Renal Cell Carcinoma

Question 1

What is renal cell carcinoma (RCC)?

Answer 1

Malignancy arising from proximal convoluted tubule in the renal cortex (90% of kidney cancers)

Question 2

What is sporadic RCC like?

Answer 2

• Solitary tumours

- Upper kidney

Question 3

What is the epi for sporadic RCC?

Answer 3

• Older men

- Smoking, Obesity, HTN

Question 4

What are the inherited causes of RCC?

Answer 4

1. Von Hippel Lindau disease: familial multisystem tumour syndrome
2. AD mutation in VHL tumour suppressor gene

Question 5

What does VHL cause?

Answer 5

multiple benign tumours & cysts: Retinal and CNS hemangioblastomas, RCC, phaeos, pancreatic islet tumour

Question 6

What is the most common epi for RCC?

Answer 6

common in old men (60s-70s)

Question 7

What is common RF for RCC?

Answer 7

1. Smoking
2. Obesity
3. HTN
4. End stage renal disease
   Linked to mutations in chromosome 3
5. VHL gene leads to von Hippel–Lindau tumour suppressor gene

Question 8

What is RCC also known as?

Answer 8

silent cancer

Question 9

What are symptoms of RCC?

Answer 9

1. Flank pain
2. Palpable mass
3. Haematuria
4. Varicocele on left
5. Can cause pareneoplastic syndrome

Question 10

Why is the varocele on the left in RCC?

Answer 10

1. Compression of left renal vein, into which left testitucular veins drain into
2. Backflow into testicular veins causing them to become dilated
3. Left testicle feels like a bag of worms
   (right drain straight into IVC)

Question 11

What would EPO secreting lead to?

Answer 11

increased RBCs so polycythaemia

Question 12

What would renin releasing cause?

Answer 12

high BP

Question 13

What would PTHrP releasing cause?

Answer 13

High Calcium

Question 14

What would ACTH releasing lead to?

Answer 14

high cortisol leading to Cushings

Question 15

How is RCC staged?

Answer 15

TNM

Question 16

How do you determine the size of the tumour (T)?

Answer 16

CT MRI abdo/pelvis 1st line and MRI If contrast contraindicated (i.e.: renal insufficiency or allergy)

Question 17

How do you determine degree of spread (N)?

Answer 17

lymph node biopsy

Question 18

How do you determine degree of metastasis?

Answer 18

1. CXR

2. Bone Markers: check for elevated ALP

Question 19

What does CXR show in RCC?

Answer 19

cannonball metastases

Question 20

What is stage 1 and 2 RCC?

Answer 20

Confined to kidney

Question 21

What is stage 3 RCC?

Answer 21

• Extends into major veins, adrenal gland, or perinephric tissue (NOT beyond Gerota fascia)
• May spread into a single regional LN

Question 22

What is the gerota fascia?

Answer 22

FASCIAL LAYER SURROUNDING ANTERIOR SURFACE OF KIDNEY

Question 23

What is stage 4 RCC?

Answer 23

extends beyond Gerota fascia or distant metastases

Question 24

What are prognostic factors for RCC?

Answer 24

1. Anaemia
2. Hypercalcaemia
3. Neutrophilia
4. Thrombocytosis
5. Unable to carry out normal activity

Question 25

What is favourable Memorial Sloan Kettering Cancer Center (MSKCC) prognostic model?

Answer 25

0 prognostic factors

Question 26

What is interemediate on Memorial Sloan Kettering Cancer Center (MSKCC) prognostic model?

Answer 26

1-2 prognostic factors

Question 27

What is poor on Memorial Sloan Kettering Cancer Center (MSKCC) prognostic model?

Answer 27

≥3 prognostic factors

Question 28

What is RCC resistant to?

Answer 28

resistant to chemo and radiotherapy

Question 29

What is the conservative management for RCC?

Answer 29

• Active surveillance if:
  1. Stage 1&2 or <4cm
  2. Unfit for surgery

Question 30

What is the medical management for RCC?

Answer 30

Immunotherapy if Stage 4 (metastatic disease)

Question 31

What is the interventional management for RCC?

Answer 31

Surgical resection (1st line) - curvative