Kidney Cancer

Question 1

What is the most common type of kidney tumour?

Answer 1

Renal cell carcinoma (RCC)

Question 2

RCC is a type of _______ that arises from renal tubules

Answer 2

adenocarcinoma

Question 3

What is the classic triad of presentation for RCC?

Answer 3

Haematuria
Flank pain
Palpable mass

Question 4

What are the 3 most common subtypes of renal cell adenocarcinoma?

Answer 4

Clear cell
Papillary
Chromophobe

Question 5

Carcinoma vs adenocarcinoma

Answer 5

Carcinoma = starts in epithelial tissue of skin or internal organs, malignant most common

Adenocarcinoma = starts in glandular tissue, malignant

Question 6

What are benign epithelial tumours called?

Answer 6

Papillomas

Question 7

What are benign glandular tissue tumours called?

Answer 7

Adenomas

Question 8

What tumour is a specific tumour affecting the kidney in children typically under 5 y/o?

Answer 8

Wilm’s tumour

Question 9

What are risk factors for renal cancer?

Answer 9

Smoking
Obesity
Hypertension
ESRF
Von Hippel-Lindau Disease
Tuberous sclerosis

Question 10

What is Von Hippel-Lindau Disease?

Answer 10

Autodominant conditions
Loss of tumour suppressor gene
Bilateral RCC with renal and pancreatic cysts and cancers of the cerebellum.

Question 11

How might RCC present?

Answer 11

May be asymptomatic

Haematuria
Vague loin pain
Weight loss
Fatigue
Anorexia
Night sweats
Palpable renal mass on examination

May have left sided varicocele

Question 12

What is the first line investigation for suspected kidney cancer?

Answer 12

USS

Question 13

What is the gold standard investigation for kidney cancer?

Answer 13

CT of chest/abdomen/ pelvis

Question 14

What does NICE say about recognising cancer?

Answer 14

Do a two week wait referral for those over 45 with unexplained visible haematuria

Question 15

Where does RCC tend to spread?

Answer 15

To surrounding tissue, within Gerota’s fascia.
Renal vein then IVC.

Question 16

What is a classic feature of metastatic RCC?

Answer 16

Cannonball metastases, clearly-defined circular opacities scattered through lung on XR.

Question 17

True or false: RCC is associated with several paraneoplastic syndromes

Answer 17

True

Question 18

How can RCC lead to polycythaemia?

Answer 18

The RCC may produce ectopic erythropoietin stimulating the bone marrow to make many RBCs

Question 19

How can RCC lead to hypercalcaemia?

Answer 19

The RCC may secrete a hormone like PTH affecting the uptake and resorption of calcium. Also bony metastases.

Question 20

Why may RCC lead to hypertension?

Answer 20

Several factors like tumour secreting renin, polycythaemia (if tumour secreting EPO) and physical compression.

Question 21

What staging is used for RCC?

Answer 21

TNM staging system + number staging system (specific to RCC, Robson staging)

Question 22

How does the number system for RCC work (Robson staging)?

Answer 22

1-4

Question 23

True or false: stage 1 RCC is bigger than 7cm but confined to the kidney

Answer 23

False - that is stage 2.
Stage is is Smaller than 7cm but confined to the kidney

Question 24

True of false: Stage 3 RCC is local spread to nearby tissues or veins but not beyond Gerota’s fascia

Answer 24

True

Question 25

What is Gerota’s fascia?

Answer 25

Also called renal fascia, layer of connective tissue surrounding kidneys and adrenal glands, helping to anchor and protect them within the retroperitoneal space.
Consists of outer layer of pararenal fat
Inner true renal fascia

Question 26

True or false: Stage 4 RCC is spread beyond Gerota’s fascia excluding metastasis

Answer 26

False - including metastasis.

Question 27

How do you manage RCC?

Answer 27

Partial or radical nephrectomy

If surgery not suitable:
Arterial embolization (cutting off blood supply to affected kidney)

Percutaneous cryotherapy (injecting liquid nitrogen to freeze and kill tumour cells)

Radiofrequency ablation )needle in tumour and using electrical current to kill tumour cells)

Chemotherapy
Radiotherapy