RCC and Testicular Cancer

Question 1

RCC

Answer 1

An adenocarcinoma from tubular epithelial cells (80-90% of all malignant tumors of the kidney)

Tumors can spread along renal vein to the IVC and can met to the lung and bone

Risk factors: Male, smoking, obesity, acquired cystic kidney disease in ESRD, and von Hippel-Lindau disease

Question 2

History and exam for RCC

Answer 2

1) Presenting signs include hematuria, flank pain and palpable flank mass (5-10% have all 3 of the triad). Met disease can present with weight loss and malaise
2) Many patients have fever or other constitutional symptoms. L-sided varicocele may be seen in males (due to tumor blockage of L gonadal vein which empties into L renal vein; the R gonadal vein empties directly into IVC)
3) Anemia is common, but polycythemia* due to increased EPO production may be seen in 5-10% of patients

Question 3

Dx of RCC

Answer 3

US and/or CT to characterize the renal mass (usually complex cysts or solid tumor)

Question 4

Tx of RCC

Answer 4

1) Surgical resection may be curative in localized disease
2) Response rates from radiation or chemo are only 15-30%. newer tyrosine kinase inhibitors (sorafenib, sunitinib) which lower tumor angiogenesis and cell proliferation have shown promising results and have recently been approved by FDA for treatment of RCC

Question 5

Testicular cancer

Answer 5

A heterogeneous group of neoplasms. 95% of testicular tumors derive from germ cells*, and almost all are malignant.

Cryptorchidism is associated with increased risk of neoplasia in both testes.

Klinefelter’s syndrome is also a risk factor.

Testicular cancer is the most common malignancy in males 15-34

Question 6

History and exam for testicular cancer

Answer 6

1) Patients most often present with painless enlargement of the testes
2) Most testicular cancers occur between ages 15 and 30, but seminomas have peak incidence between 40 and 50.

Question 7

Dx of testicular cancer

Answer 7

1) Testicular US
2) CXR and abdominal/pelvic CT to evaluate for mets
3) Tumor markers are useful for dx and in monitoring treatment response
4) B-hCG is always elevated in choriocarcinoma and is elevated in 10% of seminomas
5) AFP is often elevated in nonseminomatous germ cell tumors, particularly endodermal sinus (yolk sac) tumors. It is also elevated in hepatocellular carcinoma, hepatoblastoma, and neuroblastoma

Question 8

Tx of testicular cancer

Answer 8

1) Radical orchiectomy
2) Seminomas are exquisitely radiosensitive and also respond to chemo
3) platinum based chemo is used for nonseminomatous germ cell tumors