Renal cancer Flashcards

1
Q

Most common type renal cancer

A

Renal cell carcinoma

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2
Q

Other renal cancers

A
  • Transitional cell carcinoma (urothelial tumour)
  • Nephroblastoma in childrn (Wilms)
  • Squamous cell carcinomas (chronic inflammation secondary to renal calculi, infection and schistosomiasis)
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3
Q

RCC pathophys

A
  • Adenocarcinoma of renal cortex
  • Arises mostly from proximal convoluted tubules
  • Most often appears in upper pole of kidney
  • Microscopic - polyhedral clear cells, dark staining nuclei, cytoplasm rich with lipid and glycogen granules
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4
Q

How can RCCs spread?

A
  • Direct invasion - perinephric tissue, adrenal gland, renal vein or IVC
  • Lymphatic system - pre aortic and hilar nodes
  • Haematogenous - bones, liver, brain, lung
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5
Q

What can RCCs do to the renal vein if spread?

A
  • Distinct feature - can invade through renal vein wall and into lumen
  • Condition called tumour thrombosis
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6
Q

RF for RCC

A
  • Smoking
  • Industrial exposure to carcinogens - cadmium, lead, aromatic hydrocarbons
  • Dialysis - 30x increase
  • HTN
  • Obesity
  • Anatomical abnormalities eg PCKD or horseshoe kidney
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7
Q

Genetic disorders pre-disposing to RCC

A
  • Von Hippel-Lindau - bilateral multifocal tumours
  • BAP1 mutation
  • Birt-Hogg-Dube disease
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8
Q

Symptoms of RCC

A
  • Haematuria - non-visible or visible
  • Flank pain
  • Flank mass
  • Non-specific - lethargy, weight loss
  • Mets - haemoptysis, pathological #

Lots are diagnosed incidentally on abdominal imaging - lack symptoms

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9
Q

Examination findings of RCC

A
  • Large can be palpated in flank or hypochondrial region
  • Left sided masses - left varicocele due to compression of left testicular vein as it drains into left renal vein

Retroperitoneal so takes time before signs and symptoms

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10
Q

Paraneoplastic syndromes of RCC

A
  • Polycythaemia due to EPO
  • Hypercalcaemia due to PTHrP
  • HTN due to renin
  • Pyrexia of unknown origin
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11
Q

Bedside and bloods for ?renal cancer

A
  • FBC
  • U&E
  • LFT
  • CRP
  • Urinalysis for haematuria and send for cytology
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12
Q

Imaging for ?renal cancer

A
  • USS
  • CT imaging abdomen pelvis pre and post IV contrast (then chest staging CT after confirmation)
  • Biopsy esp if small when surveillance or minimally invasive ablation therapies are considered
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13
Q

Staging for renal cancer

A
  • American joint committee on cancer (AJCC) staging
  • 4 stages
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14
Q

Stages of renal cancer

A
  • 1 - tumour 7cm or less, confined to renal capsule
  • 2 - tumour >7cm, invading the renal capsule (but confined to Gerotas fascia)
  • 3 - tumour extending into renal vein, vena cava or spread to 1 local LN
  • 4 - extending beyond gerotas fascia, >1 local LN, involvement of ipsilateral adrenal gland or perinephric fat, or distant mets
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15
Q

Management localised renal cancer

A
  • Surgical - laparascopic or open
  • Smaller tumour - partial nephrectomy
  • Larger - radical nephrectomy (kidney, perinephric fat, local lymph nodes), sparing adrenal gland if possible
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16
Q

Management localised renal cancer if unsuitable for surgery

A
  • Percutaenous radiofrequency ablation
  • Or laparascopic/percutaenous cryotherapy
  • If slow growing and small- surveillance
  • Renal artery embolisation for haemorrhaging disease prior to ablation and if unresectable palliative
17
Q

Management metastatic renal cancer

A
  • Chemotherapy = INEFFECTIVE
  • If otherwise fit, nephrectomy + immunotherapy (IL-2 or IFN-a agents
  • Biological agents - Sunitinib, Pazopanib (tyrosine kinase inhibitors)
  • Metastasectomy - surgical resection of solitary mets if resectable and pt well

Interferon alfa and interleukin 2

18
Q
A