Renal Cell Carcinoma

Question 1

Where does renal cell carcinoma arise from, how common is it and what type is most common?

Answer 1

1. From proximal renal tubular epithelium
2. 90% of all renal cancers
3. Clear cell adenocarcinoma

Question 2

What are the risk factors for renal cell carcinoma?

Answer 2

1. Smoking
2. M:F >4:1
3. Age >55, developed nations.
4. Black, obese, HTN, FHx
5. Von Hippel Lindau syndrome
6. Haemodialysis, ionising radiation

Question 3

What is this a presentation of?

50% asymptomatic and picked up incidentally, microscopic/frank haematuria. Loin pain, loin mass, non-specific symptoms.

Answer 3

Renal cell carcinoma

Question 4

What might an x-ray show in renal cell carcinoma?

Answer 4

Cannonball metastases

Question 5

How is a suspected renal cell carcinoma investigated?

Answer 5

1. BP - increased renin production
2. FBC - polycythaemia form increased EPO
3. LDH - poor prognosis in advanced RCC if >1.5x upper limit
4. Corrected calcium and ALP - raise in poor prognosis
5. U&Es - for surgery
6. Urinalysis - haematuria and proteinuria
7. LFTs and coagulation profile - liver dysfunction/metastases
8. Fuhrman system to grade
9. CT/MRI definitive imaging to diagnose

Question 6

How is renal cell carcinoma graded?

Answer 6

Fuhrman system:

1. Grade 1 - less aggressive, closely resembles original tissue
2. Grade 4 - more aggressive, large and pleomorphic nuclei

Question 7

What is the treatment for renal cell carcinoma?

Answer 7

1. Radical nephrectomy or partial if <4cm
2. Cryotherapy and radiofrequency ablation for small tumours
3. Generally radio and chemotherapy resistant