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Cancer, Palliative Care and Pain Medicine > Renal Cancer > Flashcards

Renal Cancer Flashcards

1
Q

What percentage of adult cancers do renal cell carcinomas account for.

A

3% of all adult cancers worldwide.

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2
Q

What are the types of renal tumours. (3)

A

Renal cell carcinoma.
Transitional cell carcinoma.
Wilms’ tumour.

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3
Q

What is the incidence of men:women who get renal cell carcinoma.

A

2:1.

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4
Q

What is the average age of diagnosis of renal cell carcinoma.

A

55.

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5
Q

What part of the world has a high incidence of renal cancer.

A

The West.

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6
Q

What part of the world has a low incidence of renal cancer.

A

Asia.

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7
Q

What risk factors are associated with renal cancer. (3)

A

Smoking.
Obesity.
Chronic renal disease needing dialysis.

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8
Q

What are most renal tumours.

A

Adenocarcinomas.

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9
Q

What are the renal adenocarcinomas usually known as.

A

Renal cell carcinoma (RCC).

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10
Q

What symptom is seen in 40% of patients presenting with renal cancer.

A

Haematuria.

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11
Q

Haematuria is present in ____% of patients presenting with renal cancer.

A

40%

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12
Q

What is the classic triad that renal cancer presents with.

A

Loin pain.
Haematuria.
Palpable mass.

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13
Q

How often do you see the classical triad of renal cancer.

A

Hardly ever (in about 10% of cases).

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14
Q

What is the classical triad of renal cancer indicative of.

A

Advanced disease.

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15
Q

What are the clinical features of renal cancer. (14)

A 
They are very varied: 
Anaemia. 
Polythcthaemia. 
Hypercalcaemia. 
Anorexia.
Loin pain. 
Abdominal mass. 
Hypertension. 
Malaise. 
Fever.
Neuropathy (rarely).
Raised ESR. 
Coagulopathies. 
Abnormal plasma proteins and LFTs. 
Unexplained weight loss. 
Classical triad: loin pain, haematuria, palpable mass.
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16
Q

What percentage of renal cancers are incidental findings.

A

60% due to increased use of imaging techniques.

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17
Q

Where can renal cancer spread to. (local structures) (3)

A

Renal vein.
Inferior vena cava (IVC).
Adrenals.

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18
Q

Where does renal cancer tend to metastasize to. (4)

A

Bones.
Lung (cannon ball lesions).
Lymph nodes.
Brain.

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19
Q

What do renal cancer metastases look like in bone.

A

Canon ball lesions.

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20
Q

How are renal tumours imaged. (2)

A

Ultrasound is more sensitive than IVU for renal lesions.

CT is gold standard for staging.

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21
Q

When would you do a bone scan in a patient with renal cancer. (2)

A

If symptomatic disease.

If raised alkaline phosphatase. (ALP)

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22
Q

What is a T1 renal tumour. (2)

A
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23
Q

What is a T2 renal tumour. (2)

A

> 7cm.

Confined to kidney.

24
Q

What is a T3 renal tumour.

A

Extends beyond the kidney. (eg renal vein, IVC or adrenal gland).

25
Q

What is a T4 renal tumour.

A

Extends beyond Gerota’s fascia.

26
Q

What is Gerota’s fascia.

A

Connective tissue capsule of the kidney.

27
Q

What percentage of renal tumours are renal cell carcinomas.

A

90%

28
Q

What percentage of patients on HD will develop renal cell carcinoma.

A

15%

29
Q

What percentage of renal cell carcinomas are found incidentally.

A

50%

30
Q

What is a rare associated features of renal cell carcinoma. Why.

A

Varicocele.

Rarely, invasion of the left renal vein compresses the left testicular vein, causing a varicocele.

31
Q

What percentage of renal cell carcinomas have metastases at presentation.

A

25%

32
Q

Where do renal cell carcinomas arise from.

A

Proximal renal tubular epithelium.

33
Q

Why may the BP be raised with a renal cell carcinoma.

A

Due to the excretion of renin.

34
Q

Why might there be polycythaemia with renal cell carcinoma.

A

Due to erythropoietin secretion.

35
Q

How is spread of renal cell carcinoma classified. (2)

A

Direct.

Indirect.

36
Q

What is the route of direct spread of renal cell carcinoma. (2)

A

Renal vein.

Lymph.

37
Q

What is the route of indirect spread of renal cell carcinoma. (3)

A

Haematogenous (bone, liver, lung).

38
Q

Where does transitional cell carcinoma occur. (3)

A

Bladder (50%).
Ureter.
Renal pelvis.

39
Q

What is the average age of onset of transitional cell carcinoma.

A

> 40.

40
Q

What is the ration of men:women who develop transitional cell carcinoma.

A

4:1

41
Q

What is the usual presentation of transitional cell carcinoma. (5)

A 
Painless haematuria. 
Frequency. 
Urgency. 
Dysuria. 
Urinary tract obstruction.
42
Q

What is a Wilms’ tumour.

A

A nephroblastoma.

43
Q

When do Wilms’ tumour occur.

A

Usually in childhood (first three years of life).

44
Q

What is the prevalence of Wilm’s tumours.

A

1:100,000.

It is the chief abdominal malignancy in children.

45
Q

What is the 5 year survival rate for transitional cell carcinomas.

A

10-80% (varies with clinical stage/histological stage)

46
Q

Where do Wilms’ tumours arise from.

A

A tumour of the primitive renal tubules and mesenchymal cells.

47
Q

How do Wilms’ tumours present. (2)

A

Abdominal mass.

Haematuria.

48
Q

What is the prevalence of renal adenocarcinomas.

A

16/100,000.

49
Q

What is the most common histological subtype of renal adenocarcinomas.

A

Clear cell carcinomas.

50
Q

What is the main problem with clear cell carcinomas. (3)

A

There is early spread of the tumour into the renal pelvis - causing haematuria.
Also along the renal vein, often extending into the IVC.

51
Q

What is the first line investigation if a renal adenocarcinoma is suspected.

A

Ultrasound - this can differentiate between a renal cyst and a solid tumour.

52
Q

What condition is characterised by bilateral renal cell carcinomas, haemangioblastomas, phaechromocytomas and renal cysts.

A

Von Hippel-Lindau disease.

53
Q

What is Von Hippel- Lindau disease.

A

An autosomal dominant disorder.

54
Q

What percentage of patients present with metastases from renal cell carcinomas.

A

33%

55
Q

Are Wilm’s tumours unilateral or bilateral.

A

They may be bilateral.

56
Q

What is the 5 year survival rate for children with Wilm’s tumours.

A

90%

Cancer, Palliative Care and Pain Medicine (14 decks)

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