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Y3 Lecture weeks > Patient with renal tumors > Flashcards

Patient with renal tumors Flashcards

1
Q

What’s the most common renal cancer?

A

Renal cell carcinoma - 85% of all renal cell malignancies

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2
Q

Presentation of renal cell carcinomas

A

Variety of symptoms including:

  • haematuria (50%)
  • loin pain (40%)
  • mass (30%)
  • 25% may have symptoms of metastasis
  • less than 10% have the classic triad of haematuria, pain and mass
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3
Q

What’s the classic triad of renal cancer?

A

haematuria, pain and mass

*seen in <10% patients

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4
Q

Management of T1 renal cancers

A

T1 lesions may be managed by partial nephrectomy

*this gives equivalent oncological results to total radical nephrectomy (at the mass is limited at that stage)

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5
Q

Management of T2 renal cancer

A

For T2 lesions and above

  • radical nephrectomy

(performed via a laparoscopic or open approach)

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6
Q

What do we need to at early stages of surgery for renal cancer?

A

During surgery early venous control is mandatory to avoid shedding of tumour cells into the circulation

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7
Q

What is the management of a patient with Transitional Cell cancer?

A

Patients with transitional cell cancer will require a nephroureterectomy with disconnection of the ureter at the bladder

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8
Q

Types of renal cancer (2) general devision

A

A. Renal Cells Ca

B. Urothelium-based cancers

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9
Q

Types of renal cell carcinoma

A

Renal Cell Ca:

  • clear cell
  • papillary
  • collecting duct
  • renal medullary
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10
Q

Types of urothelium - based cancers

A

Urothelium based cancers

  • urothelial carcinoma
  • squamous cell carcinoma
  • adenocarcinoma
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11
Q

Why would we develop squamous cell carcinoma or adenocarcinoma in cell lining?

A

Chronic irritation/ inflammation -> dysplasia -> metaplasia -> completly different type of cell- line

*e.g. chronic pyelonephritis, untreated for years stones

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12
Q

Some of the uncommon types of renal cancers

A
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13
Q

What cancers tend to metastasise to the kidneys?

A
  • breast
  • thyroid
  • lungs
  • adjacent neoplasm (e.g. pancreas, stomach, adrenal) -> local invasion
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14
Q

Factors that increase the risk of renal cancer

A

- obesity

- smoking (20 a day will double the risk)

- hypertension

  • chronic renal failure and dialysis (3-6 x risk)
  • thyroid cancer
  • previous radiotherapy
  • familiar history (1st degree relative with kidney ca -> 2x risk)
  • genetics (only 2% of renal cancers)
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15
Q

Some genes associated with kidney cancers (just look)

A
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16
Q

What renall Ca is von Hippel Lindau associated with?

A
  • clear cell carcinoma

*VHL gene

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17
Q

What renal ca is Hereditary Papillary Renal Cancer associated with?

A

Papillary type 1 RCC

*MET gene

18
Q

What renal cancer is Birt Hogg Dubé associated with?

A

Birt Hogg Dubé

  • Chromophobe RCC / Oncocytoma

*Folliculin Gene

19
Q

What renal cancer is Hereditary Leiomyomatosis Renal Cell Carcinoma (HLRCC) associated with?

A

Papillary type II RCC

*FH gene (Fumarate hydratase)

20
Q

What may paraneoplastic syndrome present with?

A

Paraneoplastic syndrome

  • Hypercalcaemia (PTHrP) – seen in approximately 25%
  • Anaemia
  • Hyponatraemia
  • Raised ESR
  • Polycythaemia (increased Hb)
21
Q

What are the signs of obstruction to IVC from a renal tumour?

A
  • bilateral limb oedema
  • varicocele
22
Q

When do the cachexia present in cancer?

A

Late signs - poor prognosis

23
Q

How are the kidney cancers usually picked up?

A

Incidental finding on USS for various other, unrelated conditions

24
Q

Why it is especially important to pick up kidney cancers early?

A

Options for Mx of kidney cancer is only surgery -> if not possible then palliative care

* similar is pancreatic cancer

25
Q

What is a bone pain suggestive of ?

A

metastatic disease

26
Q

General modes of Ix for renal Ca (4)

A
  • Urine test
  • Blood test
  • Scans
  • Cystoscopy
27
Q

Blood Ix in renal Ca

A

  • FBC
  • U& E -> to look at kidney function
  • Clotting -> if we want to operate we need to know
  • Liver function
  • calcium and ESR-> to look for paraneoplastic syndrome

(paraneoplastic: raised Ca, raised ESR)

28
Q

What’s the primary aim of the Ix in renal Ca?

A

To see if metastasis are present -> need to stage in order to decide what Rx we can offer

(if not, then maybe able to operate; if yes, then palliative care)

29
Q

What is there present in urine in renal Ca?

A
  • blood
  • associated infection
30
Q

What is a gold standard scan used for evaluation of renal Ca?

A

CT scan

*those who cannot have CT, then MRI

31
Q

Why do we do cystoscopy in Ix of renal Ca?

A

Cystoscopy = camera in the bladder

We do a cystoscopy, to look if a transitional cell carcinoma there (as if we may have transitional cell carcinoma in the renal pelvis -> then it may spread with the urine as its draining there)

*if transitional cell Ca in renal pelvis -> 30% chances of developing second tumour inside the bladder

32
Q
A
33
Q

What type of CT scan we do in renal Ca?

A

3 phase contrast CT staging scan

*3 phases = images taken at 3 different time points following contrast administration

34
Q

What’s PET CT scan used for?

A

For detection of an active metastatic disease elsewhere

*little relevance in kidney cancer though

* more important for prostate, bladder

35
Q

What’s DMSA scan?

A

Functional scan to find out about nephron function in each kidney (how much of function is left in each of the kidney)

*e.g. when we plan for the removal of the kidney of the tumour -> to see if other kidney could cope or if dialysis is needed

36
Q

What staging is used to grade kidney cancer?

A

TNM staging

37
Q

What are the main features T1, T2, T3 and T4?

A

Gerota’s facia - fat around the kidney

38
Q

Nodal staging

  • N0
  • N1
A

N0 - no lymph node involved

N1 - regional lymph nodes involved

39
Q

What are:

  • M0
  • M1
A

M0 - no distant metastasis

M1 - distant spread of cancer

40
Q

What are the stages

Stage 1, 2, 3 and 4

(characterised by T- staging)

A
  • Stage 1 - T1
  • Stage 2 - T2
  • Stage 3 - any N1 or T3
  • Stage 4 - any T4 or M1
41
Q

Do we need to worry about cysts in the kidney?

A

Generally not, but need to classify them (Bosniak classification)

*depends on the presence of septa inside the cyst

*pt may require follow up for few years with CT/USS - in stage II

42
Q

Palliative modes of renal cancer management

A
  • radiotherapy -> for pain in the bone, to shrink tumours there
  • chemotherapy
  • VGEF/ mTOR inhibitor
  • immunotherapy

Y3 Lecture weeks (65 decks)

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