RCC Flashcards
Where does it arise from?
Renal tubular epithelium
What are the 2 subtypes and which is more common?
- Clear cell - more common
(adenocarcinoma) - Papillary tumour
Give 4 RF
- Middle-aged male
- Smoking, obesity, HTN
- Renal transplant/ dialysis
- +ve FH: von Hippel-Lindau
- tuberous sclerosis
What are the 3 ways of spread?
- Direct - via renal vein
- Lymph - para-aortic then mediastinal
- Haematogenous - (cannon ball mets) lung/bone/liver
What is the classical triad of SX?
Haematuria
Loin pain
Abdo mass
How does it present?
Often ASX - some have mets at presentation Classical triad Anorexia, wt loss, malaise Paraneoplastic effects Left varicocele
What causes the left varicocele?
Invasion of L renal vein = compression of L testicular vein
What are the paraneoplastic effects?
Secretes:
- EPO = polycythaemia
- PTH = hyperCa
- Renin = HTN
- ACTH
What is Stauffer syndrome?
Paraneoplastic hepatic dysfunction syndrome
?2nd to increased levels of IL-6
Cholestasis in absence of liver mets
Increase bilirubin, thrombocytosis and hepatosplenomegaly
What IX do you need to do?
BP FBC - polycythaemia U&E Cr - elevated ESR - high LFTs - abnormal (return to normal after surgery)
Urinalysis
- Haematuria
- Red cell casts
- MCS of MSU - exclude UTI
Imaging
- USS - differentiate between tumour and cyst
- CT - see small tumours
- MRI - staging
- Bone scan
What scale is used for staging?
TNM
What is used for staging?
USS - assess tumour size
MRI - lymph and venous involvement
Bone scan - mets
How is it MX?
Surgical resection/ local ablation
Nephrectomy +/- radical
Advanced disease:
- targeted molecular therapy e.g. tyrosine kinase inhibitor SUNITINIB +/- palliative local radiation + bisphosphonates for bone mets
What is the prognosis?
5 year survival
