Malignant renal tumours Flashcards
What are some types of malignant renal tumour?
- Renal cell carcinoma
- Transitional cell carcinoma
- Adenocarcinoma
- Wilm’s tumour - Nephroblastoma
What is renal cell carcinoma?
Adenocarcinoma of the renal cortex; most common type of kidney tumour
What are some risk factors for renal cell carcinoma?
- Smoking
- Renal failure and dialysis
- Obesity
- Hypertension
- Low socio-economic status
- Asbestos, cadmium exposure, phenacetin
- Genetic - VHL
Where in the kidney does RCC occur?
Proximal convoluted tubule
What is the function of the Bosniak score?
Used to predict cancer vs cystic kidney disease (10-25% of RCC contains cysts)
What are the 5 main histological classes of renal cell carcinoma?
Conventional clear cell carcinoma - 80%
Papillary - 10-15%
Chromophobe - 5%
Collecting duct - Rare
Medullary cell - rare
Characteristics of conventional clear cell carcinoma
- Loss of VHL
- Clear cells - Cytoplasm rich in lipids and glycogen 3p deletion
Characteristics of papillary RCC
Elongated papillae often with foamy cells
Characteristics of chromophobe RCC
- Large cells with defined cell borders
- Atypical nuclei resembling raisins - ‘raisinoid’
- Histologically similar to oncocytomas
Characteristics of Collecting duct RCC
- Young patients
- Poor prognosis
- Most aggressive cancer
- High grade carcinoma of mixed cell type
Characteristics of medullary cell RCC
- Young patients
- Sickle cell patients
- Very poor prognosis
What are some places that RCC can invade?
Renal vein
Vena cava -> Heart
How may RCC present?
- Haematuria
- Loin mass
- Loin pain
- Pyrexia of unknown origin
- Varicoele
What are some paraneoplastic syndromes of RCC?
Polycythaemia - 5%
Hypertension - 25%
Hypercalcaemia
Anaemia - 30%
What causes polycythaemia in RCC?
Renal cell carcinoma may produce excessive erythropoietin (EPO)
What causes hypertension in RCC?
Increased renin production by the tumour
Renal artery compression
What causes hypercalcaemia in RCC?
Parathyroid hormone-related peptide (PTHrP)produced by the tumour
What are some investigations required in RCC
- USS
- CT chest abdomen, pelvis for staging
- FBC
- Renal and liver function
What are the 4 T grades of RCC?
- T1 - Up to 7cm
- T2 - >7cm confined to the kidney
- T3 - Extends beyond the kidney into the renal vein, perinephric fat, renal sinus and IVC
- T4 - Beyond Gerotas fascia into the surrounding structures
How are small (<3-4cm) RCC tumours managed?
- Surveillance in elderly unfit patients
- Ablation techniques in fit, elderly patients and selected younger patients
- Partial nephrectomy
How are medium (>3-4cm) RCC tumours managed?
- Surveillance, ablative techniques
- Partial nephrectomy
- Radical nephrectomy
How are large RCC tumours managed?
Radical nephrectomy
How is small volume metastatic RCC managed (E.g. 1 lung module)?
Nephrectomy, which in some cases may cause regression of the met
How is wide-spread metastatic RCC managed?
observation and systemic anti-cancer treatment with immunotherapy and tyrosine kinase inhibitors
What follow-up investigations are required in RCC?
- FBC, renal and liver functions
- Imaging - CT/USS + CXR
- Duration 5-10 years
What is Wilm’s tumour?
Nephroblastoma
Cancer of the kidneys that typically occurs in children
How will Wilm’s tumour present?
- Painless, palpable abdominal mass
- Loss of appetite
- Abdominal pain
- Fever
- Nausea and vomiting
- Haematuria
What investigations are required in Wilm’s tumour?
USS initially, CT/MRI for more detailed imaging
How is Wilm’s tumour managed?
Resection +/- radiotherapy depending on stage
What is transitional cell carcinoma?
This is a cancer of the lining of the kidneys and ureter and therefore is technically also a cancer of the bladder
How is transitional cell carcinoma managed?
This is treated with nephro-uretectomy as the ureters are also removed
