Cancer - Renal Cell Carcinoma Flashcards
What is the main malignant renal cancer and what is the main histological sub-types?
Renal adenocarcinoma - mainly in the proximal tubule
85% are clear cell
10% are papillary
Main benign renal tumours?
Oncocytoma
Angiomyolipoma
Risk factors for renal cell carcinoma?
Family history Smoking Obesity Anti-hypertensive treatment ESRF Acquired renal cystic disease
How does a RCC present?
Mostly asymptomatically, they’re found incidentally on imaging.
10% show the classic triad of flank pain, mass and haematuria.
30% can have paraneoplastic syndromes
30% can have metastatic disease
Where does RCC metastasize to?
Bone
Brain
Lungs
Liver
Describe paraneoplastic syndrome resulting from RCC?
Anorexia, cachexia & pyrexia
Hypertension, hypercalcaemia & deranged LFTs
Anaemia, Polycythaemia & raised ESR
How does renal cell carcinoma tend to spread?
Directly - spread through renal capsule to surrounding tissue & occasionally bowel
Hematogenously - Lungs & Bone
Venous - Renal vein/IVC
Lymphatically - Paracaval Nodes
What tests would you do to diagnose and stage renal cancer?
CT abdo & Chest - Confirms diagnosis, stages and assesses contralateral kidney
What other tests can be done to assess the contralateral kidneys function?
DMSA or MAG-3 isotope testing
USS differentiates a tunour from a cyst
What bloods would you run if you suspect RCC?
FBC & U&Es
How is RCC treated?
Mainly surgican via Laparoscopic Radical Nephrectomy
Patients with small number of mets can get palliative Cytoreductive Nephrectomy to prolong life
Some have immunotherapy or Tyrosine Kinase Inhibitors
Why isn’t RT / Chemo used in RCC?
RCC is largely chemo and RT resistant
How is RCC staged?
T1 - in capsule <7cm T2 - In capsule >7cm T3 - Outside capsule T3a - In fat T3b - Renal Vein or IVC below diaphragm T3C - IVC above diaphragm T4 - Beyond Gerota's Fascia
Prognosis for RCC?
Depends on stage:
T1 - very good - 95% 5 yr survival
T4 - Very bad - 20% 5 yr survival
M1 - 12-18 months
