Renal Cancer Flashcards
What percentage of adult cancers do renal cell carcinomas account for.
3% of all adult cancers worldwide.
What are the types of renal tumours. (3)
Renal cell carcinoma.
Transitional cell carcinoma.
Wilms’ tumour.
What is the incidence of men:women who get renal cell carcinoma.
2:1.
What is the average age of diagnosis of renal cell carcinoma.
55.
What part of the world has a high incidence of renal cancer.
The West.
What part of the world has a low incidence of renal cancer.
Asia.
What risk factors are associated with renal cancer. (3)
Smoking.
Obesity.
Chronic renal disease needing dialysis.
What are most renal tumours.
Adenocarcinomas.
What are the renal adenocarcinomas usually known as.
Renal cell carcinoma (RCC).
What symptom is seen in 40% of patients presenting with renal cancer.
Haematuria.
Haematuria is present in ____% of patients presenting with renal cancer.
40%
What is the classic triad that renal cancer presents with.
Loin pain.
Haematuria.
Palpable mass.
How often do you see the classical triad of renal cancer.
Hardly ever (in about 10% of cases).
What is the classical triad of renal cancer indicative of.
Advanced disease.
What are the clinical features of renal cancer. (14)
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.
What percentage of renal cancers are incidental findings.
60% due to increased use of imaging techniques.
Where can renal cancer spread to. (local structures) (3)
Renal vein.
Inferior vena cava (IVC).
Adrenals.
Where does renal cancer tend to metastasize to. (4)
Bones.
Lung (cannon ball lesions).
Lymph nodes.
Brain.
What do renal cancer metastases look like in bone.
Canon ball lesions.
How are renal tumours imaged. (2)
Ultrasound is more sensitive than IVU for renal lesions.
CT is gold standard for staging.
When would you do a bone scan in a patient with renal cancer. (2)
If symptomatic disease.
If raised alkaline phosphatase. (ALP)
What is a T1 renal tumour. (2)
What is a T2 renal tumour. (2)
> 7cm.
Confined to kidney.
What is a T3 renal tumour.
Extends beyond the kidney. (eg renal vein, IVC or adrenal gland).
What is a T4 renal tumour.
Extends beyond Gerota’s fascia.
What is Gerota’s fascia.
Connective tissue capsule of the kidney.
What percentage of renal tumours are renal cell carcinomas.
90%
What percentage of patients on HD will develop renal cell carcinoma.
15%
What percentage of renal cell carcinomas are found incidentally.
50%
What is a rare associated features of renal cell carcinoma. Why.
Varicocele.
Rarely, invasion of the left renal vein compresses the left testicular vein, causing a varicocele.
What percentage of renal cell carcinomas have metastases at presentation.
25%
Where do renal cell carcinomas arise from.
Proximal renal tubular epithelium.
Why may the BP be raised with a renal cell carcinoma.
Due to the excretion of renin.
Why might there be polycythaemia with renal cell carcinoma.
Due to erythropoietin secretion.
How is spread of renal cell carcinoma classified. (2)
Direct.
Indirect.
What is the route of direct spread of renal cell carcinoma. (2)
Renal vein.
Lymph.
What is the route of indirect spread of renal cell carcinoma. (3)
Haematogenous (bone, liver, lung).
Where does transitional cell carcinoma occur. (3)
Bladder (50%).
Ureter.
Renal pelvis.
What is the average age of onset of transitional cell carcinoma.
> 40.
What is the ration of men:women who develop transitional cell carcinoma.
4:1
What is the usual presentation of transitional cell carcinoma. (5)
Painless haematuria. Frequency. Urgency. Dysuria. Urinary tract obstruction.
What is a Wilms’ tumour.
A nephroblastoma.
When do Wilms’ tumour occur.
Usually in childhood (first three years of life).
What is the prevalence of Wilm’s tumours.
1:100,000.
It is the chief abdominal malignancy in children.
What is the 5 year survival rate for transitional cell carcinomas.
10-80% (varies with clinical stage/histological stage)
Where do Wilms’ tumours arise from.
A tumour of the primitive renal tubules and mesenchymal cells.
How do Wilms’ tumours present. (2)
Abdominal mass.
Haematuria.
What is the prevalence of renal adenocarcinomas.
16/100,000.
What is the most common histological subtype of renal adenocarcinomas.
Clear cell carcinomas.
What is the main problem with clear cell carcinomas. (3)
There is early spread of the tumour into the renal pelvis - causing haematuria.
Also along the renal vein, often extending into the IVC.
What is the first line investigation if a renal adenocarcinoma is suspected.
Ultrasound - this can differentiate between a renal cyst and a solid tumour.
What condition is characterised by bilateral renal cell carcinomas, haemangioblastomas, phaechromocytomas and renal cysts.
Von Hippel-Lindau disease.
What is Von Hippel- Lindau disease.
An autosomal dominant disorder.
What percentage of patients present with metastases from renal cell carcinomas.
33%
Are Wilm’s tumours unilateral or bilateral.
They may be bilateral.
What is the 5 year survival rate for children with Wilm’s tumours.
90%
