Renal Carcinoma

Question 1

What is it?

Answer 1

Cancer of the Kidney

Question 2

Which cells does it arise from?

Answer 2

The proximal renal tubular epithelium

Question 3

What is the most common type?

Answer 3

Clear Cell

Question 4

What are other types of renal carcinoma? (3)

Answer 4

Papillary, Chromophobe, Collecting duct

Question 5

Is it common?

Answer 5

Accounts for 2-3% of all cancers in the UK

Question 6

Who does it affect?

Answer 6

Affects more males 1.5:1, highest incidence is in 60-70 year olds

Question 7

Risk factors (8)

Answer 7

Lifestyle, smoking, obesity, hypertension, long term renal dialysis, tuberous sclerosis, renal transplant recipients, acquired renal cystic disease

Question 8

Symptoms (8)

Answer 8

50% found incidentally, haematuria, loin pain, abdominal mass, anorexia, malaise, weight loss, bone pain (25% have mets on presentation)

Question 9

How does this cancer spread? (3)

Answer 9

Direct, lymphatic or haematogenous

Question 10

Is there any paraneoplastic syndromes?

Answer 10

Yes, 30% get hypercalcaemia

Question 11

Differentials (4)

Answer 11

UTI, Urinary Tract obstruction, Bladder tumour, retroperitoneal fibrosis

Question 12

What bloods would you do? (5)

Answer 12

FBC, U&E, CRP, LFT, Calcium

Question 13

Other investigations (10)

Answer 13

Urinalysis, urine culture, CT scan, MRI, ultrasound, IV urogram, Cystoscopy, renal angiography, Chest xray, renal biopsy

Question 14

What treatment is there? (7)

Answer 14

Radical nephrectomy, nephron sparing surgery, radio&chemo resistant, angiogenesis targeted agents, mTOR inhibitors, laser ablation, renal artery embolisation

Question 15

Complications (2)

Answer 15

Polycythaemia due to excess EPO production, Hypercalcaemia due to production of Parathyroid-like Hormone

Question 16

Is there a good prognosis?

Answer 16

50% of people survive 10 years or more, survival is higher in men