Renal cancer Flashcards
what is the most common renal cancer?
- Renal cell carcinoma
- Other types:
- Transitional cell carcinoma (urothelial tumours)
- Nephroblastoma in children (Wilm’s tumour)
- SSC (chronic inflammation secondary to calculi, infections)
Describe the incidnce of renal cell carcinoma?
- Developed countries
- More common in men
- Peak incidence 50-70
Describe the pathophysiology of renal cell carcinoma?
- Adenocarcinoma of the renal cortex
- Arises mostly from PCTs, often appearing in upper pole of the kidney
- Microscopically: polyhedral clear cells, with dark staining nuclei and lipid and glycogen granules in the cytoplasm
How do RCCs spread?
- Direct invasion into peripheral tissues, adrenal gland, renal vein or IVC
- Lymphatics to para-aortic and hilar nodes
- Haematogenously to bones, liver, lung and brain
- Cannon ball mets in lung
Describe tumour thrombosis of RCCs?
RCCs can invade through renal vein wall into the lumen which can create a tumour thrombosis
Describe the aetiology of renal cell carcinoma?
- Smoking (doubles risk)
- Industrial exposure to carcinogens
- Dialysis
- Hypertension, obesity, PCKD, horshoe kidneys
- Genetic disorders:
- von Hippel-Lindau syndrome (bilateral multifocal tumours)
- BAP1 mutant disease
- Birt-Hogg-Dube syndrome
Describe the clinical features that occur with renal cell carcinoma?
- Haematuria (visible or non-visible)
- Flank pain/mass
- Lethargy, weight loss
How is renal cell carcinoma commonly diagnosed?
- Incidental finding on abdominal imaging
- 15% have classic triad of haematuria, mass and flank pain
How can large RCCs present on examination?
- Palpation of tumour in the flank or hypochondrial regions
- Left sided masses may present with a left varicocoele
- Due to compression of left testicular vein as it joints the left renal vein
Name some differentials for the presentation of renal cell carcinoma?
- Other causes of haematuria
- Urological malignancy
- Renal stones
- Urinary tract infection
What investigations should be performed if someone is suspected of having a RCC?
- FBC, U&Es, calciu, LFTs, CRP
- Urinalysis (for invisible haematuria)
- Ultrasound
- CT with contrast (gold standard)
- Biopsy of renal lesions
Describe the staging of RCC?
- American Joint Committee on Cancer (AJCC) staging classification
Describe the management of localised RCC?
- Partial or radical nephroctomy
- Unfit for surgery:
- Radiofrequency ablation
- Laparoscopic cryotherapy
- Renal artery embolisation for haemorrhaging disease
Describe the management of metastatic RCC?
- Nephrectomy + immunotherapy (IFN-alpha or IL-1 agents)
- Biologic agents can be used
- Sunitinib (alpha tyrosine kinase inhibitor)
- Pazopanib (alpha tyrosine kinase inhibitor)
- Metastectomy
- Resection of solitary masses
What vertebral level do the renal hilum typically lie?
L1
