Renal carcinoma

Question 1

renal cancer triad

Answer 1

loin pain
haematuria
palpable abdominal mass

Question 2

management of renal cancer

Answer 2

stage 4: targeted molecular therapy
(metastases)
immunomodulatory drugs / targeted molecular therapy.

sunitinib
temsirolimus
nivolumab

Question 3

nephrogenic diabetes insipidus

Answer 3

thiazide diuretics (chlorothiazide) to treat nephrogenic diabetes insipidus

block the NaCl transporter in the distal tubule

Question 4

fistula steal syndrome

Answer 4

common complication of an ateriovenous fistual

artery distal to the fistula becomes narrowed due to atherosclerosis or vasculitis so the blood from the artery takes the route with less resistance (through the vein)

Question 5

presentation of renal carcinoma

Answer 5

often asymptomatic
haematuria
vauge loin pain
non specific symptoms- weight loss, fatigue, anorexia, night sweats

*cannon ball metastases are in the lungs are typical of metastatic renal cell carcinoma

Question 6

types of renal cell carcinoma

Answer 6

Clear cell (75-90%)
Papillary (10%)
Chromophobe (5%)
Collecting duct carcinoma (1%)
Children: Wilms Tumour (in children < 5 years old)

Question 7

risk factors of renal cancer

Answer 7

Smoking
Obesity
Hypertension
Long-term dialysis
Von Hippel-Lindau Disease

Question 8

management of RCC

Answer 8

Surgery (partial nephrectomy first line)

/- radiotherapy and chemotherapy depending on disease stage.

Question 9

paraneoplastic features of RCC

Answer 9

Polycythaemia (RCC secretes unregulated erythropoietin)
Hypercalcaemia (RCC secretes a hormone that mimics the action of PTH)
Stauffer Syndrome (abnormal liver function tests demonstrating an obstructive jaundice – without any localised liver or biliary metastasis!)