Renal cell cancer

Question 1

Origin

Answer 1

Hypernephroma, 80% clear cell carcinoma, adenocarcinoma of the renal cortex arising from proximal convoluted tubule.

Question 2

Symptoms

Answer 2

Haematuria, loin pain, mass, metastatic features of disease.

Left testicular varicocele due to occlusion of left testicular vein which drains directly into the left renal vein.

Question 3

Associated genetic conditions

Answer 3

Von-Hipple-Lindau syndrome, tubular sclerosis.

Question 4

Risk factors

Answer 4

Old age (60s), male, smoker, obesity, HTN, haemodialysis

Question 5

Paraneoplastic syndromes

Answer 5

EPO -> polycythaemia
PTHrp -> hypercalcaemia
ACTH -> Cushing’s

Question 6

Treatment

Answer 6

Partial or radical nephrectomy for confined disease

Alpha interferon, IL2 or tyrosine kinase inhibitors e.g. sunitinib

Question 7

Wilms’ tumours

Answer 7

Nephroblastoma in 3-5 year olds
Abdominal mass, painless haematuria, loin pain, fever.
Usually unilateral.
20% have metastases.
Treatment: nephrectomy, chemo, RT if advanced, good cure rate