Renal Cell Carcinoma Flashcards
What is renal cell carcinoma (RCC)?
Malignancy arising from proximal convoluted tubule in the renal cortex (90% of kidney cancers)
What is sporadic RCC like?
- Solitary tumours
- Upper kidney
What is the epi for sporadic RCC?
- Older men
- Smoking, Obesity, HTN
What are the inherited causes of RCC?
- Von Hippel Lindau disease: familial multisystem tumour syndrome
- AD mutation in VHL tumour suppressor gene
What does VHL cause?
multiple benign tumours & cysts: Retinal and CNS hemangioblastomas, RCC, phaeos, pancreatic islet tumour
What is the most common epi for RCC?
common in old men (60s-70s)
What is common RF for RCC?
- Smoking
- Obesity
- HTN
- End stage renal disease
Linked to mutations in chromosome 3 - VHL gene leads to von Hippel–Lindau tumour suppressor gene
What is RCC also known as?
silent cancer
What are symptoms of RCC?
- Flank pain
- Palpable mass
- Haematuria
- Varicocele on left
- Can cause pareneoplastic syndrome
Why is the varocele on the left in RCC?
- Compression of left renal vein, into which left testitucular veins drain into
- Backflow into testicular veins causing them to become dilated
- Left testicle feels like a bag of worms
(right drain straight into IVC)
What would EPO secreting lead to?
increased RBCs so polycythaemia
What would renin releasing cause?
high BP
What would PTHrP releasing cause?
High Calcium
What would ACTH releasing lead to?
high cortisol leading to Cushings
How is RCC staged?
TNM
How do you determine the size of the tumour (T)?
CT MRI abdo/pelvis 1st line and MRI If contrast contraindicated (i.e.: renal insufficiency or allergy)
How do you determine degree of spread (N)?
lymph node biopsy
How do you determine degree of metastasis?
- CXR
2. Bone Markers: check for elevated ALP
What does CXR show in RCC?
cannonball metastases
What is stage 1 and 2 RCC?
Confined to kidney
What is stage 3 RCC?
- Extends into major veins, adrenal gland, or perinephric tissue (NOT beyond Gerota fascia)
- May spread into a single regional LN
What is the gerota fascia?
FASCIAL LAYER SURROUNDING ANTERIOR SURFACE OF KIDNEY
What is stage 4 RCC?
extends beyond Gerota fascia or distant metastases
What are prognostic factors for RCC?
- Anaemia
- Hypercalcaemia
- Neutrophilia
- Thrombocytosis
- Unable to carry out normal activity
What is favourable Memorial Sloan Kettering Cancer Center (MSKCC) prognostic model?
0 prognostic factors
What is interemediate on Memorial Sloan Kettering Cancer Center (MSKCC) prognostic model?
1-2 prognostic factors
What is poor on Memorial Sloan Kettering Cancer Center (MSKCC) prognostic model?
≥3 prognostic factors
What is RCC resistant to?
resistant to chemo and radiotherapy
What is the conservative management for RCC?
- Active surveillance if:
1. Stage 1&2 or <4cm
2. Unfit for surgery
What is the medical management for RCC?
Immunotherapy if Stage 4 (metastatic disease)
What is the interventional management for RCC?
Surgical resection (1st line) - curvative
