#9. Renal Cell Cancer and Upper Urinary Tract Urothelial Cancer Flashcards
What is the Incidence of RCC?
Renal Cell Carcinoma = ADENOCARCIOMA of Renal Cortex, Originating from PCT
- MAKES up 2.3% of ALL Malignant Neoplasms
- Male : Female = 1.5 : 1
- PEAK Incidence = 60 - 70 Years of Age
What are the Risk Factors for RCC?
- Smoking
- Obesity
- Arterial Hypertension
- Acetaminophen / NSAIDs
What are the Subtypes of RCC?
1) Clear-Cell RCC = 80% POOR Prognosis
2) Papillary RCC = 10 - 15% Associated with Trisomies 7, 16, 17
3) Chromophobe RCC = 5% FAVOURABLE Prognosis
4) Collecting Duct Tumour / Bellini Tumour
5) Medullary Cell RCC = VERY POOR Prognosis
- BENIGN Tumours = Oncocytoma / Angiomyolipoma
What is Fuhrmann System and What is it Based on?
Based on NUCLEAR GRADING
- Size
- Shape
- Prominence of Nucleus
What is the Classic Triad of RCC and what is the Approximate Incidence?
1) Lumbar Pain = 50%
2) Haematuria = 50%
3) Palpable Tumour = 25%
What are the Paraneoplastic Syndromes of RCC and what are they Due to?
Paraneoplastic RCC = ECTOPIC Hormone Secretion FROM Tumour
- Anaemia / Polycythaemia = EHS of ERYHTOPOIETIN
- Hypertension = EHS of RENIN
- HYPO-glycaemia = EHS of INSULIN
- Cushing’s Syndrome = EHS of ADENOCORTICOTROPIC Hormone
- HYPER-glycaemia = EHS of PARATHYROID Hormone
- Gynaecomastia / Amenorrhoea = EHs of GONADOTROPIN Hormone
What are the Routes of Spreading of RCC?
METASTATIS ROUTE
1) Lymphatic = Para-Aortic / Aortocaval Lymph Nodes
2) Hematogenous = Lungs / Bones / Brain
SPECIFIC MECHANISM via TUMOUR THROMBUS via Renal Vein TO Vena Cava TO Right Atrium
What Imaging Studies are used in RCC Diagnosis?
- Abdominal US
- CT with Enhanced Contrast
- MRI (IF Allergic to Contrast / Kidney Failure / Pregnant)
When is Embolisation Indicated in Patients with RCC?
OF the RENAL ARTERY
- Bleeding
- IMPOSSIBILITY for Nephrectomy
What are the Indications for Performing Organ-Preserving Surgical Treatment in RCC?
- Tumours in SINGLE Kidney
- Bilateral Tumours
- Tumours UPTO 7cm in a Pole, NOT Including the Cavity System
What are the Principles in Treatment of Metastatic RCC?
- Performing NEPHRECTOMY in Patients with METASTASIS as a PALLIATIVE Measure
- Chemotherapy = RCC with SARCOMATOID (Mesenchymal)
- 1st Line Immunotherapy = For Clear-Cell RCC / Lung Metastasis
- Nephrectomy ONLY BENEFITS Patients who are OLGIOMETASTATIC
Risk Factors for Upper UT Urothelial Carcinomas
- Smoking
- Aristocholic Acid in Plants
- Interstitial Nephritis = DUE to Carcinomas / Kidney Failure
- Infections
- Phenacetin
Clinical Picture of Upper UT Urothelial Carcinomas
- Painless Macroscopic Haematuria (MOST COMMON!)
- Urination of URETER-SHAPED Clots, as they pain they cause LUMBAR PAIN = SIMILAR to RENAL COLIC
Why is it Possible to Diagnose Synchronous / Metachronous Bladder Cancer with Upper UT Urothelial Carcinomas?
- Symptom of HAEMATURIA originates from the BLADDER ALONE
What is the Image like in Retrograde Ureteropyelography of a Patient with Urothelial Carcinoma in Renal Pelvis?
Shows a DEFECT in FILLING of CONTRAST AGENT in the RENAL PELVIS
What Instrumental Methods can be Used in Upper UT Urothelial Carcinomas?
- Cytoscopy = For BLEEDING from Ureter / Bladder Carcinoma
- UreteRENOscopy = Direct Visualisation of Tumour with Biopsy / Laser Ablation
What is the Role of Cytological Test of Urine in Urothelial Carcinomas?
- Performed on EACH URETER Separately
- DURING Cytoscopy / Ureterenoscopy
- POSITIVE Result indicates Carcinoma
What is the Treatment for Upper UT Urothelial Carcinomas?
1) Localised LOW Risk
- Ureteral Resection
- Laser Ablation VIA Ureteroscopy
- Mitomycin Instillation in Upper UT
2) Localised HIGH Risk = Nephrouterectomy with Resection of Part of Bladder around Ureteral Opening
3) Metastatic Disease
- Chemotherapy / Immunotherapy
- Nephrouterectomy with Resection of Part of Bladder around Ureteral Opening
Which Instrumental Examination is Performed in the Follow-Up of Patients with Upper UT Urothelial Carcinomas? Why?
CYTOSCOPY is used for METACHRONOUS Bladder
