Renal Cancer Flashcards
What is the most common kidney tumour in adults?
- Renal Cell Carcinoma
What are the types of renal tumours?
- Renal Cell Carcinoma (RCC)
- Transitional Cell Carcinoma
- Wilm’s tumour - most common in children
- Angiomyolipoma
- Leiyomyosarcoma
Where do RCC originate from?
- Proximal renal tubular epithelium
Which chromosome is associated with renal cancer?
- short arm of chromosome 3 (3p)
What are the types of RCC?
- clear cell (most common)
- papillary
- chromophobe
- collecting duct carcinoma
How does RCC spread?
- Direct invasion in to perinephric tissues, adrenal gland, renal vein* or the inferior vena cava
- Lymphatic system to pre-aortic and hilar nodes
- Haematogenous spread to the bones, liver, brain and lung
What are the RF of renal cancer?
- Smoking - most common
- Industrial exposure (cadmium, lead, or aromatic hydrocarbons)
- Obesity
- HTN
- Long term renal dialysis
- tuberous sclerosis
- renal transplant
- acquired renal cystic disease
- PKD
What genetic disorders can predispose to RCC?
- von Hippel-Lindau disease (tumours at multiple organs)
- BAP1 mutant disease
- Birt-Hogg-Dube syndrome
What is the classic triad of RCC?
- haematuria
- loin pain
- loin mass
What other sx would RCC present with?
Non specific
- weight loss
- fatigue
- fever
- lethargy
Paraneoplastic syndrome
- neuromyopathy
- anaemia
- polycythaemia
- amyloidosis
- hypercalcaemia
- abnormal LFT
- HTN
How do you get Paraneoplastic syndrome in RCC?
- ectopic secretion of hormones by RCC
- EPO
- PTH
- Renin
What is the differential diagnosis of RCC?
- Other urological malignancies
- kidney stone
- UTI
What Ix would you order for RCC?
Urine
- urine dip
- MSU
- urine cytology
Blood
- FBC, U&E, LFT, ESR, Bone profile
Imaging
- CT renal scanning before and after IV contrast
- MRI
- USS abdo - incidentally picked up
Biopsy
What classification is used for RCC?
- Bosniak classification
- American joint committee on cancer (AJCC)
Describe the Bosniak classification
Describe the AJCC classification of RCC
Stage 1
(T1N0M0)Tumour ≤7 cm and confined to the renal capsule
Stage 2
(T2N0M0)Tumour >7 cm or invading the renal capsule (but confined to Gerota’s fascia)
Stage 3
(T3 or N1M0)Tumour extending into the renal vein, vena cava, or spread to 1 local lymph node
Stage 4
(T4N2 or M1)Tumour extending beyond Gerota’s fascia, >1 local lymph node, involvement of ipsilateral adrenal gland or perinephric fat, or distant metastases
How would you mx localised disease of RCC?
- partial nephrectomy / radical nephrectomy
- laparoscopic nephrectomy
- image-guided percutaneous radiofrequency (RF) ablation
- cryotherapy
- Renal artery embolisation
How would you mx metastatic diseas of RCC?
- nephrectomy combined with immunotherapy (such as IFN-α or IL-2 agents) - if fit and well
- Sunitinib (a tyrosine kinase inhibitor) and Pazopanib (also a tyrosine kinase inhibitor)
- Metastasectomy
What is the prognosis for RCC?
- Survival for patients who have undergone nephrectomy is around 70% at 3 years and 60% at 5 years
