Kidney Cancer RCC Flashcards
What are the common malignancies of the urinary tract?
Renal cell carcinoma
Urothelial/transitional cell carcinoma (bladder cancer)
Where does renal cell carcioma effect?
Parenchyma of the kidneys
In the cortex + medulla
Arises from the tubular cells
What is the most common renal malignant tumour in adults?
Renal cell carcinoma
What type of epithelium does renal cell carcinoma arise from?
Tubular epithelium
Types of renal cell carcinomas
- clear cell (most common)
- papillary
- chromophobe
What is a Wilm’s tumour?
specific kidney tumour affecting children <5
Risk factors of renal cell carcinoma
Dialysis
Smoking
Obesity
Hypertension
End stage renal failure
(male > female)
Classical triad of renal cell carcinoma
haematuria
loin pain
abdominal mass
Presentation of renal cell carcinoma
- haematuria
- flank pain
- palpable mass
- fatigue
- weight loss
- fever
- varicocele (advanced)
Investigations of renal cell carcinoma
USS
CT thorax, abdomen, pelvis with IV contrast for staging
Flexible cystoscopy
Cytology
STaging of renal cell carcinoma
TNM staging
Who do NICE recommend 2WW referral for in haematuria?
- over >45 with unexplained visible haematuria +/- UTI
- over >60 with microscopic haematuria PLUS dysuria or raised white cells on FBC
Paraneoplastic features of renal cell carcinomas
- polycythaemia - unregulated EPO
- hypercalcaemia - secretion of hormone that mimics PTH or bony metastases
- hypertension - increased renin, physical compression
- stauffer’s syndrome - abnormal LFTs without liver metastases
What is stauffer’s sydnrome?
- paraneoplastic syndrome of renal cell carcinoma
- abnormal liver function tests without liver metastasis
- cholestasis + hepatosplenomegaly
Treatment of localised renal cell carcinoma
- surveillance
- partial nephrectomy for small tumours
- radical nephrectomy for large tumours > removal of the associated renal gland, perinephric fat, upper ureter + para-aortic lymph nodes
Treatment of renal cell carcinoma when patient is unsuitable for surgery
- arterial embolisation
- percutaneous cryotherapy using liquid nitrogen
- radiofrequency ablation
what are cannonball metastases?
- classic feature of metastatic renal cell carinoma spread to lungs
- clear defined circular opacities scattered through lung on CXR
Treatment of metastatic renal cell carcinoma
- little efffective treatment
- resistant to chemo + radiotherapy
- palliative treatment - target angiogenesis (reduces blood flow to tumours by preventing it from making more vessels))
Presentation of urothelial cell carcinoma
Haematuria
Weight loss
Loss of appetite
Signs/symptoms of obstruction
Why is renal cell carcinoma rare in children?
Long developmental time of the tumour
Demographic of renal cell carcinoma
- 60-70 years old
- Male > female
- On dialysis
- Smoker
- Obese
Why can a patient with renal cell carcinoma present with Varicocele?
- As tumour grows it can grow across left renal vein
- Blocks the testicular vein
- Fluid cannot drain into renal vein from testis
- Enlargement of vessels in scrotum
Only on left hand side (right drains into IVC)
What does a radical nephrectomy involve?
What would it be used for?
- Removal of associated adrenal gland, perinephric fat, upper ureter + para-aortic lymph node
- Large renal cell carcinoma with no distant metastases
How can patients with urothelial cell carcinoma of the upper urinary tract go on to develop bladder cancer?
Seeding
Malignant cells from upper urinary tract can travel to bladder > bladder cancer
