Renal Cancer

Question 1

What is the most common kidney tumour in adults?

Answer 1

• Renal Cell Carcinoma

Question 2

What are the types of renal tumours?

Answer 2

• Renal Cell Carcinoma (RCC)
• Transitional Cell Carcinoma
• Wilm’s tumour - most common in children
• Angiomyolipoma
• Leiyomyosarcoma

Question 3

Where do RCC originate from?

Answer 3

• Proximal renal tubular epithelium

Question 4

Which chromosome is associated with renal cancer?

Answer 4

• short arm of chromosome 3 (3p)

Question 5

What are the types of RCC?

Answer 5

• clear cell (most common)
• papillary
• chromophobe
• collecting duct carcinoma

Question 6

How does RCC spread?

Answer 6

• 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

Question 7

What are the RF of renal cancer?

Answer 7

• 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

Question 8

What genetic disorders can predispose to RCC?

Answer 8

• von Hippel-Lindau disease (tumours at multiple organs)
• BAP1 mutant disease
• Birt-Hogg-Dube syndrome

Question 9

What is the classic triad of RCC?

Answer 9

• haematuria
• loin pain
• loin mass

Question 10

What other sx would RCC present with?

Answer 10

Non specific

• weight loss
• fatigue
• fever
• lethargy

Paraneoplastic syndrome

• neuromyopathy
• anaemia
• polycythaemia
• amyloidosis
• hypercalcaemia
• abnormal LFT
• HTN

Question 11

How do you get Paraneoplastic syndrome in RCC?

Answer 11

• ectopic secretion of hormones by RCC
  
  • EPO
  • PTH
  • Renin

Question 12

What is the differential diagnosis of RCC?

Answer 12

• Other urological malignancies
• kidney stone
• UTI

Question 13

What Ix would you order for RCC?

Answer 13

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

Question 14

What classification is used for RCC?

Answer 14

• Bosniak classification
• American joint committee on cancer (AJCC)

Question 15

Describe the Bosniak classification

Answer 15

Question 16

Describe the AJCC classification of RCC

Answer 16

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

Question 17

How would you mx localised disease of RCC?

Answer 17

• partial nephrectomy / radical nephrectomy
• laparoscopic nephrectomy
• image-guided percutaneous radiofrequency (RF) ablation
• cryotherapy
• Renal artery embolisation

Question 18

How would you mx metastatic diseas of RCC?

Answer 18

• 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

Question 19

What is the prognosis for RCC?

Answer 19

• Survival for patients who have undergone nephrectomy is around 70% at 3 years and 60% at 5 years