Renal Cancer Flashcards
What is the most common type of renal cancer?
Renal cell carcinoma (RCC)
What is the peak incidence of RCC?
50-70 yrs
What are other less common types of renal cancers?
Transitional cell carcinoma
Nephroblastoma in children (Wilms tumour)
SCC
What is the pathophysiology of RCC?
Adenocarcinoma of the renal cortex, arising predominantly from the proximal convoluted tubules, most often appearing in the upperpole of the kidney.
What is the microscopic compostion of RCC?
Polyhedral clear cells, with dark staining nuclei and cytoplasm rich with lipid and glycogen granules.
How can RCC spread?
Direct invasion into perinephric tissues, adrenal glands, renal vien or inferior vena cava.
Via lymphatic system to pre-aortic and hilar nodes
Haematogenous spread to bones, liver, brain and lung.
What are the risk factors for RCC?
Smoking Industrial exposure to carcinogens Dialysis Hypertension Obesity Anatomical abnormalities (PCKD, horseshoe kidney) Genetic disorders
What are the clinical features of RCC?
Haematuria - visible or non-visible
Also may have flank pain, flank mass
Weight loss and lethargy
Left-sided mass may also have left varicocele due to compresion of left testicular vein.
How is RCC found 50% of the time?
Incidental on abdominal imaging
What are the uncommon presentations in paraneoplastic syndrome caused by ectopic secretion of hormone by RCC?
Polycythaemia due to erythromycin
Hpercalcaemia due to parathyroid hormone
Hypertension due to renin
Clinical feature of meatatasis (haemoptysis or pathological fractures)
Pyrexia of unknown origin
What are the differential diagnosis for RCC?
Other urological malignancy
Renal stone
UTI
What laboratory tests should be done for RCC?
Routine bloods - FBC, U&Es, calcium, LFTS and CRP
Urinalysis + cytology
What imaging may be requested in RCC?
Ultrasound
CT imaging of abdo-pelvis - pre and post IV contrast - GOLD standard
Biopsy of renal lesions
What is the staging classfication used for RCC?
American joint commitee on cancer (AJCC) staging classification
What is the staging of RCC?
Stage 1(T1N0M0) - tumour ≤7 cm and confined to renal capsule Stage 2(T2N0M0) - tumour >7 cm or invading the renal capsule (but confined to Gerota fascia) Stage 3(T3orN1M0) - tumour extending into renal vein, vena cava or spread to 1 local lymph node Stage 4(T4N2orM1) - tumour extended beyond Gerotas fascia, >local lymph node, invlovement of ipsilateral adrenal gland or perinephric fat or distant metastases.
What is the surgical management of localised disease in RCC?
Smaller tumours - partial nephrectomy
Larger tumors - radical nephrectomy
What is involved in a radical nephrectomy?
Remove kidney, perinephric fat and local lumph nodes.
Adrenal galnd is spared unless large upper pole tumours
What is the management for localised RCC that are not fit or suitable for surgery?
Percutaneous radiofrequency ablation or laparoscopic/percutaneuos cryotherapy may be considered.
Renal artery embolistaion may be required for haemorrhaging disease, prior to any radiofrequency ablation or for unresectable palliative cases.
When is surveillance considered in localised RCC?
Small growing renal masses in pts ufit or unwilling to undergo surgery with limited life expectancy.
What is the management of metastaic disease for RCC?
Nephrectomy with immunotherapy (IFN-alpha or IL-2 agents)
Biological agents can also be used
Metastasectomy is recommended where disease is resectable and pt otherwise well.
What is the prognosis of RCC?
25 % have mets at presentations
Survival rate for pts undergone nephrectomy is 70% at 3 years and 60% at 5 years. However the worse the stage the worse the prognosis.
