Renal Cancer

Question 1

RCC etiology

Answer 1

Adenoma
Smoking esp cigars
Obesity( hpt)
Acquired renal cystic disease (CRF on dialysis)
Von Hippel-Lindau disease (rare autosomal dom)

Question 2

Pathological traits

Answer 2

Can grow to large sizes without mets 15cm
May pro a solitary met
Paraneoplastic synd
May spontaneously disappear

Question 3

Presentation

Answer 3

Triad: pain, mass and haematuria
Endo: hype Ca, polycythemia
Toxin: anaemia, pyrexia of unknown origin, neuropathy, non-metastatic hepatopathy
Vascular: hypertension, dvt, varicocele, oedema of lower legs (blocked IVC), HOCF

Question 4

Ultrasound signs of simple cyst vs solid mass

Answer 4

Simple cyst
Uniform round border with thin wall
No internal echoes
Posterior wall sign enhancement

Solid mass
Irregular poorly defined border
Internal echoes (hyper echoic)
No posterior wall sign enhancement

Question 5

Classification

Answer 5

Benign
Oncocytoma (benign version of RCC, clinically indistinguishable)
Adenoma (precursor of RCC)
Angiomyolipoma (harmatoma, 🚺common esp preggies, asso tuberous sclerosis the therefore operate when >4cm, preggies and travel)

Malignant
Primary
Parenchymal: RCC, Wilms,
Urothelium: tumors of renal pelvis and ureter
Secondary
Bronchus, breast, stomach, contra lateral RCC lymphoma and malignant melanoma.

Bilateral in 50% and poor prognosis

Question 6

Management

Answer 6

Palliative/conservative: symptoms based

• immunotherapy with interleukins or interferon for palliative, some research says to do nephrectomy first to decrease tumor burden
• Renal artery ablation for advanced with severe bleeding

Curative: only in absence of mets= radical nephrectomy, hemi nephrectomy

(Radiation and chemo not effective)