Renal Cancer

Question 1

What type of cancer is renal cancer?

Answer 1

Adenocarcinoma

Question 2

Where does the renal cancer develop?

Answer 2

Epithelium of proximal tubule

Question 3

What is the main histological type of adenocarcinoma?

Answer 3

Clear cell carcinoma

Question 4

What are the main risk factor of renal cancer?

Answer 4

• smoking
• family history
• von Hippel-Lindau syndrome
• obesity and hypertension

Question 5

How does renal cancer present?

Answer 5

Triad:
Flank pain
Mass
Haematuria

Question 6

How else can renal cancer present?

Answer 6

• Left varicocele
• Pyrexia (PUO)

Question 7

What endocrine symptoms can present with renal cancer?

Answer 7

• Parathyroid hormone (PTH)- Hypercalcaemia
• Polycythaemia-erythropoietin
• Renin- Hypertension

Question 8

What paraneoplastic syndrome can present with renal cancer?

Answer 8

Stauffer syndrome-cholestasis or hepatosplenomegaly

Question 9

Where can renal cancer metastasise to?

Answer 9

Lungs

Question 10

What is metastasis to the lung called?

Answer 10

Cannonball metastasis

Question 11

Where else can renal cancer metastasise to?

Answer 11

Brain
Bone
Liver

Question 12

How would you diagnose renal cancer?

Answer 12

Ultrasound

Question 13

What would you use to differentiate a tumour from a cyst?

Answer 13

Ultrasound

Question 14

How would you stage renal cancer?

Answer 14

CT

Question 15

What is the management of renal cancer?R

Answer 15

Radical nephrectomy

Question 16

What is the management to reduce tumour size (and treat metastases)?

Answer 16

Alpha-interferon or interlukin-2

Question 17

What is better to reduce tumour size and reduce metastasis than Alpha-interferon or interlukin-2?

Answer 17

Tyrosine kinase inhibitors (e.g. sorafenib, sunitinib)

Question 18

What is seen on microscopic appearance of renal cell carcinoma?

Answer 18

• Cytoplasm contains glycogen fats
• High fat content accounts for golden colour macroscopically
• Areas of haemorrhage (black) and Necrosis (grey)

Question 19

How do renal cell cancers usually appear?

Answer 19

Well circumscribed with a yellowish appearance which represents their high content of fat and glycogen

Question 20

What is the management of a T1 renal cancer?

Answer 20

Partial nephrectomy

Question 21

What is the management of a T2 and above renal cancer?

Answer 21

radical nephrectomy

Question 22

What would you find on urinanalysis of someone with renal cell carcinoma?

Answer 22

Haematuria

Question 23

What Other ingimging can be used in someone with renal cell carcinoma?

Answer 23

CT- Confirm diagnosis and staging

Question 24

What is renal cell carcinoma?

Answer 24

• An adenocarcinoma of the renal cortex and that arises from the proximal convoluted tubule

Question 25

What syndrome increases the risk of renal cell carcinoma?

Answer 25

Von Hippel–Lindau

Question 26

How can renal cell carcinoma present in males?

Answer 26

Varicocele
(abnormal enlargement of testicular vein)

Question 27

What treatment is renal cell carcinoma usually resistant to?

Answer 27

Radiotherapy or chemotherapy

Question 28

What are the main paraenoplastic features of renal cell carcinoma?

Answer 28

Hypertension
Polycythaemia
Hypercalcaemia
Cushing’s syndrome

Question 29

How do most patients present with renal cell carcinoma?

Answer 29

Asymptomatic until stage 4

Question 30

At which stage do patients typically become sypmtomatic with renal cell carcinoma?

Answer 30

Stage 4