kidney cancer Flashcards
epidemiology
male
older age
risk factors
- age
- sex
- ethnicity - native american, indinesious alaskan + african american
- hypertension
- smoking
- obesity
- alcohol
- occupational + environmental exposures
genetic conditions
- von hippel lindau
- tuberous sclerosis
genetic syndromes causing renal cancer? (3)
- von hippen lindau
- birt hogg dube
- tuberous sclerosis
others:
- hereditary leiomyomatosis and RRC syndrome
- hereditary papillary RCC syndrome
types of renal tumour
Benign Renal tumours:
- Renal adenoma
- Oncocytoma
Malignant Renal Cell Carcinoma:
- Clear cell carcinoma – 70-80%
- Papillary carcinoma – 5-10%
- Chromophobe – 3-5%
- Collecting duct – 2%
Wilms tumour – in children
Upper tract Urothelial carcinoma - 10%
Others:
Sarcoma
Presentation
Classic triad (<10%):
- Haematuria
- Loin pain
- Mass
- Incidental on scan: >50%
- Metastatic disease
- Paraneoplastic syndromes
- Varicocele
systemic effects (paraneoplastic syndrome) of kidney cancer
- The kidney produces 1,25-dihydroxycholecalciferol, renin, erythropoietin and various prostaglandins
- Hypercalcaemia
- Hypertension
- Polycythaemia
- Anaemia
- Systemic symptoms – cachexia, weight loss, pyrexia
- Staffer syndrome – non metastatic hepatic dysfunction in RCC patients
Presentation - Varicocele
- Right testicular vein drains into vena cava
- Left testicular vein drains into left renal vein
- Testicular vein can become occluded by Left Renal tumour leading to varicocele
Investigations
- US kidneys- 1st line
- CT chest/abdo/pelvis
- If enhancing mass–stagingCT chest
- renal biopsy - diagnostic
- If extending into vein – MRI
- Metastatic disease – bone, brain
staging
Renal Biopsy
- Small renal mass
- Indeterminate mass
- Prior to ablation
- Metastatic disease systemic therapy
- Not for cystic masses
surgery for invasive cancers
Partial nephrectomy if cancer is:
- T1/T2
- bilateral
- contralateral
radical nephrectomy if cancer is:
- T2+
Management – advanced cancer
Palliative:
- Pain relief
- Bleeding – embolization
- Radiotherapy
Systemic treatments
Urothelial cell carcinoma upper tract
- Less common
- Risk factors as for bladder cancer
- Present with haematuria, loin pain, “clot colic”
- Managed by nephroureterectomy
Kidney Cancer: Complications
paraneoplastic changes - polycythenia, HTN, hypercalcaemia, cushings
Kidney Cancer: What is the most common RCC?
malignant cancer of the proximal convoluted tubule
What are the different types of Renal Cell Carcinomas?
lear cell and papillary are both types of renal cell carcinoma.
Clear cell is the commonest, accounting for ~75% of cases with papillary accounting for 10-15%.
