Renal cancer Flashcards
1
Q
Most common type renal cancer
A
Renal cell carcinoma
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)
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
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
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
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
7
Q
Genetic disorders pre-disposing to RCC
A
- Von Hippel-Lindau - bilateral multifocal tumours
- BAP1 mutation
- Birt-Hogg-Dube disease
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
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
10
Q
Paraneoplastic syndromes of RCC
A
- Polycythaemia due to EPO
- Hypercalcaemia due to PTHrP
- HTN due to renin
- Pyrexia of unknown origin
11
Q
Bedside and bloods for ?renal cancer
A
- FBC
- U&E
- LFT
- CRP
- Urinalysis for haematuria and send for cytology
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
13
Q
Staging for renal cancer
A
- American joint committee on cancer (AJCC) staging
- 4 stages
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
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