Renal Cancer Flashcards
What are the types of renal cancer
Renal Cell carcinoma (85%): adenocarcinoma of the renal cortex originating from the proximal convoluted tubules
Transitional cell carcinoma: squamous differentiation with extensive keratinisation and intracellular bridges
Aetiology of renal cell carcinoma
Unknown
Genetics:
- Von Hippel-Lindau (VHL) - autosomal dominant Von Hippel Lindau syndrome.
- Folliculin (FLCN)
- Mesenchymal-epithelial transition factor (MET)
- Fumarate hydratase (FH)
- Succinate dehydrogenase (SDH)
- BAP1
Renal cell carcinoma can spread haematogenously (classically to the lungs, leading to ‘cannon ball metastases’), locally (into the renal vein and inferior vena cava for example), and via the lymphatic system.
Risk factors for renal cell carcinoma
Smoking (20-30% in men, 10-20% in women)
Male
Obesity
Hypertension
Renal transplantation and end-stage renal disease
Age >55
Residence in developed countries
Black/american-indian ethnicity
+ve family history of RCC
History of hereditary syndromes of acquired renal cystic disease
Epidemiology of renal cell carcinoma
Peak incidence in middle age (40 -60 years old)
Male: Female ration is 2:1
Symptoms of renal cancers
Often asymptomatic
Haematuria
Flank pain
Systemic symptoms: weight loss, lethargy, fever, sweats, pallor
L-sided varicocoele
Von Hipperl Lindau → vision loss
Differentials for renal cancer
Polycystic kidney disease
Renal angiomyolipoma
Oncocytoma
Signs of renal cancer on examination
Haematuria
Palpable abdominal mass
- renal masses move with respiration and can be balloted bi-manually, just like the kidneys themselves.
Lower limb oedema (inferior vena cava involvement)
Scrotal varicocoele
Paraneoplastic presentation:
- Hepatic dysfunction: ascites, hepatomegaly, spider angiomata
- Myoneuropathy
Investigations for renal cancer
Urinalysis: ?haematuria/proteinuria
FBC: Deranged RBC (paraneoplastic)
Bone profile: hypercalcaemia (paraneoplastic)
LDH: raised
LFTs: deranged (mets or paraneoplastic)
Clotting: elevated PT (paraneoplastic)
U&Es: renal function
Cr: reduced clearance
US abdomen: Abnormal renal cyst/mass, lymphadenopathy, and/or other visceral metastatic lesions
CT abdomen: Abnormal renal cyst/mass, lymphadenopathy, and/or other visceral metastatic lesions
Biopsy: Not required where imaging demonstrates a malignant renal mass | Mandatory for any ablative procedure.
Flexible cystoscopy: ?bladder cancer
CT chest/CXR/MRI brain/MRI spine/bone scan: ?mets
Management for renal cell carcinoma
First line: Surgical resection
- T1 lesions: Usually managed by partial nephrectomy, providing equivalent oncological outcomes to radical nephrectomies.
- T2 and above: Typically managed by radical nephrectomy. A partial nephrectomy would be considered if the contralateral kidney offers insufficient function on its own.
Management for transitional cell carcinoma
Surgery and chemotherapy
- Surgery: radical nephroureterectomy (removal of kidney and ureter)
- - Offered if there is no distant disease
- One kidney/poor renal function/not fit for surgery: laser
- Chemotherapy: incomplete resection or palliative patients
Complications of renal cancer
Paraneoplastic syndrome:
Anaemia
Hypercalcaemia
Erythrocytosis
SIADH
Hepatic dysfunction (mets or Stauffer’s syndrome)
Prognosis for renal cancer
Renal cell carcinomas often present late on in their course, and up to 30% of patients may have metastases and a poor prognosis by that time.
If the cancer has not spread, then surgical resection is the treatment of choice and 5 year survival is in the order of 80%.
Prognosis is particularly poor in those who develop paraneoplastic syndromes
