Renal Carcinoma Flashcards
1
Q
EPIDEMIOLOGY
How does rank in most common types of kidney tumour
A
The most common type, is adenocarcinoma arising from renal tubules
2
Q
CLINICAL FEATURES
Classic triad of presentation
A
- Haematuria
- Flank pain
- Palpable mass
3
Q
Types of renal cell carcinoma
A
- Several subtypes of renal cell adenocarcinoma
- Clear cell (80%)
- Papillary (15%)
- Chromophobe (5%)
- Wilm’s tumour specific type affecting kidney in children <5 years
4
Q
AETIOLOGY
Risk factors
A
- Smoking
- Obesity
- Hypertension
- End-stage renal failure
- Von Hippel-Lindau disease
- Tuberous sclerosis
5
Q
CLINICAL FEATURES
Presentation
A
- May be asymptomatic
- Haematuria
- Vague loin pain
- Palpable renal mass
- Non-specific cancer symptoms
- Weight loss, fatigue, anorexia, night sweats)
6
Q
Where does it typically spread
A
- Tissues around kidney within Gerota’s fascia
- Often to renal vein and then inferior vena cava
- “Cannonball metastases” in lungs
7
Q
What paraneoplastic syndromes commonly associated with
A
- Polycythaemia
- Due to secretion unregulated erythropoitin
- Hypercalcaemia
- Secretion of hormone that mimics action of parathyroid hormone
- Hypertension
- Increases renin secretion, polycythaemia and physical compression
- Stauffers syndrome
- Abnormal LFT without liver metastasis)
8
Q
INVESTIGATIONS
First choice
A
- CT thorax, abdomen, pelvis - definitive for diagnosis and staging
- MRI if contrast is contraindicated
- Bloods
- FBC, calcium, LFT, creatinine
9
Q
MANAGEMENT
General principles
A
- MDT team
- Surgery to remove tumour (first line)
- Options if patient not suitable for surgery
- Chemotherapy and radiotherapy may be used
10
Q
MANAGEMENT
Surgical options
A
- Partial nephrectomy
- Radical nephrectomy
11
Q
MANAGEMENT
Non-surgical options
A
- Arterial embolism
- Percutaneous cryotherapy
- Radiofrequency ablation
12
Q
What is arterial embolisation
A
Cutting of blood supply to affected kidney
13
Q
What is percutaneous cryotherapy
A
Injecting liquid nitrogen to freeze and kill tumour cell
14
Q
What is radiofrequency ablation
A
Needing in the tumouur and using electrical current to kill tumour cells
15
Q
Staging
A
- TNM staging is most common
- Also number staging system specific to renal cell carcinoma
