Renal Cell Cancer

Question 1

weight loss,

night sweats,

fevers,

microscopic hematuria

significant erythrocytosis

Answer 1

think renal cell carcinoma

Question 2

most common way of diagnosing renal cell carcinoma

Answer 2

found incidentally on imaging

most are asymptomatic

Question 3

advanced renal cell cancer can have associated paraneoplastic symptoms seen:

Answer 3

anemia (microcytic or normocytic)

erythrocytosis (increased EPO production)

non metastatic liver function abnormalities

fever and weight loss

hypercalcemia (due to bone metastasis with increased PTHrP and increased prostaglandins)

amyloidosis

Question 4

how to treat or confirm diagnosis of renal cell carcinoma?

Answer 4

nephrectomy

Question 5

do we ever biopsy renal cell

Answer 5

no because it can seed the tumor

Question 6

elevated alkaline phosphatase, unexplained fever weight loss and hypercalcemia and erythrocytosis

Answer 6

renal cell carcinoma

Question 7

hematuria and flank pain with increased EPO and weight loss right scrotal varicocele

Answer 7

renal cell carcinoma

Question 8

difference between perinephric abscess and renal cell carcinoma:

Answer 8

perinephric abscess - fever, flank pain and leukocytosis NO erythrocytosis or normal WBC

renal cell carcinoma- can also present with fever, flank pain and normal WBC and high EPO.

Question 9

which genetic syndromes are associated with renal cell carcinoma?

Answer 9

Von Hipple Lindau

Tuberous sclerosis

Birt-Hogg- Dube syndrome

Hereditary papillary renal carcinoma

Question 10

VHL syndrome

Answer 10

autosomal dominant pattern with variety of both benign and malignant tumors

see renal clear cell carcinoma and other tumors like brain hemangioblastomas, pancreatitc neuroendocrine tumors. retinal angiomas, pheochromocytomas

Question 11

tuberous sclerosis also develops from

Answer 11

bilateral angiomyolipomas of kidney about 5% of renal cell carcinoma

Question 12

Birt Hogg Dube syndrome is associated with

Answer 12

chromophobe see clear renal cell carcinoma

pulmonary cysts, pneumothorax, fibrofolliculomas

Question 13

3 biggest risk factors for sporadic renal cell carcinoma?

Answer 13

smoking obesity hypertension

Question 14

Treatment for clear cell renal carcinoma that is organ confined is

Answer 14

nephrectomy partial nephrectomy is only for tumors <4 cm

radical nephrectomy >4 cm

Question 15

paraneoplastic syndromes of renal cell carcinoma

Answer 15

anemia hepatic dysfunction without liver metastasis (Stauffer syndrome) fever hypercalcemia erythrocytosis AA amyloidosis thrombocytosis polymyaglia rheumtica these improve when the resection of primary tumor or metastatic sites or both

Question 16

adjuvant chemotherapy after resection of RCC

Answer 16

sunitinib

improves dx free survival by 1.2 years

Question 17

after resection of renal cancer what needs to be done?

Answer 17

post operative surveillance to identify recurrent dx and frequency of interventions depends upon the extent of local dx.

may need H & P, BMP, imaging of chest and abdomen

Question 18

who gets cryoablation and radiofrequency ablation or active surveillance of renal cell carcinoma?

Answer 18

those who are frail and have small tumors or those who are high risk of postoperative complications.

Question 19

Renal cell carcinoma will have elevated

Answer 19

EPO