RCC and TCC Flashcards
Risk factors for RCC
- Obesity
- Smoking x 2
- HTN
- Dialysis
- VHL syndrome - Von Hippel Lindau
- Industrial exposure to carcinogens - lead or aromatic hydrocarbons
- PCKD
Pathology of RCC
Adenocarcinoma from proximal renal tubular epithelium
Presentation of RCC
• Triad
- Haematuria
- loin pain
- loin mass
- Systemic: anorexia, malaise, wt. loss, PUO
- Clot retention
- Invasion of L renal vein → varicocele
- Cannonball mets → SOB
Paraneoplastic Features of RCC
- EPO → polycythaemia
- PTHrP → ↑ Ca
- Renin → HTN
- ACTH → Cushing’s syn.
- Amyloidosis
Ix of RCC
Blood: polycythaemia, ESR, U+E, ALP, Ca
- Urine: dip, cytology
- Imaging
- first line USS: mass
- CXR: cannonball mets
- IVU (intravenous urography): filling defect
- CT KUB IV contrast - gold standard
- biopsy
Mx of RCC
• Medical
- pts. with poor prognosis
- Temsirolimus
• Surgical + immunotherapy:
- Radical nephrectomy
- Consider partial if small tumour or 1 kidney
Chemotherapy - ineffective
Transitional Cell Carcinoma Risk factors
- Smoking
- Amine exposure (rubber industry)
- Cyclophosphamide
Transitional Cell Carcinoma Pathology
• Highly malignant • Locations - Bladder: 50% - Ureter - Renal pelvis
Presentation of TCC
- Painless haematuria
- Frequency, urgency, dysuria
- Urinary tract obstruction
- UTI
Mx of TCC
- Nephro-uretectomy
* Regular f/up: 50% develop bladder tumours
Wilm’s Tumour
• Nephroblastoma
• Childhood tumour of primitive renal tubules and
mesenchymal cells
Presentation: • 2-5yrs • 5-10% bilateral • Abdo mass • Haematuria • Abdo pain • HTN
SCC
Associated with chronic infected staghorn calculi
Associated with schistosomiasis - bladder
Mx of bladder Ca
T1 (non muscular invasive) - Transurethral resection of bladder tumour (TURBT)
Invasive:
- Radical cystectomy with ileal conduit (urostomy)
- Radiotherapy
- Neoadjuvant chemo - cisplatin
- Regular follow-up with CT imaging
T4:
- Palliative chemo/radiotherapy
- Long term catheter
RCC spread
Direct invasion - adrenal gland, renal vein or the inferior vena cava. R
Lymphatic system - pre-aortic and hilar nodes
Haematogenous spread - bones, liver, brain and lung
Radical nephrectomy
Remove the kidney, perinephric fat and local lymph nodes en bloc
Not fit for renal surgery
Percutaneous radiofrequency ablation
or
laparoscopic/percutaneous cryotherapy
Renal artery embolisation - required for haemorrhaging disease prior to any radiofrequency ablation
At what vertebral level do the renal hilum typically lie
L1
Classifications of bladder cancer
- Non-muscle-invasive bladder cancer – does not penetrate into the deeper bladder wall (80% cases)
- Muscle-invasive bladder cancer – penetrates the bladder wall
- Locally advanced or metastatic bladder cancer – spreading beyond the bladder and distally
Investigations of bladder cancer
- Urine cytology
- CT staging
- IVU: pelviceal filling defect
- urgent flexible bladder cystoscopy
- If lesion identified - rigid cystoscopy with bladder biopsy
For a patient presenting with new visible haematuria, what is the recommended first-line investigations (after routine bloods and urine dipstick testing)?
CT scan KUB + flexible cystoscopy
New pigmented lesion on trunk after renal transplantation
Squamous cell carcinoma
