Renal cell carcinoma

Question 1

Define

Answer 1

• Primary malignancy of the kidneys

Question 2

What’s the aetiology?

Answer 2

• Renal clear cell carcinoma (80%) - UNKNOWN CAUSE
• Papillary carcinoma (10%) - UNKNOWN CAUSE
• Transitional cell carcinoma (10%)

Question 3

What are the risk factors?

Answer 3

o Associated with certain inherited conditions:
• von Hippel-Lindau disease
 Mutation in the von Hippel-Lindau protein, which causes headaches, balance issues, dizziness, limb weakness, vision problems and high blood pressure
• Tuberous sclerosis
 A rare genetic disease that causes benign tumours to grow in the brain and other organs (e.g. skin, kidneys, lungs, eyes)
• Polycystic kidney disease
• Familial renal cell cancer (increases risk x4)
• Smoking
• Chronic dialysis
• Renal transplant
• Male gender
• Obesity
• Hypertension
• Black or native ethnicity
o NOTE: renal cell cancer can cause abnormal LFTs in the absence of liver metastases = Strauffer’s Syndrome

Question 4

Epidemiology

Answer 4

• UNCOMMON
• 3% of all adult malignancies
• Peak incidence: 40-60 yrs

Question 5

What are the presenting symptoms?

Answer 5

•	Renal Cell Carcinoma
o	Usually present LATE 
o	Asymptomatic in 90%
o	Triad of Symptoms:
•	Haematuria
•	Flank pain
•	Abdominal mass
•	Transitional Cell Carcinoma
o	Presents EARLIER with haematuria
•	Systemic Signs of Malignancy
o	Weight loss
o	Malaise 
o	Paraneoplastic syndromes (e.g. fever, hypercalcaemia, polycythaemia)

Question 6

WHat are the signs?

Answer 6

• Palpable renal mass
• Hypertension
• Plethora (excess of blood)
• Anaemia
• A left-sided tumour can obstruct the left testicular vein as it joins the left renal vein, and cause a left-sided varicocoele

Question 7

WHat are the appropriate investigations?

Answer 7

• Urinalysis
o Haematuria/ proteinuria
o Cytology

•	Bloods
o	FBC
o	U&Es
o	Calcium
o	LFTs (liver metastases or Stauffer’s)
o	High ESR (in 75%)

• Abdominal Ultrasound

o Best first-line investigation
o Can distinguish between solid masses and cystic structures

• CT/MRI
o Useful for staging
• Staging system: Robson Staging