Kidney Cancer Flashcards
What is the most common type of kidney tumour?
Renal cell carcinoma (RCC)
RCC is a type of _______ that arises from renal tubules
adenocarcinoma
What is the classic triad of presentation for RCC?
Haematuria
Flank pain
Palpable mass
What are the 3 most common subtypes of renal cell adenocarcinoma?
Clear cell
Papillary
Chromophobe
Carcinoma vs adenocarcinoma
Carcinoma = starts in epithelial tissue of skin or internal organs, malignant most common
Adenocarcinoma = starts in glandular tissue, malignant
What are benign epithelial tumours called?
Papillomas
What are benign glandular tissue tumours called?
Adenomas
What tumour is a specific tumour affecting the kidney in children typically under 5 y/o?
Wilm’s tumour
What are risk factors for renal cancer?
Smoking
Obesity
Hypertension
ESRF
Von Hippel-Lindau Disease
Tuberous sclerosis
What is Von Hippel-Lindau Disease?
Autodominant conditions
Loss of tumour suppressor gene
Bilateral RCC with renal and pancreatic cysts and cancers of the cerebellum.
How might RCC present?
May be asymptomatic
Haematuria
Vague loin pain
Weight loss
Fatigue
Anorexia
Night sweats
Palpable renal mass on examination
May have left sided varicocele
What is the first line investigation for suspected kidney cancer?
USS
What is the gold standard investigation for kidney cancer?
CT of chest/abdomen/ pelvis
What does NICE say about recognising cancer?
Do a two week wait referral for those over 45 with unexplained visible haematuria
Where does RCC tend to spread?
To surrounding tissue, within Gerota’s fascia.
Renal vein then IVC.
What is a classic feature of metastatic RCC?
Cannonball metastases, clearly-defined circular opacities scattered through lung on XR.
True or false: RCC is associated with several paraneoplastic syndromes
True
How can RCC lead to polycythaemia?
The RCC may produce ectopic erythropoietin stimulating the bone marrow to make many RBCs
How can RCC lead to hypercalcaemia?
The RCC may secrete a hormone like PTH affecting the uptake and resorption of calcium. Also bony metastases.
Why may RCC lead to hypertension?
Several factors like tumour secreting renin, polycythaemia (if tumour secreting EPO) and physical compression.
What staging is used for RCC?
TNM staging system + number staging system (specific to RCC, Robson staging)
How does the number system for RCC work (Robson staging)?
1-4
True or false: stage 1 RCC is bigger than 7cm but confined to the kidney
False - that is stage 2.
Stage is is Smaller than 7cm but confined to the kidney
True of false: Stage 3 RCC is local spread to nearby tissues or veins but not beyond Gerota’s fascia
True
What is Gerota’s fascia?
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
True or false: Stage 4 RCC is spread beyond Gerota’s fascia excluding metastasis
False - including metastasis.
How do you manage RCC?
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
