Renal cell carcinoma

Question 1

where does it arise from

Answer 1

proximal renal tubular epithelium

Question 2

what % does it account for renal tumours

Answer 2

90

Question 3

what % of haemodialysis patients develop RCC

Answer 3

15%

Question 4

features

Answer 4

haematuria, loin pain, abdo mass, anorexia, malaise, weight loss. rarely- invades left testicular vein causing varicocele.

Question 5

how can spread occur

Answer 5

directly- via renal vein; or indirect- via lymph, or haematogenous (bone, liver, lung)

Question 6

what tests can be done

Answer 6

bp- incr from renin secretion; bloods; urine; imagine;

Question 7

tests- blood

Answer 7

FBC (polycythaemia from erythropoietin secretion), ESR, U&E, ALP

Question 8

tests- urine

Answer 8

RBCs, cytology

Question 9

tests- imaging

Answer 9

US,CT/MRI, IVU, CXR (cannon ball mets)

Question 10

treatment

Answer 10

radical nephrectomy. in general chemo and radio resistant. biological therapies- sunitinib, bevacizumab, sorafenib. temsirolimus.

Question 11

what is survival predicted on

Answer 11

Mayo prognostic risk score- stage, size, grade, necrosis