RCC/ Hypernephroma Flashcards
1
Q
Epidemiology
A
90% of renal cancers
Age: 55yrs
Sex: M>F=2:1
2
Q
Risk factors
A
Smoking Obesity HTN Dialysis: 15% of pts. develop RCC 4% heritable: e.g. VHL syndrome
3
Q
Pathology
A
Adenocarcinoma from proximal renal tubular epithelium Clear Cell (glycogen) subtype: 70-80%
4
Q
Presentation
A
50% incidental finding
Triad: Haematuria, loin pain, loin mass
Invasion of L renal vein → varicocele (1%)
Cannonball mets → SOB
5
Q
Paraneoplastic features
A
EPO → polycythaemia PTHrP→↑Ca Renin → HTN ACTH → Cushing’s syn. Amyloidosis
6
Q
Spread
A
Direct: renal vein
Lymph
Haematogenous: bone, liver and lung
7
Q
Investigations
A
Blood: polycythaemia, ESR, U+E, ALP , Ca Urine: dip, cytology Imaging CXR: cannonball mets US: mass IVU: filling defect CT/MRI
8
Q
Medical management
A
Reserved for pts. ̄c poor prognosis
Temsirolimus (mTOR inhibitor)
9
Q
Surgical management
A
Radical nephrectomy
Consider partial if small tumour or 1 kidney
10
Q
Prognosis
A
45% 5ys
11
Q
What is Von Hippel-Lindau
A
Autosomal Dominant
Renal and pancreatic cysts
Bilateral renal cell carcinoma Haemangioblastomas
Often in cerebellum → cerebellar signs Phaeochromocytoma
Islet cell tumours
