Renal Cancers and Transitional CA Flashcards
What is the most common tumor of childhood?
Wilms tumor (nephroblastoma)
Which type of descent has the highest rate of Wilms tumor?
African descent
What is a Wilms tumor?
Malignancy derived from the primitive cells of the renal cortex
What are some genetic anomalies that may be associated with a patient with a Wilms tumor?
Abesence of iris- aniridia
Enlargement of one side of face
Genitourinary complications
What is the most common presentation of a Wilms tumor?
Often asymptomatic - large abdomen
What are some clinical manifestations associated with an advanced Wilms tumor?
Pain w/ vomiting
Hematuria
HTN
Why should you not biopsy a Wilms tumor?
Risk of spreading it to other tissue, significantly increases staging if ruptured
What is the imaging method of choice for a Wilms tumor?
CT scan
How do you manage a Wilms tumor?
Surgery
Chemotherapy
Sometimes radiatiom
What is the prognosis of a Wilms tumor?
Good if caught early before METs or rupture
90% survival over 5 years if caught before
Which type of ancestry is renal cell carcinoma most common in?
Northern European ancestry
What are the 3 symptoms associated with renal cell carcinoma?
flank pain, palpable flank mass, and painless hematuria
What are some other symptoms associated with renal cell carcinoma?
weight loss, malaise, anemia, hypertension, hypercalcemia, recurrent fevers
What age/gender is renal cell carcinoma common in?
50-70 usually male
What are the three synthetic substances that can increase the risk for renal cell carcinoma with prolonged exposure?
Asbestos, cadmium, petroleum products
What disorders/diseases put a patient at risk for renal cell carcinoma?
Tuberos sclerosis (Genetic benign tumors) Von Hippel-Lindau disease (CNS, kidneys MC)
Long term dialysis puts a patient at risk for ??
Renal cell carcinoma
Usually grows shperical , well circumscribed mass in the cortex of the kidney
Renal cell carcinoma
Where does renal cell carcinoma arise from?
Epithelial lining of the proximal tubule
Where does renal cell carcinoma grow into?
Renal vein
Inferior vena cava
Can occlude R side of the heart
What will you find on a UA of a patient with renal cell carcinoma?
Microscopic hemturia - always retest if you are suspicious!
What is the best initial diagnosis of renal cell carcinoma?
CT scan (91% accuracy in staging)
What is the DEFINITIVE diagnosis of renal cell carcinoma?
Biopsy
When should you use an MRI in a patient with renal cell carcinoma?
To look for METS once diagnosed
When would you use a CXR or CT of lungs in a patient with renal cell carcinoma?
METS concern once diagnosed
When does renal cell carcinoma usually present?
When it is advanced
Most common sites of METS with renal cell carcinoma?
Lung, Lymph nodes, Bone, Liver, Brain
What is the only cure of renal cell carcinoma?
Surgical eradication (resection, ablation with cryotherapy, embolization of arteries)
What type of staging is used in renal cell carcinoma?
TNM and Robson staging
Which stages of renal cell carcinoma do you treat with resection and which do you treat with palliative care?
I-III = resection IV = palliative care
What are the two most common types of renal cell cancer?
Clear cell and papillary
Papillary renal cell carcinoma looks like ____-____ projections on the tumor
Finger-like
Type of kidney cancer that begins in the blood vessels or connective tissue of the kidneys
Renal sarcomas
Where does transitional cell cancer typically reside?
Bladder
Most common study for bladder, kidney abnormalities
Intravenous pyelogram
What is one major risk factor for transitional cell cancer?
SMOKERS! Half of the cases
Which chemical exposure puts a patient at a risk for transitional cell cancer?
Aniline dyes (leather woodwork)
Symptoms of urothelial carcinoma
PAINLESS hematuria- typical
Similar to Renal Cell presentation - may have more back pain
If involving the ureters/bladder may have dysuria
How do you diagnose urothelial carcinoma?
Cystoscopy and Biopsy
Cancer of the mucosal lining of the bladder
Urothelial carcinoma (Renal pelvis, Ureters , Urethra)
Urothelial carcinoma = Transition cell cancer
What can lead to invasive urothelial carcinoma without warning?
Urothelial Carcinoma in situ (CIS)
CIS and low-grade papillary urothelial carcinoma can be treated with?
Bacillus Calmette –Guerin (BCG)
This is the TB vaccine!
Recurrent CIS or invasive urothelial carcinoma must be treated with?
Resection of all or part of the bladder with/without chemotherapy
Monitoring the cytology of a patients urine who has or had urothelial carcinoma frequently gives an almost ____% survival rate
100%
Common spots of METS for urothelial cancer?
Lungs, liver, bones
Tumor occupying the renal pelvis and into upper and mid pole calyces
Transitional cell CA - renal pelvis
Transitional cell carcinoma is most commonly associated with?
The bladder
Most common neoplasm arising from the kidney in 9/10 cases?
Renal cell cancer
What are the two major groups of malignant tumors int he kidneys?
Wilms tumor and renal cell carcinoma
What type of pattern would you describe a renal cell cancer that has proliferation along fibrovascular core?
Papillary
What is the first line treatment for RCC?
Resection
Does transitional cancer have a high chance of recurrence?
Yes
1 risk factor for bladder cancer??
Smoking!
