RCC Flashcards
What is the most common cause of renal cancer?
RCC (85%)
What are the genetic risk factors for RCC?
The 2 most common:
- Mutation of vHL on chromosome 3 (3p).
- Tuberous sclerosis.
Does having inherited polycystic kidney disease increase the risk for developing RCC?
No.
Unlike acquired cystic kidney disease, hereditary polycystic kidney disease is not associated with an increased risk of RCC. If RCC does occur in patients with hereditary polycystic kidney disease, it typically menifests with bilateral, multifocal, and sarcomatoid tumors.
What are the non-genetic risk factors for RCC?
- smoking
- obesity
- aquired cystic disease
- nephrolithiasis
- long term aspirin or acetaminophen use
- HTN
- Immunodeficiency
- Chronic Hepatitis C
- Exposure (Cadmium, asbestos, trichloroethylene)
- Chemo drugs with platinum since childhood
RCC is most commonly inherited or sporatic?
sporatic
Most renal cell carcinomas (RCCs) occur sporadically.
RCC most commonly arises from … ?
- most commonly consists of clear cells from the PCT
- less commonly arise from papillary tumors from the PCT or intercalated cell tumors (oncocytomas) associated with tuberous sclerosis
What is the triad for RCC?
A palpable abdominal mass (firm/non-tender) that moves with respiration
Flank pain
Hematuria (when the tumor invades the renal collecting system), which may lead to iron deficiency anemia)
What causes the flank pain in RCC?
Dragging/colicky, caused by the passage of clots (clot colic)
How many patients have the complete triad associated with RCC?
less than 10%
Although RCC has a variable presentation, what are some strong indicators?
Patient History:
Age >50 years old, Obesity, history of smoking, history of chemical exposure, history of cytotoxic medications, exposure to asbestos
Patient symptoms:
RCC triad, intermittent fever, night sweats, weight loss
What are the paraneoplastic conditions associated with this condition?
Paraneoplastic RCC:
* Polycythemia and leukemoid Reaction from high EPO
* Renin elevation causes HTN
* Calcium is high from PTHrp
* Cortisol is high from high ACTH leading to memory loss, psychosis and depression
What are the paraneoplastic symptoms associated with RCC?
Increased Hct due to increased EPO
Increased Ca levels due to PTHrp or lytic lesions
RCC on the left side in a male can lead to … ?
varicocele that does not compress
How is RCC diagnosed?
The primary imaging modality is an abdominal ultrasound, or CT or MRI with contrast.
Ultimately an abdominal CT (with and without contrast) with biopsy will be needed. The preference is perform a partial/complete nephrectomy for histology (biopsy)
Further evaluation followed by staging imaging (eg, CT chest).
How is RCC managed?
Surgical resection is first-line treatment in localized nonmetastatic disease, therefore for localized RCC, perform a partial/radical nephrectomy. A partial nephrectomy is considered for tumors < 2.5 cm and no extra-renal extension.
For advanced RCC: targeted immunotherapy* with surgical nephrectomy/debulking.
Since most RCC tumors are resistant to radiotherapy and classical chemotherapeutic agents, for metastatic RCC, immunotherapy (checkpoint inhibitors like CTLA4 inhibitors and PD-1 inhibitors) and targeted therapy like anti-vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) inhibitors are used.
