Renal cell carcinoma

Question 1

What is the characteristic triad of RCC symptoms?

Answer 1

Haematuria, flank pain and abdominal mass.

But this is only present in 10-15% of cases and is indicative of advanced disease.

Question 2

Why do you have increased RBCs and platelets in RCC?

Answer 2

Due to erythrocytosis as result of increased EPO production as part of paraneoplastic syndrome.

Question 3

What are the superior, medial and lateral relations of the left kidney?

Answer 3

Superior: suprarenal glands, splenic vein, pancreatic head and splenic artery

Medial: small intestine and stomach

Lateral: splenic flexure of the colon

Question 4

What nerve supplies psoas major?

Answer 4

It is attached from lumbar vertebrae to the lesser trochanter of the femur. It is supplied by L1, 2 and 3 lumbar nervous supply.

Question 5

What nerve supplies iliacus muscle?

Answer 5

Femoral nerve (L2-L4 supply)

Question 6

What nerve supplies quadratus lumborum muscle?

Answer 6

Anterior branches of T12 and L1-L4 nerves.

Question 7

What are some local complications of RCC?

Answer 7

Cancer can invade into collecting system leading to haematuria.
It can invade into IVC directly causing lower limb oedema, hepatic dysfunction, ascites, pulmonary metastases.
It can invade into left renal vein leading to left testicular varicocele.

Question 8

What are some paraneoplastic syndromes associated with RCC?

Answer 8

• Renin: hypertension
• PTH and PTH-like proteins: hypercalcaemia
• EPO –> erythrocytosis
• Cytokines –> fever, weight loss
• Stauffer’s syndrome: non-metastatic liver dysfunction

Question 9

Where does it metastasise to?

Answer 9

Lung (most common), liver, bone

Question 10

What is the mechanism behind lumbar spine pain?

Answer 10

This is due to bony metastases to the spine, causing stretch of the periosteum. There is also reactive muscle spasm.

There is nerve root infiltration and compression of nerves by collapse of vertebra.

Question 11

Why did the patient have a pleural effusion?

Answer 11

Metastatic spread to the lungs. Pleural effusion can be transudate or exudate (through increased capillary and pleural membrane permeability or impaired lymphatic drainage of the pleural space).

Question 12

What is the name of the fascia lining the kidneys?

Answer 12

Gerota’s fascia.

Question 13

List some risk factors of RCC.

Answer 13

Male 
Old age 
Family history 
Smoking and obesity 
HTN 
Cystic disease of kidney 
Chronic HCV infection