Renal cell carcinoma

Question 1

Renal cell carcinoma : Incidence

Answer 1

Most common type of malignant kidney cancer in adults,
Generally affecting middle aged men

Question 2

Renal cell carcinoma : Pathophysiology

Answer 2

Most common renal cell cancer
Rises fro the Proximal tubular epithelium

Question 3

Renal cell carcinoma : Risk factors

Answer 3

1. Smoking
2. Von-Hippel Lindau syndrome
3. Autosomal dominant PKD - slight increase in risk of renal cell carcinoma

Question 4

Renal cell carcinoma : Von Hippel Lindau disease

Answer 4

• Autosomal dominant disorder
• Mutation of the pVHL gene - leads to cyst formation ad benign tumors
• Increases risk of Renal cell carcinoma : main cause of death in VHL disease

eveloping tumors and cysts in multiple organs, including the eyes, brain, spinal cord, kidneys, adrenal glands, pancreas, and inner ear. These tumors can be both benign (non-cancerous) and, in some cases, malignant (cancerous).

Hemangioblastomas: Hemangioblastomas are one of the characteristic tumors associated with VHL syndrome. They often occur in the central nervous system, particularly in the retina, brain, and spinal cord.

Renal Cell Carcinoma: People with VHL syndrome have an increased risk of developing renal cell carcinoma, a type of kidney cancer.

Pheochromocytomas: Pheochromocytomas, tumors of the adrenal glands that produce excess adrenaline, can also occur in individuals with VHL syndrome.

Question 5

Renal cell carcinoma : Prognosis

Answer 5

• 25% has metastasis at presentation

Question 6

Renal cell carcinoma : Clinical features

Answer 6

1. Classical triad:
   
   • haematuria
   • loin pain
   • abdominal mass
2. Pyrexia of unknown origin

Question 7

Renal cell carcinoma : Extra-renal manifestation

Answer 7

1. Left sided varicocele :
   - Large tumors can put pressure of the left renal vein and prevent venous drainage of the left testes
   - leading to dilatation of testicular veins and forming a left sided varicocele
   - right testicular vein drains directly to the IVC thus does not pose the same issue
2. Frequently causes paraneoplastic syndromes:
   • Tumors release erythropeitin which increases production of new red blood cells - leads to polycythemia
   • Tumors release renin activating RAAS system and raising BP
   • Tumors can release parathyroid hormone causing hyercalcaemia
   • Tumors can release ACTH causing release of cortisol and resulting in