Renal Cell Carcinoma

Question 1

What is Renal Cell Carcinoma (RCC)?

Answer 1

RCC is the most common form of kidney cancer in adults. It arises from the renal tubular epithelium and presents with a variety of features based on its stage, grade, and presence of metastases.

Question 2

What are the common clinical presentations of RCC?

Answer 2

RCC can present with a range of symptoms including local symptoms, paraneoplastic syndromes, imaging findings, and metastatic spread. Common symptoms include hematuria, flank pain, abdominal mass, weight loss, fatigue, and unexplained fever.

Question 4

What is the most common presenting symptom in RCC?

Answer 4

Hematuria (blood in urine) is the most common presenting symptom, occurring in approximately 40% of patients. It may be gross (visible) or microscopic, often due to tumor growth involving the renal pelvis.

Question 5

What causes hematuria in RCC?

Answer 5

Hematuria in RCC occurs when tumor growth involves the renal pelvis, leading to irritation and bleeding.

Question 6

What other local symptoms can occur in RCC?

Answer 6

Other local symptoms include flank pain (dull or sharp), palpable abdominal mass (often seen in advanced stages), and nonspecific symptoms like weight loss and fatigue.

Question 7

What causes flank pain in RCC?

Answer 7

Flank pain in RCC can result from tumor growth or hemorrhage within the tumor, which stretches the renal capsule.

Question 8

When is a palpable abdominal mass seen in RCC?

Answer 8

A palpable abdominal mass is more commonly seen in advanced stages of RCC when the tumor is large enough to be felt in the flank or abdomen.

Question 9

How do weight loss and fatigue relate to RCC?

Answer 9

Weight loss and fatigue are nonspecific symptoms that are more likely to occur in advanced RCC or when the cancer has spread to other parts of the body (metastatic disease).

Question 10

Can fever occur in RCC?

Answer 10

Yes, unexplained fever can occur, especially with larger tumors or as part of paraneoplastic syndromes associated with RCC.

Question 11

What are paraneoplastic syndromes in RCC?

Answer 11

Paraneoplastic syndromes in RCC are systemic effects not directly related to the tumor mass. They are caused by tumor-secreted substances that affect other parts of the body.

Question 12

What is the most common paraneoplastic syndrome in RCC?

Answer 12

Hypercalcemia is the most common paraneoplastic syndrome in RCC, occurring in about 20% of patients, often due to parathyroid hormone-related peptide (PTHrP) production by the tumor.

Question 13

What are the symptoms of hypercalcemia in RCC?

Answer 13

Symptoms of hypercalcemia include confusion, lethargy, constipation, and polyuria.

Question 14

How does erythrocytosis (polycythemia) occur in RCC?

Answer 14

RCC tumors can secrete erythropoietin or erythropoietin-like substances, leading to increased red blood cell production, causing polycythemia. Symptoms include headache, dizziness, and an increased risk of thrombosis.

Question 15

How does hypertension develop in RCC?

Answer 15

Hypertension in RCC can occur due to the tumor’s production of renin or by compression of renal vessels, which activates the renin-angiotensin-aldosterone system (RAAS).

Question 16

What is Stauffer Syndrome?

Answer 16

Stauffer Syndrome is a rare paraneoplastic syndrome associated with RCC, characterized by liver dysfunction (elevated liver enzymes) and systemic symptoms like fever and malaise, without evidence of liver metastasis.

Question 17

What is cachexia in RCC?

Answer 17

Cachexia in RCC refers to unintentional weight loss and muscle wasting, common in advanced stages of the disease and contributing to a poor prognosis.

Question 18

What is the role of ultrasound in RCC diagnosis?

Answer 18

Ultrasound is used for the initial detection of a mass or abnormality. RCC typically appears as a solid, hypoechoic mass, though it can sometimes be cystic. Ultrasound can also detect hydronephrosis or renal vein involvement.

Question 19

What are the advantages of CT scan in RCC?

Answer 19

CT scan is the gold standard for staging RCC. A contrast-enhanced CT provides detailed information about the tumor’s size, location, and extent, as well as involvement of the renal veins or inferior vena cava (IVC). RCC has a characteristic heterogeneous appearance on CT, with areas of necrosis or hemorrhage.

Question 20

When is MRI used in RCC?

Answer 20

MRI is useful when a patient cannot undergo CT due to contraindications like allergy to contrast material or renal insufficiency. MRI offers superior soft tissue contrast and is helpful for assessing the extent of local invasion.

Question 21

What is the role of bone scintigraphy and PET scans in RCC?

Answer 21

Bone scintigraphy is used when bone metastases are suspected, while PET scans assess distant metastases, helping in the staging and management of RCC.

Question 22

How does RCC metastasize and what are the common sites of metastasis?

Answer 22

RCC can metastasize to distant organs, with about 30% of patients having metastatic disease at diagnosis. The most common sites of metastasis are the lungs, bones, liver, and brain.

Question 23

What symptoms are associated with lung metastases in RCC?

Answer 23

Symptoms of lung metastasis include cough, hemoptysis, and dyspnea. The lungs are the most common site of RCC metastasis, affecting up to 50% of patients with advanced disease.

Question 24

How do bone metastases present in RCC?

Answer 24

Bone metastases, especially to the spine, are common in RCC. They can cause bone pain, fractures, and neurological deficits.

Question 25

What are the symptoms of liver metastases in RCC?

Answer 25

Liver metastases occur in about 30% of patients with advanced RCC, but specific symptoms are not always clear. It may present with vague abdominal discomfort, hepatomegaly, or jaundice in advanced cases.

Question 26

How do brain metastases present in RCC?

Answer 26

Brain metastases in RCC are less common but still significant, presenting with neurological symptoms such as headache, seizures, and focal deficits.

Question 27

What is the main treatment approach for localized RCC?

Answer 27

The main treatment for localized RCC is surgical resection, with radical nephrectomy being the standard procedure. This involves the removal of the entire kidney along with surrounding fat and lymph nodes.

Question 28

What is partial nephrectomy (PN) and when is it used in RCC?

Answer 28

Partial nephrectomy is performed when the tumor is small and confined to the kidney or when renal preservation is important (e.g., in patients with a solitary kidney or pre-existing renal dysfunction). Only the tumor is removed, sparing the rest of the kidney.

Question 29

How do laparoscopic and robotic surgeries benefit RCC patients?

Answer 29

Laparoscopic and robotic surgeries are minimally invasive techniques that reduce postoperative pain, shorten recovery times, and minimize complications compared to traditional open surgery.

Question 30

What is the role of targeted therapy in RCC management?

Answer 30

Targeted therapy is used for metastatic or locally advanced RCC when surgery is not an option. These therapies target molecular pathways like VEGF or mTOR, which are involved in tumor growth and survival.

Question 31

What are VEGF inhibitors and how do they work?

Answer 31

VEGF inhibitors, such as sorafenib, sunitinib, and pazopanib, block the vascular endothelial growth factor (VEGF) pathway, which is responsible for the formation of blood vessels that supply tumors.

Question 32

What are mTOR inhibitors and how do they help in RCC treatment?

Answer 32

mTOR inhibitors, such as everolimus and temsirolimus, target the mTOR pathway involved in tumor cell growth and survival, helping to control the progression of RCC.

Question 33

How does immunotherapy work in RCC?

Answer 33

Immunotherapy, particularly immune checkpoint inhibitors like nivolumab and pembrolizumab, enhances the immune system's ability to attack RCC tumor cells by blocking the PD-1/PD-L1 pathway.

Question 34

What is the role of Interleukin-2 (IL-2) in RCC treatment?

Answer 34

Interleukin-2 (IL-2) may be used in select RCC cases, particularly those with favorable risk factors. However, it is associated with significant toxicity and is typically reserved for patients with good performance status.

Question 35

When is radiation therapy used in RCC?

Answer 35

Radiation therapy is not typically used as a primary treatment for RCC because the tumor is often resistant to radiation. However, it can be used palliatively in cases of bone or brain metastases.

Question 36

What are cryoablation and radiofrequency ablation (RFA) in RCC?

Answer 36

Cryoablation and radiofrequency ablation (RFA) are techniques used to destroy small, localized RCC tumors in patients who are not surgical candidates. Cryoablation uses extreme cold, while RFA uses heat.

Question 37

What is active surveillance in RCC and when is it used?

Answer 37

Active surveillance involves monitoring small, low-grade tumors with regular imaging. It may be appropriate for elderly patients or those with multiple comorbidities who are not candidates for surgery.

Question 38

What factors determine the prognosis of RCC?

Answer 38

The prognosis of RCC is primarily determined by the stage at diagnosis. Early-stage tumors confined to the kidney have a good prognosis, while advanced RCC with metastases has a poorer prognosis, with survival rates depending on metastasis location and treatment response.

Question 39

What is the conclusion regarding the management of RCC?

Answer 39

The management of RCC has evolved over time. Surgery remains the cornerstone for localized disease, while targeted therapies and immunotherapy provide new treatment options for metastatic disease. Early diagnosis and individualized treatment plans are essential for improving patient outcomes.