Renal Cancer Lecture Flashcards
One of the most common tumors of childhood
A malignancy derived from the primitive cells of renal cortex
* Average age of diagnosis is 38mths , usally between 3-5yrs of age
Wilms Tumor (Nephroblastoma)
Large abdomen Often asymptomatic Some pain with vomiting Hematuria 20-25% some have HTN
Wilms Tumor
25% have genetic anomalies
- absence of iris: aniridia
- enlargement of 1 side of face
- genitourinary complications
Wilms Tumor
Image of choice for Wilms Tumor
CT scan
Should you biopsy Wilms tumor?
NO! …risk of spreading Ca to surrounding tissue!!
Management of Wilms tumor..
Surgery/chemo and sometimes radiation
Usually good if caught early before METS
Good response to Tx with 90% 5 yr survival rate-dependent on staging and treatment
Wilms tumor
flank pain, palpable flank mass, & painless hematuria
Renal cell carcinoma
Rare to have presentation of full TRIAD. (Only 9%)
Often incidental finding on other imaging work-up.
Other – weight loss, malaise, anemia, hypertension, hypercalcemia, recurrent fevers
Renal cell carcinoma
Risk Factors: SMOKING Age 50-70 yrs of age higher Male sex Obese Prolonged exposure to asbestos, cadmium, or petroleum products Hx of Tuberous Sclerosis Von Hippel-Lindau Dz.- family Hx , genetic Long term dialysis
Renal cell carcinoma
Usually grows shperical , well circumscribed mass in the cortex of the kidney
Arises from the epithelial lining of proximal tubule
Grow into renal vein, inferior vena cava , and occlude the right side of heart- (L/E edema & ascites)
Renal cell carcinoma
Work-up:
Incidentally find it on routine work-up of for something else:
Urinalysis: microscopic (hematuria)- may not always show initially- re-test if suspicious
Ultrasound, CT
CT 91% accuracy in Staging RCC
MRI- if concern for METS, review of adjacent structure
Renal cell carcinoma
To definitively diagnose renal cell carcinoma you need…..
a biopsy
Slow growing- often does not present until advanced
Common Sites of Metastasis
Lung, Lymph nodes, Bone, Liver, Brain
Renal cell carcinoma
First-Line Treatment is Surgical Eradication- ONLY CURE
either by resection or by ablating with cryotherapy, or embolization of the areteries to deprive of O2 supply (for LARGE tumors)
Renal cell carcinoma
Renal cancer stage I-III, treat with…
Resection
Renal cancer stage IV, treat with..
palliative tx
TNM and Robson..
Used to stage renal cancer
is the most common type of kidney cancer (9 out of 10 cases). RCC usually begins as a tumor within a kidney; however, sometimes there can be more than one tumor or even tumors in both kidneys. These tumors can grow to be very large, but are usually found before they spread to other parts of the body.
Renal cell carcinoma
is the most common subtype within RCC (7 out of 10). Cells of this type appear clear or pale under the microscope.
Clear cell renal cell carcinoma
is the second most common, making up 10%. This type produces “finger like” projections on the tumor.
Papillary renal cell carcinoma
makes up around 5% of RCC cases. Cells of this type are also clear, but are much larger with other distinguishing features.
Chromophobe renal cell carcinoma
don’t start in the kidney itself, but instead begin in the renal pelvis (where the urine goes before it enters the ureter).
Transitional cell carcinoma
Risk Factors:
SMOKERS- half the cases
Chemical exposure- aniline dyes (leather woodwork)
Transitional cell carcinoma
Cancer of the mucosal lining of the bladder
Renal pelvis, Ureters , Urethra, where transitional cells exist
*Proliferation of cells along fibrovascular core
*Papillary pattern of growth- low or high grade, viewed under microscope
Urothelial carcinoma
What type of urothelial carcinoma does not invade submucosa- irregular red spots on cytoscopy
Urothelial carcinoma in situ
Presentation: PAINLESS hematuria- typical
Similar to Renal Cell presentation
May have more back pain
If involving the ureters/bladder may have dysuria
Urothelial carcinoma
Diagnosis of urothelial carcinoma
Cytoscopy and biopsy
Treatment:
Carcinoma InSitu and low grade papillary can be tx with immune therapy Bacillus Calmette –Guerin (BCG)- ???
Recurrent CIS or invasive urothelial carcinoma- resection of part or all of the invovled bladder
Can create new bladder from intestine
Urostomy bag- to store urine
Resection and Chemo
Urothelial carcinoma
Prognosis:
Grade and Tumor Dependent
Most detected at early stage amendable to Tx :
Transurethral resection, fulguration, intravesicle immune therapy
80% of Tumors will recur
Monitor- cytology of urine – frequent almost 100% survival
Muscle invasive carcinoma drops to 60% 5yr Survival
Urothelial carcinoma
Cancerous cells in the inner lining tissue of the bladder.
Stage 0
Tumor has spread to the bladder wall.
Stage 1
Tumor has penetrated the inner wall and is present in muscle of the bladder wall.
Stage 2
Tumor has spread through the bladder to fat around the bladder.
Stage 3
Tumor has spread to the wall of the pelvis or abdomen, to the lymph nodes, or to areas away from the bladder such as the lungs, liver, or bones.
Stage 4
