renal cell carcinoma Flashcards

1
Q

what is a renal cell carcinoma?

A
  • adenocarinoma of the renal cortex

- most common type of kidney tumour

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2
Q

what are some risk factors for renal cell carcinoma?

A
  • smoking
  • renal failure and dialysis
  • obesity
  • hypertension
  • low socio economic status
  • asbestos, cadmium exposure, phenacetin
  • genetic (VHL accounts for most sporadic renal cancers, 50% of cases of VHL syndrome develop RCC)
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3
Q

where do RCC tend to present?

A

-believe to arise from the proximal convoluted tubule

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4
Q

RC can also contain cysts or are predominantly cystic

-what scoring is used to predict cancer vs cystic kidney disease?

A

Bosniak score

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5
Q

what are the different types of RCC?

A
  • conventional clear cell carcinoma (80%)
  • papillary (10-15%)
  • chromophone (5%)
  • collecting duct
  • medullary cell
  • Wilm’s tumour (affects kids <5 years)
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6
Q

how may RCC present?

A
  • haematuria
  • vague loin pain
  • palpable renal mass on examination
  • non specific cancer symptoms (weight loss, fatigue, night sweats, anorexia)
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7
Q

what is the most common type of RCC?

A

conventional clear cell carcinoma

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8
Q

how do clear cell carcinomas present histologically?

A

clear cells

-cytoplasm rich in lipids and glycogen 3p deletion

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9
Q

what most often causes a conventional clear cell carcinoma?

A

loss of VHL

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10
Q

how do papillary RCC present histologically?

A

-elongated papillae often with foamy cells

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11
Q

what is the second most common type of RCC?

A

-papillary (10-15%)

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12
Q

what is the 3rd most common RCC?

A

Chromophone (5%)

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13
Q

how do chromophone cells present histologically?

A
  • large cells with defined borders
  • atypical nuclei resembling raisins (raisinoid)
  • histologically similar to oncocytomas (very pink and granular cytoma)
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14
Q

what is the most aggressive form of RCC?

A

-collecting duct

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15
Q

who is typically affected by medullary cell RCC?

A

-young sickle cell patients

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16
Q

what is the prognosis like for medullar cell RCC?

A

very poor prognosis

17
Q

how are RCC staged?

A

T1 up to 7cm
T2 >7cm and confined to the kidney
T3 extends beyond kidney into renal vein, perinephric fat, renal sinus, IVC
T4 beyond gerotas fascia into surrounding structures

18
Q

what is the management for RCC?

A

Small tumours (3-4cm)

  • surveillance in elderly unfit patietns
  • ablation techniques in fit elderly patients and selected younger patients
  • partial nephrectomy

> 3-4cm

  • surveillance, ablative techniqeus
  • partial nephrectomy
  • nephrectomy

Large tumours
-radical nephrectomy

Follow up:

  • FBC, renal and liver functions
  • imaging (CT/ USS + CXR)
  • Duration of 5 to 10 years
19
Q

what paraneoplastic syndromes are RCC associated with?

A
  • Polycythemia (RCC may produce exessive erythropoietin/ EPO)
  • Hypertension (due to increased renin production from the tumour)
  • Hypercalcaemia (due to PTHrP produced by the tumour)
20
Q

what may men with a left sided RCC experience?

A

-may say their left teste feels like a ‘bag of worms’ due to varicocele caused by tumour pressing on either the left renal or testicular vein