Renal Cancer Flashcards
What is renal cancer?
It is usually a malignant, adenocarcinoma growth originating from cells lining the proximal convoluted tubule
What renal cells are involved in renal cancer?
Clear cells
What are the six risk factors of renal cancer?
Gender, with males having an increased risk
Age, with the risk of renal cancer increasing with age – specifically after the age of 50
Family History
Congenital Syndromes, such as von Hippel-Lindau disease are associated with the development of renal cancer
Smoking
Obesity
What is the most important risk factor of renal cancer?
Obesity
Why is smoking a risk factor of renal cancer?
It increases the harmful chemicals the kidneys are required to filter
How does renal cancer tend to present?
Asymptomatically and and is therefore diagnosed incidentally on imaging for unrelated symptoms
What are the six clinical features of renal cancer?
Haematuria, which is the presence of blood within urine resulting in pink-coloured urine
Loin Pain, which is defined pain in one side of the body between the upper abdomen and the back
Weight Loss
Fatigue
Nausea & Vomiting
Paraneoplastic syndrome
What are the three types of haematuria?
Visible
Microscopic
Dipstick positive
What is microscopic haematuria?
It is defined as more than three RBCs per high power field
What is paraneoplastic syndrome?
A group of rare disorders in which a neoplasm triggers an abnormal immune system response, resulting in the nervous system being attacked
What are the five clinical features of paraneoplatic syndrome?
Hypertension
Hypercalcaemia
Cachexia, which is defined as a wasting disorder that causes extreme weight loss and muscle wasting
Anaemia
Polycythaemia, which refers to an increase in the number of red blood cells in the body
What four investigations are used to diagnose renal cancer?
Blood & Urine Tests
CT Scan
Renogram
Renal Biopsy
How are blood and urine tests used to diagnose renal cancer?
They indicate the underlying cause of the renal cancer, allowing the most appropriate treatment to be determined
What specific CT scan is used to treat renal cancer?
Triple phase scan of the abdomen and chest
What is the standard investigation used to diagnose renal cancer?
CT scan
How is a CT scan used to diagnose renal cancer?
It allows the kidneys to be visualised, therefore enabling diagnosis and staging of renal cancer
What is a renogram?
A scan of the kidneys to determine how well each kidney is functioning, and whether urine from the kidneys pass down into the bladder without obstruction
How is renogram scan used to diagnose renal cancer?
It is used to guide treatment options, as it allows us to determine the function of the unaffected kidney and therefore whether removal of the cancerous kidney is feasible
What is a renal biopsy?
It involves the insertion of a thin needle into the kidneys to collect a tissue sample
The tissue sample is analysed in a lab to determine whether cancer cells are present
What is staging?
The assessment of a cancer’s spread
What is staging based on?
Clinical assessment
Radiological assessment
What is staging used to determine?
Prognosis outcome
To guide treatment
How is renal cancer staged?
TNM staging
What is the T stage in TNM staging?
It considers how big the tumour is and how far it has spread
What is the N stage in TNM staging?
It considers whether the cancer cells have spread into the lymph nodes
What is the M stage in TNM staging?
It considers whether the tumour has spread anywhere else in the body
What six locations does renal cancer tend metastasise to?
Brain
Adrenal glands
Liver
Lungs
Bone
Paracaval lymph nodes
What three treatments are used to treat renal cancer?
Surgical Treatment
Pharmacological Treatment
Immunotherapy Treatment
What two surgeries are used to treat renal cancer?
Radical nephrectomy
Partial nephrectomy
What is the most effective surgical management option of renal cancer?
Radical nephrectomy
What is a radical nephrectomy?
It involves removing the entire kidney, a border of healthy tissue and occasionally additional nearby tissues, such as the lymph nodes, adrenal gland or other structures
In what cases can radical nephrectomy be conducted laproscopically?
When the renal cancer is staged between T1-T3a
In what cases can radical nephrectomy be conducted openly?
When the renal cancer is staged greater than T3b
What is a partial nephrectomy?
It involves removal of the tumour and a small margin of healthy tissue that surrounds it
When is partial nephrectomy used to treat renal cancer?
Small renal cancers
If the patient has one kidney
What is the first line treatment option of renal cancer?
Surgery
What is pharmacological treatment of renal cancer?
It involves the prescription of drugs which target specific abnormalities present within cancer cells
By blocking these abnormalities, targeted drug treatments cause cancer cells to die
When is pharmacological treatment used to treat renal cancer?
Metastatic disease
It is used with other treatment options
What pharmacological treatment is used to treat renal cancer?
Tyrosine kinase inhibitors
What are three tyrosine kinase inhibitors used to treat renal cancer?
Sunitinib
Sorafenib
Pazopanib
What is immunotherapy?
It uses the body’s own immune system to fight the cancer
The body’s immune system may not attack the cancer physiologically due to the cancer cells producing proteins that help them hide from the immune system cells
Immunotherapy works by interfering with this process.
What two immunotherapies are used to treat renal cancer?
Interferon alpha
Interleukin-one
What is the first line prophylactic treatment choice?
Thiazide diuretic
