RCC

Question 1

What is the triad for RCC?

Answer 1

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)

Question 2

How many patients have the complete triad associated with RCC?

Answer 2

less than 10%

Question 3

Although RCC has a variable presentation, what are some strong indicators?

Answer 3

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

Question 4

What are the paraneoplastic symptoms associated with RCC?

Answer 4

Increased Hct due to increased EPO
Increased Ca levels due to PTHrp or lytic lesions

Question 5

RCC on the left side in a male can lead to … ?

Answer 5

varicocele that does not compress

Question 6

What are the genetic risk factors for RCC?

Answer 6

Polycystic kidney disease (PKD)

vHL

Question 7

RCC most commonly arises from … ?

Answer 7

RCC is the most common renal cancer (85%) that …

• 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

Question 8

How is RCC diagnosed?

Answer 8

Abdominal CT (with and without contrast) with Biopsy

The preference is perform a partial/complete nephrectomy for histology (biopsy)

Further evaluation followed by staging imaging (eg, CT chest).

Question 9

How is RCC managed?

Answer 9

For localized RCC: partial/complete nephrectomy

For advanced RCC: targeted immunotherapy* with surgical nephrectomy/debulking

• immunotherapy includes:
• checkpoint inhibitors: CTLA4 inhibitors and PD-1 inhibitors
• anti-VEGF