Renal cancer Flashcards
Where is renal cell carcinoma most common?
developed countries
What percentage of renal malignancies are RCC?
85%
Apart from RCC what are the other renal malignancies?
TCC (Urothelial tumour) nephroblastoma in children and SCC
Why do renal SCC occur?
Chronic inflammation second to renal calculi, infection and schistosomiasis
What is RCC?
Adenocarcinoma of the renal cortex
Where does RCC arise from?
PCT, usually in the upper pole of the kidney
What cells are RCC usually composed of?
Polyhedral clear cells, with dark stained nuclei and cytoplasm rich with lipid and glycogen grails
How do RCC spread?
direct invasion into the perinephric tissues, adrenal gland and renal vein or inferior vena cava
Lymphatics to pre-aortic and hilar nodes and haematogenous spread to the bones, liver, brain and lungs
What is tumour thrombosis?
where the RCC invades through the renal vein wall into the lumen
What risk factor doubles the risk of RCC?
Smoking
What other risk factors are there for RCC?
industrial exposure to carcinogens, dialysis (x30) hypertension, obesity, anatomical abnormalities like polycystic kidneys and horseshoe kidneys and genetic conditions
What is the most common clinical feature of RCC?
Haematuria (visible or non-visible)
What other clinical features are there of RCC?
Flank pain, flank ass or non specific symptoms like lethargy and weight loss
What is the classic triad for RCC?
Haematuria, mass and flank pain
What percentage of people present with the classic triad for RCC?
15%
What would examination findings be for RCC?
Large ones may be palpated in the flank or hypochondrial regions, left varicocoele may be present due to compression of the left testicular vein as it joins the left renal vein
What causes paraneoplastic syndromes?
ectopic secretions of hormones
What symptoms can paraneoplastic syndromes give?
polycytheamia due to erthropoein, hypercalcaemia due to parathyroid hormone, hypertension due to renin, pyrexia
What are the differential diagnosis for RCC?
Urological malignancy, renal stones and UTI
What blood tests would you do for RCC?
FBC, U&E, calcium, liver function, c-reactive protein
Why is urinalysis done for RCC?
to check for haematuria and then sent for cytology
What imaging is done for RCC?
CT imaging abdomen pelvis pre and post IV contrast is gold standard, also do ultrasound
What is stage 1 RCC? (T1N0M0)
Tumour smaller than 7cm and confined to renal capsule
What is stage 2 RCC? (T2N0M0)
Tumour larger than 7cm or invading the renal capsule but confined to gerotas fascia
What is stage 3 RCC? (T3 or N1M0)
Tumour extends into the renal vein, vena cava or spread to local lymph node
What is stage 4 RCC? (T4N2 or M1)
Tumour extending beyond Gerotas fascia, in more than one lymph node, involvement of ipsilateral adrenal gland or perinephric fat or distant metastasis
What is the management of RCC is localised?
surgical management e.g. partial nephrectomy or radical nephrectomy
If a patient is not fit enough for surgical management what would be done in RCC?
Percutaneous radiofrequency ablation or laparoscopic percutaneous cryotherapy with renal artery embolisation if needed, or just surveillance
Should adrenal glands be spared?
Yes if possible unless a large upper pole tumour as they have high risk of adrenal invasion
What is the treatment for metastatic RCC?
Chemotherapy is ineffective, so immunotherapy is used like IFN-a or IL2 with a nephrectomy
Biological agents and metastectomy
What is the prognosis for people with RCC?
25% have metastasis at presentation, 70% 3 year survival and 60% 5 year survival after nephrectomy if not at a worse stage
