Renal Cell Carcinoma Flashcards
What is kidney cancer?
A malignant tumor of the kidney, also known as renal cell carcinoma (RCC), hypernephroma, or Grawitz tumor.
What percentage of adult malignancies does kidney cancer account for?
3% of all adult malignancies in the Western world.
What are the benign renal neoplasms?
Benign renal cyst, papillary adenoma, renal oncocytoma, metanephric adenoma, and angiomyolipoma.
What are the malignant renal neoplasms?
Conventional (clear cell) renal carcinoma, papillary renal carcinoma, chromophobe renal carcinoma, collecting duct carcinoma, and unclassified renal cell carcinoma.
What is the most common type of renal cell carcinoma (RCC)?
Conventional (clear cell) renal carcinoma.
What genetic mutations are associated with renal cell carcinoma?
VHL gene (clear cell RCC), c-Met gene (type 1 papillary RCC), fumarate hydratase gene (type 2 papillary RCC), and Birt-Hogg-Dubé (BHD) gene (chromophobe RCC).
What environmental risk factors are associated with kidney cancer?
Tobacco use, high-fat diet, low fruit and vegetable intake, coffee & tea, dairy products, dry cleaning chemicals, trichloroethylene, cadmium, asbestos, arsenic, and phenacetin exposure.
What medical conditions increase the risk of kidney cancer?
Sickle cell trait (medullary RCC), chronic dialysis, obesity, hypertension, diuretic use, polycystic kidney disease, and radiation exposure.
What are the clinical features of kidney cancer?
May be incidental or present with local tumor growth, hematuria, paraneoplastic syndrome (20% of patients), or metastatic disease.
What is the classic triad of renal cell carcinoma?
Flank pain, gross hematuria, and a flank/abdominal mass.
What laboratory investigations are done for kidney cancer?
Full blood count (FBC), erythrocyte sedimentation rate (ESR), electrolytes & urea (E&U), creatinine, liver function tests, urinalysis.
What imaging studies are used in kidney cancer diagnosis?
Ultrasound (USS) of the abdomen, CT scan (native and contrast), MRI, chest X-ray (CXR), intravenous urogram (IVU), isotope nephrogram, and bone scintigraphy.
What is the role of fine needle aspiration cytology (FNAC) in kidney cancer diagnosis?
It is controversial and not commonly used for diagnosis.
What are the staging systems used for kidney cancer?
Robson and TNM (2002) staging systems.
What are the treatment options for kidney cancer?
Observation (for small localized tumors in elderly patients), partial nephrectomy, radical nephrectomy, palliative/cytoreductive nephrectomy, immunotherapy, anti-angiogenesis agents, chemotherapy, radiotherapy, and gene therapy (future potential).
What is the role of chemotherapy and radiotherapy in kidney cancer?
They have a very poor response except for bone and brain metastases.
What emerging treatment modalities are being considered for kidney cancer?
Multi-drug resistance gene targeting, Cyclin B1 elaboration (Ikuerowo et al 2006), and gene therapy.
What is the importance of follow-up in kidney cancer management?
To monitor for recurrence, metastasis, and response to treatment.
What is another name for renal cell carcinoma?
Hypernephroma or Grawitz tumor.
What is the most common primary renal malignancy?
Renal cell carcinoma (RCC).
What is the incidence trend of kidney cancer?
It has been increasing in recent years.
What are the main types of papillary renal carcinoma?
Type 1 and Type 2 papillary renal carcinoma.
Which genetic mutation is associated with clear cell RCC?
VHL (Von Hippel-Lindau) gene mutation.
What genetic mutation is associated with type 1 papillary RCC?
c-Met gene mutation.
Which genetic mutation is associated with type 2 papillary RCC?
Fumarate hydratase gene mutation.
Which genetic mutation is associated with chromophobe RCC?
Birt-Hogg-Dubé (BHD) gene mutation.
What lifestyle factor is a major risk factor for kidney cancer?
Tobacco use (smoking).
How does obesity contribute to kidney cancer?
It increases the risk due to hormonal and metabolic changes.
What is the relationship between chronic dialysis and kidney cancer?
Long-term dialysis increases the risk of renal cell carcinoma.
What occupational exposures increase the risk of kidney cancer?
Dry cleaning chemicals, trichloroethylene, cadmium, asbestos, arsenic, and phenacetin.
What is paraneoplastic syndrome in kidney cancer?
A syndrome where tumors produce hormones or cytokines causing systemic effects like hypertension, polycythemia, and hypercalcemia.
How common is paraneoplastic syndrome in kidney cancer?
It occurs in about 20% of patients.
What is the most common symptom of kidney cancer?
Hematuria (blood in the urine).
What percentage of kidney cancers are detected incidentally?
A significant proportion, often during imaging for unrelated conditions.
What is the role of ultrasound in kidney cancer diagnosis?
It helps detect renal masses and differentiate between cystic and solid tumors.
Why is contrast-enhanced CT scan important in kidney cancer?
It provides detailed imaging of the renal mass and its vascular involvement.
When is MRI preferred over CT in kidney cancer evaluation?
When a patient has contraindications to contrast agents or for better soft tissue characterization.
Why is chest X-ray performed in kidney cancer patients?
To check for lung metastases.
What is the purpose of bone scintigraphy in kidney cancer?
To detect bone metastases in patients with bone pain or elevated alkaline phosphatase.
What is the Robson staging system used for?
To classify kidney cancer based on the extent of tumor spread.
What is the TNM staging system for kidney cancer?
A system that classifies tumors based on Tumor size (T), Node involvement (N), and Metastasis (M).
What is the primary treatment for localized kidney cancer?
Radical or partial nephrectomy.
What is a partial nephrectomy?
A surgical procedure that removes only the tumor and preserves kidney function.
When is radical nephrectomy indicated?
For larger tumors or when the entire kidney is involved.
What is cytoreductive nephrectomy?
A palliative surgery to reduce tumor burden in metastatic kidney cancer.
What is the role of immunotherapy in kidney cancer?
It helps enhance the immune response against cancer cells.
What are examples of anti-angiogenesis agents used in kidney cancer?
Drugs like sunitinib and bevacizumab that inhibit tumor blood vessel growth.
Why is chemotherapy generally ineffective in kidney cancer?
RCC is resistant to most traditional chemotherapy agents.
What is the role of radiotherapy in kidney cancer?
It is mainly used for palliative treatment of bone and brain metastases.
What is the emerging role of gene therapy in kidney cancer?
Potential future treatment targeting specific genetic mutations in RCC.
What is multi-drug resistance in kidney cancer?
A phenomenon where tumor cells become resistant to multiple chemotherapy drugs.
What protein is linked to chemotherapy resistance in kidney cancer?
Cyclin B1, which promotes tumor cell proliferation.
What is the importance of follow-up in kidney cancer?
To detect recurrence, metastasis, or complications after treatment.
What imaging modalities are used for kidney cancer follow-up?
CT scans, MRI, and chest X-rays.
What is the prognosis of localized kidney cancer after surgery?
Good, with high survival rates if detected early.
What factors indicate poor prognosis in kidney cancer?
Advanced stage, metastasis, large tumor size, and poor histologic differentiation.
