Renal Cell Carcinoma Flashcards
What are the different types of renal cancer?
- Renal cell carcinoma/adenocarcinoma (most common)
- Papillary (bilateral and better prognosis than RCC)
- Chromophobe (indolent)
- Transitional cell carcinoma
- Sarcoma,
- Metastases
What are the risk factors for renal cancer?
- Smoking,
- Obesity,
- Hypertension,
- Haemodialysis,
- Genetics (Von-Hipple Lindau syndrome)
- Tuberous sclerosis
What are the symptoms of renal cancer?
Classic triad of haematuria, loin pain and abdominal mass.
Pyrexia of unknown origin,
Paraneoplastic features
Left sided varicocele due to tumour thrombus
Lower limb oedema
What are the paraneoplastic features of renal cell carcinoma?
- Polycythaemia due to secretion of erythropoietin,
- Hypercalcaemia due to secretion of parathyroid hormone related peptide
- Hypertension
- Stauffer’s syndrome
What is Stauffer’s syndrome?
Paraneoplastic disorder which presents with cholestasis and hepatosplenomegaly and deranged LFTs.
Secondary to raised IL-6 levels
What are the investigations for suspected renal cell carcinoma?
- FBC, LDH, Corrected calcium, LFTs, Coagulation profile, U&Es,
- Urinalysis,
- Imaging: ultrasound, CT for definitive diagnosis, MRI for staging
- Renal biopsy
What are the treatments for renal cancer?
Small/T1 - Biopsy and nephron sparing surgery
Large/T2+ - Radical nephrectomy unless indication for NSS
What are the indications for nephron sparing surgery?
Single kidney, CKD, CV risk factors or a pT1a tumour
What is a radical nephrectomy?
Removal of kidney and gerota’s fascia
What is the typical spread of renal cancers?
- Around the kidney within Gerota’s fascial then to renal vein.
- Cannonball metastases in the lungs is classic of RCC mets. These are clearly defined circular opacities on the lung feilds
What is the staging of renal cancer?
TNM is most common but there is also a number staging:
Stage 1/T1 - less than 7cm and confined to kidney
Stage 2/T2 - greater than 7cm and confined to kidney
Stage 3/T3 - Local spread but not beyond gerota’s fascia
Stage 4/T4 - Beyond gerot’s fasica and mets
What are some less invasive procedure’s for renal cancer if patient is not fit for surgery?
Arterial embolisation which cuts off blood supply to affected kidney.
Percutaneous cryotherapy to freeze cancer cells
Radiofrequency ablation
What are some medical therapies for renal cancer?
1, Receptor tyrosine kinase inhibitors eg, sorafenib (most efficacy)
2, Alpha-interfeuron or interleukin 2
Used in metastatic disease. Chemo is not very effective.
What is the difference for RCC and TCC
RCC - Adenocarcinoma of the renal cortex. Insensitive to chemotherapy and radiotherapy so surgery is primary treatment.
TCC - Carcinoma of the renal pelvis which is similar to TCCs of the bladder and ureter. Can be treated with surgery and chemo
