renal cell carcinoma Flashcards
what is a renal cell carcinoma?
- adenocarinoma of the renal cortex
- most common type of kidney tumour
what are some risk factors for renal cell carcinoma?
- 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)
where do RCC tend to present?
-believe to arise from the proximal convoluted tubule
RC can also contain cysts or are predominantly cystic
-what scoring is used to predict cancer vs cystic kidney disease?
Bosniak score
what are the different types of RCC?
- conventional clear cell carcinoma (80%)
- papillary (10-15%)
- chromophone (5%)
- collecting duct
- medullary cell
- Wilm’s tumour (affects kids <5 years)
how may RCC present?
- haematuria
- vague loin pain
- palpable renal mass on examination
- non specific cancer symptoms (weight loss, fatigue, night sweats, anorexia)
what is the most common type of RCC?
conventional clear cell carcinoma
how do clear cell carcinomas present histologically?
clear cells
-cytoplasm rich in lipids and glycogen 3p deletion
what most often causes a conventional clear cell carcinoma?
loss of VHL
how do papillary RCC present histologically?
-elongated papillae often with foamy cells
what is the second most common type of RCC?
-papillary (10-15%)
what is the 3rd most common RCC?
Chromophone (5%)
how do chromophone cells present histologically?
- large cells with defined borders
- atypical nuclei resembling raisins (raisinoid)
- histologically similar to oncocytomas (very pink and granular cytoma)
what is the most aggressive form of RCC?
-collecting duct
who is typically affected by medullary cell RCC?
-young sickle cell patients
what is the prognosis like for medullar cell RCC?
very poor prognosis
how are RCC staged?
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
what is the management for RCC?
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
what paraneoplastic syndromes are RCC associated with?
- Polycythemia (RCC may produce exessive erythropoietin/ EPO)
- Hypertension (due to increased renin production from the tumour)
- Hypercalcaemia (due to PTHrP produced by the tumour)
what may men with a left sided RCC experience?
-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
