Renal cell carcinoma

Question 1

What is renal cell carcinoma?

Answer 1

Malignancy arising from renal parenchyma/cortex (containing corpuscle, vasculature, PCT, DCT and cortical colleting ducts)

Question 2

What is the aetiology of renal cell carcinoma? (x3)

Answer 2

• Mostly sporadic
• Von Hippel-Lindau syndrome (autosomal dominant condition)
• Succinate dehydrogenase related RCC (autosomal dominant condition)
• Birt-Hogg-Dube syndrome

Question 3

What are the risk factors for renal cell carcinoma? (x3)

Answer 3

Smoking, obesity, hypertension

Question 4

What are the main types of renal cell carcinoma? (x5)

Answer 4

• Clear cell RCC: gold-yellow solitary cortical lesions, and bilateral in von Hippel-Lindau. So-called because the cells have a clear cytoplasm
• Papillary RCC: originating from renal tubular cells
• Chromophobe tumours: characterised by not staining readily
• Multilocular cystic carcinoma: tumour contains multiple cysts
• Mucinous tubular and spindle cell carcinoma: composed of mucin, tumour cells forming tubules, and spindle cells

Question 5

What is the epidemiology of renal cell carcinoma: Kidney cancers? Most common type? Gender? Age?

Answer 5

Accounts for 85% of kidney cancers. Clear cell RCC is the most common. More common in men. Increased incidence with age.

Question 6

What are the signs and symptoms of renal cell carcinoma?

Answer 6

• Asymptomatic – most are incidental findings
• Triad of haematuria, flank pain, palpable abdominal mass
• May have systemic symptoms or hepatic impairment in paraneoplastic presentations

Question 7

What is paraneoplastic syndrome? Types? (x4)

Answer 7

Consequence of cancer producing hormones or cytokines, or an immune response against the tumour. There are four types: endocrine dysfunction (tumour produces hormones), neurological dysfunction (usually from immune response to tumour cell antigen with concurrent auto-immune response to neurones containing similar-looking antigen), mucocutaneous dysfunction, and haematological (the latter two have same mechanism as neurological).

Question 8

What are the investigations for renal cell carcinoma? (x4)

Answer 8

• BLOODS: U&Es show elevated creatinine from chronic renal insufficiency, high calcium is a marker of advanced disease, and FBC, LFTs, coagulation profiles can also be measured to assess for paraneoplastic syndrome
• URINALYSIS: haematuria and/or proteinuria
• ABDOMINAL USS: test for masses and lymphadenopathy
• CT/MRI: definitive test for diagnosis and staging. MRI indicated in patients where contrast dye is contraindicated e.g., renal insufficiency