Renal Cell Carcinoma

Question 1

What is the classic triad of renal cell carcinoma?

Answer 1

Haematuria
Flank pain
Palpable mass

Question 2

What are the 3 most common types of renal cell adenocarcinoma?

Answer 2

Clear cell- 80%

Papillary- 15%

Chromophobe- 5%

Wilm’s tumour (children, < 5)

Question 3

What are the risk factors of renal cell carcinomas?

Answer 3

Smoking

Obesity

Hypertension

End-stage renal failure

Von Hippel-Lindau disease

Tuberous sclerosis

Question 4

How do patients with renal cell carcinoma present?

Answer 4

May be asymptomatic but can have:

• Haematuria
• Vague loin pain
• Non-specific cancer symptoms
• Palpable renal mass

Question 5

What do NICE guidelines recommend for renal cancer?

Answer 5

Two week wait referral for

• Aged over 45 with unexplained visible haematuria without a UTI or persisting after UTI treatment

Question 6

What do renal cell carcinomas tend to spread?

Answer 6

Tissues around the kidney within Gerota’s fascia

Often spread to renal vein then IVC

Question 7

What X-ray finding is a classic feature of metastatic renal cell carcinoma?

Answer 7

Cannonball metastases

Question 8

What paraneoplastic features is renal cell carcinoma associated with?

Answer 8

Polycythaemia
Unregulated EPO secretion

Hypercalcaemia
Secretion of a hormone that mimics PTH

Hypertension
Increased renin + polycythaemia + physical compression

Stauffer’s syndrome
Abnormal LFTs without liver metastasis

Question 9

Alongside TNM staging, what number staging is used for renal cell carcinoma?

Answer 9

Stage 1
Less than 7 cm, confined to kidney

Stage 2
Bigger than 7 cm, confined to kidney

Stage 3
Local spread to nearby tissues or veins, not beyond Gerota’s fascia

Stage 4
Spread beyond Gerota’s fascia, including metastasis

Question 10

What is the first-line management of renal cell carcinoma?

Answer 10

Partial nephrectomy

Radical nephrectomy
Kidney, surround tissue, lymph nodes, adrenal gland

Question 11

When surgical intervention is not suitable, what procedures may be used to treat renal cell carcinoma?

Answer 11

Arterial embolisation
Cutting off blood supply to affected kidney

Percutaneous cyrotherapy
Liquid nitrogen to freeze and kill tumour cells

Radiofrequency ablation
Needle into tumour, electrical current to kill the tumour

Chemotherapy and radiotherapy