Renal Cancer Flashcards by Rebecca Kelly

What are the main types of benign renal cancer?

Simple cysts.

Angiomyolipoma.

Oncocytoma.

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What are the main types of malignant renal cancer?

Renal cell carcinoma (sold/complex cystic).

Transitional cell carcinoma.

Lymphoma.

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What is the appearance of an oncocytoma?

Spherical.

Capsulated.

Brown/tan colour.

Central scar.

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What is seen histologically in an oncocytoma?

Aggregates of eosinophilic cells.

Mitosis is rare.

Cells are packed with mitochondria.

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What does a spoke wheel pattern on CT suggest?

Oncocytoma.

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What is the treatment for an oncocytoma?

Small tumours less than 3 cm: surveillance in elderly unfit patients; ablation techniques in fit elderly patients and elected younger patients.

More than 3cm: partial nephrectomy; radical nephrectomy.

Large tumours: radical nephrectomy; laparoscopic approach gold standard.

Same as a renal cell carcinoma.

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What is the associated between angiolipoma and tuberous sclerosis?

80% of patients with tuberous sclerosis develop angiolipoma.

This makes up for 20% of all angiolipoma cases.

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What are the investigations used to diagnose angiolipoma?

USS (bright echo pattern).

CT (fatty tumour of low density).

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What is Wunderlich’s syndrome?

Massive retroperitoneal renal haemorrhage that occurs in 10% of angiolipomas.

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What is the treatment for an angiolipoma?

4cm is the cutoff for treatment.

Elective: embolisation or partial nephrectomy.

Emergency: embolisation or emergency nephrectomy.

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What is a renal cell carcinoma?

Adenocarcinoma of the renal cortex.

Believed to arise from the proximal convoluted tubule.

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What is the gross appearance of a renal cell carcinoma?

Tan coloured.

Lobulated.

Solid.

10-25% either contain cysts or are predominantly cysts.

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How are renal cell carcinomas classified histologically?

Conventional clear cell carcinoma (80%) - loss of Von Hippel Landau (VHL) gene on short of chromosome 3.

Papillary (10-15%): 40% are multifocal.

Chromophobe (5%).

Collecting duct: rare, young patients, poor prognosis.

Medullary cell: young sickle cell patients, very poor prognosis.

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What are the risk factors for renal cell carcinoma?

Smoking.

Renal failure and dialysis.

Obesity.

Hypertension.

Low socio-economic status, asbestos, cadmium exposure, phenacetin.

Genetic: Von Hippel Landau (VHL) syndrome.

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What is Von Hippel Landau (VHL) syndrome?

Autosomal dominant syndrome.

50% of cases develop renal cell carcinoma.

Loss of both copies of a tumour suppressor gene at chromosome 3p25.

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How does renal cell carcinoma commonly present?

Haematuria, loin pain, mass.

Pyrexia of unknown origin (8-9 %)

Varicocoele.

Paraneoplastic syndrome (30%).

What investigations aid diagnosis of renal cell carcinoma?

USS.

CT chest, abdomen and pelvis (staging).

Bloods: FBC, renal and liver functions.

What is the treatment for renal cell carcinoma?

Small tumours less than 3 cm: surveillance in elderly unfit patients; ablation techniques in fit elderly patients and elected younger patients.

More than 3cm: partial nephrectomy; radical nephrectomy.

Large tumours: radical nephrectomy; laparoscopic approach gold standard.

Same as oncocytoma.

How long do you follow up patients who have had a renal cell carcinoma?

5-10 years.

In the follow up do FBC, renal and liver function and imaging (CT/USS + CXR).

What is cryptorchidism?

A condition in which one or both of the testes fail to descend from the abdomen into the scrotum.

What does cryptorchidism put you at risk of?

5-10% of testicular cancer patients have a history of cryptorchidism.

Orchidopexy (surgery to move a testicle that has not descended or moved down to its proper place in the scrotum) before 13 years of age: 2 fold increase in risk.*
Orchidopexy after 13 years of age: 5 fold increase in risk.*

What are the risk factors for testicular cancer?

HIV.

Family history.

Cryptorchidism.

Previous testicular cancer.

What are the histopathological types of testicular cancer?

90% originate from germ cells.

What is the common clinical presentation of testicular cancer?

Scrotal lump.

Delayed presentation occasionally seen.

5% have acute pain due to bleeding.

10% have symptoms of advanced disease including weight loss, neck lumps, chest symptoms or bone pain.

On examination, what suggests someone has testicular cancer?

Asymmetry or slight scrotal discolouration. Examine the normal side first. Hard, non-tender, irregular mass mostly intratesticular. Assess involvement of epididymis, spermatic cord and scrotal skin. Secondary hydrocoele. **Abdominal mass – advanced disease.**

What investigations are carried out to diagnose a testicular cancer?

USS of the testicle. CT chest and abdomen for staging. Bloods: serum tumour markers (alpha-fetoprotein, B-HCG, LDH) - raised in 50% of cases; FBC, LFTs, RFTs.

What is the treatment for testicular cancer?

**Radical inguinal orchidectomy** (offer sperm preservation and testicular prosthesis). Re-check tumour markers 1-week post-op, if they were elevated. Chase CT scan. Further follow-up by an oncologist with **chemotherapy** as an adjuvant treatment even in non-metastatic cases.

When performing a radical orchidectomy, why approach from the inguinal canal instead of the scrotum?

So as to not expose the scrotum to the excised cancer.

What has a protective effect against penile cancer?

Circumcision.

What are the types of penile cancer?

Squamous cell carcinoma (95%). Kaposi's sarcoma. Basal cell carcinoma. Malignant melanoma. Sarcoma.

What are the risk factors for penile cancer?

Phimosis (chronic inflammation). Geography: Asia, Africa and South America. HPV types 16 and 18. Smoking. Immunocompromised patients.

What are the common sites of penile cancer?

Glans - 48%. Prepuce - 21%. Glans and prepuce - 9%. Coronal sulcus - 6%. Shaft - 2%.

What is the common presentation of penile cancer?

Hard painless lump. 15-50% delayed presentation for \>1 year due to embarrassment, neglect, fear, ignorance. Urinary retention/groin mass (inguinal lymphadenopathy) - rare.

What investigations are carried out for suspected penile cancer?

MRI scan to assess tumour depth. CT scan abdomen, pelvis and chest in advanced disease.

What is the treatment for prepucial penile cancer?

Circumcision.

What is the treatment for glans penile cancer?

Superficial - glans resurfacing. Deep - glansectomy.

What is the treatment for advanced penile cancer?

Total penile amputation with the formation of perineal urethrostomy.

What is the treatment for inguinal lymphadenopathy from penile cancer?

Inguinal lymphadenectomy if the lymph nodes are involved. In high-risk penile cancers, this is also done, even when the lymph nodes are not involved.