6.1. Cancer - Renal Adenocarcinoma Flashcards
What is the most common Renal Cell Malignancy?
Renal Adenocarcinoma
Where do most Renal Adenocarcinoma’s occur?
The Proximal Tubules
What are the 4 Differentiated Histological sub-types of Renal Adenocarcinoma?
- Clear Cell Carcinoma - 85%
- Papillary Carcinoma - 10%
- Chromophobe Carcinoma - 4%
- Bellini-type Ductal Carcinoma - 1%
What are the main Risk Factors of Renal Adenocarcinoma?
- Family History
- Lifestyle
- Renal Damage
How is Family History related to Renal Adenocarcinoma?
This can be Autosomal Dominant
How is Lifestyle related to Renal Adenocarcinoma?
- Smoking
2. Obesity
What Renal Damage is related to Renal Adenocarcinoma?
- Anti-Hypertensive Medications
- End-Stage Renal Failure
- Acquired Renal Cystic Disease
How can Renal Adenocarcinoma spread?
- Direct - To the Renal Capsule
- Venous - To the Renal Vein and the Inferior Vena Cava
- Lymphatic - To the Para-Aortic Lymph Nodes
- Haematogenous - To the Bone and the Lungs
What are the Clinical Features of Renal Adenocarcinoma?
- Asymptomatic - 50% of cases are incidentally noticed
- The “Classic Triad” - 10% present with this
- Paraneoplastic Syndromes - 30% present with this
- Metastatic Disease Symptoms - 30% present with this
What does the “Classic Triad” of Renal Adenocarcinoma consist of?
- Flank Pain
- An Abdominal Mass
- Haematuria
What are some Paraneoplstic Syndrome Symptoms?
- Anorexia, Cachexia (weakness of the body) and Pyrexia
- Hypertension, Hypercalcaemia and Abnormal LFT’s
- Anaemia, Polycythaemia (too many RBC’s) and a Raised ESR
Where does Renal Adenocarcinoma metastasis to?
- Bone
- Brain
- Lungs
- Liver
What investigations are necessary?
- CT KUB / Abdomen / Chest
- Renal Ultrasound
- Blood Tests
- Intravenous Urogram
- Radioacitve Renogram
What is the purpose of the CT KUB / Abdomen / Chest?
- TNM Staging
2. Assessing the Contralateral Kidney
What is the purpose of the Renal Ultrasound?
To differentiate between a tumour and a cyst
What blood tests will be done?
- A Full Blood Count
- Urea and Electrolytes
- Serum Creatinine
What is the purpose of an Intravenous Urogram?
To show calcyceal distortion and soft tissue mass
What is the purpose if a Radioactive Renogram?
To assess split renal function in the contralateral kidney
How is the Renal Adenocarcinoma staged?
TNM
What are the different T stages of Renal Adenocarcinoma?
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
What are the different N stages of Renal Adenocarcinoma?
N0 - No nodal involvement
N1 - Proximal Nodal involvement
N2 - Distal Nodal Involvement
What are the different M stages of Renal Adenocarcinoma?
M0 - No distant metastases
M1 - Distant metastases
What is the 5 year survival rate for T1 - 4 Tumours?
T1 - 95%
T2 - 90%
T3 - 60%
T4 - 20%
What is the 5 year survival rate for Tumours with Nodal involvement?
20%
What is the median survival for Tumourswith distant metastases?
12-18 months
What are the treatment options for Renal Adenocarcinoma?
- Radical Nephrectomy (Curative below T3)
- Cytoreductive Nephrectomy (Palliative for M1)
- Immunotherapy (Interferon Alpha)
- Tyrosine-Kinase inhibitor
What common cancer treatments have no effect?
- Chemotherapy
2. Radiotherapy
