Renal carcinoma (brief)

Question 1

How common is it?

Answer 1

2% of all cancer. Incidence 2-5/100.

Question 2

Who does it affect?

Answer 2

M:F 3:1.

Question 3

What causes it?

Answer 3

Renal carcinomas are often small and can be multiple. Local spread often includes spread via intravascular invasion to the renal vein and IVC.

Question 4

What risk factors are there?

Answer 4

+ve FHX or clinical evidence of neurological or ocular disease should raise the possibility of von Hippel-Lindau disease.

Question 5

How does it present?

Answer 5

May be asymptomatic, the tumour being detected during imaging of the abdomen for an unrelated condition. Symptoms include painless haematuria, groin pain, awareness of a mass arising from the flank. Chest symptoms and bone pain may be present with mets to these sites.

Question 6

Investigations

Answer 6

Blood tests and ferritin to check for anaemia; electrolytes and creatinine to check for overall renal function. Raised corrected calcium and alkaline phosphatase suggest possibly bony mets. Diagnostic staging and diagnosis by CT with contrast. Isotope bone scan if there is clinical or biochemical evidence of bony mets.

Question 7

Treatment

Answer 7

Surgery: Recommended as the only curative treatment except in the very elderly, extensive local invasion, and the presence of mets. Partial or radical nephrectomy depending on size.

Medical therapy: used for metastatic disease. Biological therapy can be with immune modulators such as interferons and interleukins. Partial response rates of 15-20% can be achieved but the treatment carries significant morbidity. This is reserved for patients with good performance status. Chemotherapy is rarely used as renal cancers are not usually sensitive. Radiotherapy is used to palliate painful bony mets. Hormones may have some benefit.