History related to Renal Adenocarcinoma?

A

This can be Autosomal Dominant

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6
Q

How is Lifestyle related to Renal Adenocarcinoma?

A
  1. Smoking

2. Obesity

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7
Q

What Renal Damage is related to Renal Adenocarcinoma?

A
  1. Anti-Hypertensive Medications
  2. End-Stage Renal Failure
  3. Acquired Renal Cystic Disease
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8
Q

How can Renal Adenocarcinoma spread?

A
  1. Direct - To the Renal Capsule
  2. Venous - To the Renal Vein and the Inferior Vena Cava
  3. Lymphatic - To the Para-Aortic Lymph Nodes
  4. Haematogenous - To the Bone and the Lungs
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9
Q

What are the Clinical Features of Renal Adenocarcinoma?

A
  1. Asymptomatic - 50% of cases are incidentally noticed
  2. The “Classic Triad” - 10% present with this
  3. Paraneoplastic Syndromes - 30% present with this
  4. Metastatic Disease Symptoms - 30% present with this
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10
Q

What does the “Classic Triad” of Renal Adenocarcinoma consist of?

A
  1. Flank Pain
  2. An Abdominal Mass
  3. Haematuria
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11
Q

What are some Paraneoplstic Syndrome Symptoms?

A
  1. Anorexia, Cachexia (weakness of the body) and Pyrexia
  2. Hypertension, Hypercalcaemia and Abnormal LFT’s
  3. Anaemia, Polycythaemia (too many RBC’s) and a Raised ESR
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12
Q

Where does Renal Adenocarcinoma metastasis to?

A
  1. Bone
  2. Brain
  3. Lungs
  4. Liver
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13
Q

What investigations are necessary?

A
  1. CT KUB / Abdomen / Chest
  2. Renal Ultrasound
  3. Blood Tests
  4. Intravenous Urogram
  5. Radioacitve Renogram
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14
Q

What is the purpose of the CT KUB / Abdomen / Chest?

A
  1. TNM Staging

2. Assessing the Contralateral Kidney

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15
Q

What is the purpose of the Renal Ultrasound?

A

To differentiate between a tumour and a cyst

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16
Q

What blood tests will be done?

A
  1. A Full Blood Count
  2. Urea and Electrolytes
  3. Serum Creatinine
17
Q

What is the purpose of an Intravenous Urogram?

A

To show calcyceal distortion and soft tissue mass

18
Q

What is the purpose if a Radioactive Renogram?

A

To assess split renal function in the contralateral kidney

19
Q

How is the Renal Adenocarcinoma staged?

A

TNM

20
Q

What are the different T stages of Renal Adenocarcinoma?

A

T1 - Tumour < 7cm, within the Renal Capsule
T2 - Tumour > 7cm, within the Renal Capsule
T3 - Local Extension outside the Capsule:
a) Into the Adrenal / Perirenal Fat
b) Into the Renal Vein / IVC (below the diaphragm)
c) Tumour Thrombus in IVC (above the diaphragm)
T4 - Tumour invades beyond Gerota’s (the Renal) Fascia

21
Q

What are the different N stages of Renal Adenocarcinoma?

A

N0 - No nodal involvement
N1 - Proximal Nodal involvement
N2 - Distal Nodal Involvement

22
Q

What are the different M stages of Renal Adenocarcinoma?

A

M0 - No distant metastases

M1 - Distant metastases

23
Q

What is the 5 year survival rate for T1 - 4 Tumours?

A

T1 - 95%
T2 - 90%
T3 - 60%
T4 - 20%

24
Q

What is the 5 year survival rate for Tumours with Nodal involvement?

A

20%

25
Q

What is the median survival for Tumourswith distant metastases?

A

12-18 months

26
Q

What are the treatment options for Renal Adenocarcinoma?

A
  1. Radical Nephrectomy (Curative below T3)
  2. Cytoreductive Nephrectomy (Palliative for M1)
  3. Immunotherapy (Interferon Alpha)
  4. Tyrosine-Kinase inhibitor
27
Q

What common cancer treatments have no effect?

A
  1. Chemotherapy

2. Radiotherapy

2nd Year - Urinary Diseases (16 decks)

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