Background

Question 1

Order the following 5 tissues from outermost to innermost: renal cortex, Gerota fascia, adrenal gland, perirenal fat, and renal capsule.

Answer 1

From outermost to innermost:

1. Gerota fascia
2. Perirenal fat
3. Adrenal gland (which is embedded in the perirenal fat sup to the kidney)
4. Renal capsule
5. Renal cortex

Question 2

Name 3 environmental risk factors for renal cell carcinoma (RCC).

Answer 2

Environmental risk factors for RCC:

1. Cigarette smoking
2. Phenacetin exposure (found in analgesics)
3. Heavy metal exposure

Question 3

Name the most important nonenvironmental risk factor for RCC.

Answer 3

Obesity. The risk of RCC increases by 7% per unit increase in BMI. (Bergstrom A et al., Br J Cancer 2001)

Question 4

Familial RCC makes up what % of RCC cases? Name 5 familial syndromes.

Answer 4

Familial RCC makes up ∼4% of RCC cases. Familial syndromes:

1. Von Hippel–Lindau
2. Birt–Hogg–Dube syndrome
3. Tuberous sclerosis
4. Hereditary papillary RCC
5. Familial clear cell RCC

Question 5

What is the estimated annual incidence of new RCC cases in the United States?

Answer 5

∼58,000 cases/yr of new RCC in the United States

Question 6

Has the incidence of RCC been increasing or decreasing over the past 30 yrs? Is there a sex predilection?

Answer 6

The incidence of RCC has been increasing by 2%/yr over the past 30 yrs according to NCI SEER data. Men appear to be more commonly diagnosed with RCC than women.

Question 7

In which decade of life is RCC typically diagnosed?

Answer 7

RCC is typically diagnosed in the 7th decade of life.

Question 8

RCC represents what % of all urinary tract tumors?

Answer 8

RCC represents ∼6% of all urinary tract tumors.

Question 9

What benign tumors can exist in the kidney?

Answer 9

Benign tumors of the kidney:

1. Angiomyolipomas
2. Fibromas
3. Lipomas
4. Lymphangiomas
5. Oncocytomas
6. Hemangiomas

Question 10

What % of RCC pts will present with a palpable mass on physical exam?

Answer 10

∼10% of RCC pts will have a palpable mass at the time of presentation.

Question 11

RCC pts are at increased risk of having what other type of synchronous urinary cancer?

Answer 11

RCC pts have an RR of 1.5 of having a synchronous bladder cancer, though the authors do not screen for bladder cancer in RCC pts. This increased risk may be related to smoking.

Question 12

What is the classic triad of RCC? With what other clinical Sx can pts with RCC present?

Answer 12

Pts with RCC present with classic triad Sx of hematuria, flank pain, and a palpable mass. Sx of fever, night sweats, and weight loss suggest the presence of metastatic Dz.

Question 13

What are some paraneoplastic syndromes associated with RCC? In what % of pts would these syndromes be found?

Answer 13

Paraneoplastic syndromes associated with RCC:

1. Hypercalcemia
2. Elevated LFTs
3. Hypertension
   These paraneoplastic syndromes arise in 20% of pts.

Question 14

What % of RCC pts present with bilat kidney involvement?

Answer 14

3% of RCC pts will have bilat involvement at Dx.

Question 15

What are 4 pathologic subtypes of RCC?

Answer 15

Pathologic subtypes of RCC:

1. Clear cell
2. Chromophilic (or papillary)
3. Chromophobic
4. Collecting duct

Question 16

What is the most common pathologic subtype of RCC?

Answer 16

Clear cell is the most common subtype of RCC (∼70%), demonstrating large clear cells with abundant cytoplasm.

Question 17

What is the most common histologic grading system for RCC?

Answer 17

The most common histologic grading system for RCC is the Fuhrman grading system from I to IV based on nuclear roundness, size, nucleoli presence, and the presence of clumped chromatin.

Question 18

Sporadic RCC is characterized by what genetic mutation?

Answer 18

Sporadic RCC is characterized by a mutation in the VHL tumor suppressor gene on chromosome 3p25, which is silenced in >50% of sporadic RCC.