Renal cancer Flashcards
What is the most common type of adult renal tumour?
Renal cell carcinoma
Name the different types of renal malignancies
Renal cell carcinoma (most common)
Transitional cell carcinoma (urotehlial)
Nephroblastoma in children (Wilm’s tumour)
Squamous cell carcinomas
Where are renal cell carcinomas?
In the renal cortex (renal parenchyma) - most commonly in the upper pole of the kidney
What type of tumour are renal cell carcinomas?
Adenocarcinoma
Where do renal cell carcinomas metastasize to?
Direct invasion to perinephritic tissues, adrenal gland + renal vein
Lymphatic spread to pre aortic and hilar lymph nodes
Haematogenous spread to bones, liver, brain and lung (2 Bs 2 Ls)
Lungs - seen as ‘cannonball metastases’
What are the risk factors for renal cell carcinoma?
Smoking Industrial exposure to carcinogens Dialysis Hypertension Obesity Anatomical abnormalities Polycystic kidney disease
How does renal cell carcinoma present?
May be asymptomatic - found incidentally Haematuria - visible or non visible Flank pain Flank mass Non specific symptoms - e.g. lethargy and weight loss
Left sided - may present with varicocele
Some paraneoplastic syndromes
Why may left sided renal tumours present with a varicoele?
Due to compression of the left testicular vein as it joins the left renal vein.
What investigations are done for renal cell cancers?
Bloods - FBC, U+Es, Ca2+, LFTs, CRP
Urinanalysis
CT imaging - abdo/pelvis with IV contrast
Biopsy of lesion
What is the management for localised renal cell carcinoma?
Surgery
- partial nephrectomy - if small
- radical nephrectomy - removal of kidney, perinephric fat + lymph nodes
Percutaneous radiofrequency ablation or cryotherapy (freezing) - if not suitable for surgery
Renal artery embolisation if haemorrhaging
What is the management for metastatic renal cell carcinoma?
Immunotherapy - if patient is otherwise well
Biological agents
Metastasectomy - surgical removal of solitary metastases where possible if otherwise well
**chemotherapy generally ineffective
Where are transitional cell carcinomas found?
From the calyx of the kidney to + including the bladder
