Renal Cell Carcinoma

Question 1

what type of tumour are most renal cell carcinomas

Answer 1

85% clear cell

Question 2

4 types of renal cell carcinoma

Answer 2

clear cell
papillary
chromophobe
bellini type ductal carcinoma

Question 3

T1 tumour

Answer 3

<7cm and confined to capsule

Question 4

T2 tumour

Answer 4

> 7cm and confined to capsue

Question 5

T3 tumour

Answer 5

outside capsule

a. peri-renal fat
b. into renal vein/IVC
c. thrombus in IVC past diaphragm

Question 6

T4 tumour

Answer 6

tumour invading outside renal fascia

Question 7

4 ways of renal cell carcinoma spread

Answer 7

direct, venous, haematogenous and lymphatic

Question 8

presentation of renal cell carcinoma

Answer 8

50% asymptomatic
haematuria
loin pain
mass
metastases
- bone pain
- hypercalcaemia
- lung, brain or liver

Question 9

investigations

Answer 9

CT or chest and abdomen is mandatory (provides TNM and diagnosis)
U&Es, FBC
US
DMSA or MAG-3

Question 10

treatment of a T1/2 tumour

Answer 10

laparoscopic radical nephrectomy

Question 11

true/false radical nephrectomy is curative in T3

Answer 11

false - but it is still worthwhile

Question 12

treatment of metastases

Answer 12

radio and chemo resistant so gotta use immunotherapy and RTK inhibitors

Question 13

true/false renal metastases are resistant to radio and chemo

Answer 13

true - got to use immunotherapy and receptor TK inhibitors

Question 14

prognosis for T1-4 at 5 years

Answer 14

T1 = 95%
T2 = 90%
T3 = 60%
T4 = 20%

Question 15

prognosis of nodal involvement

Answer 15

20% at 5 years

Question 16

prognosis of metastatic disease

Answer 16

12-18 months survival

Question 17

what is the classic triad of renal cell carcinoma

Answer 17

haematuria, flank pain and a mass

Question 18

what proportion of RCC presents with a classic triad

Answer 18

10%

Question 19

30% of RCC presents with _________ syndrome

Answer 19

paraneoplastic

Question 20

metastatic sites of RCC

Answer 20

brain, bone, lungs, liver