Renal Cell Carcinoma Flashcards
What is the most common type of cancer in the kidney?
Renal cell carcinoma- the most common type if clear cell carcinoma
Where do renal cell carcinomas arise from?
Epithelial cells of the proximal convoluted tubule
What gene mutations are renal cell carcinomas associated with?
VHL Mutations- both in the hereditary (often bilateral) and sporadic form
What type of carcinoma might arise at the renal pelvis?
Transitional cell carcinoma
What are some risk factors for renal cell carcinoma?
Smoking history
Obesity
Genetics- VHL
Exposure to chemicals- e.g. rubber, leather, metal industry
Long term dialysis and ESRD- increased risk of cyst development
Age
History of thyroid cancer
What are some symptoms for renal cell carcinoma?
Give classic triad
Also include paraneoplastic features
Hematuria
Flank pain
Abdominal mass
Weight loss
Fatigue
Varicocele (due to compression of left renal vein where the left gonadal vein drains to- right gonadal vein drains to IVC.
Paraneoplastic features-
XS EPO - Polycythaemia vera
XS Renin- Hypertension
Sx due to metastatic disease
Why might a varicocele be a presentation of renal cell carcinoma?
Left sided varices may occur with renal cell carcinomas due to invasion into or compression of the left renal vein where the left gonadal vein drains into
The right gonadal vein drains into the IVC
What is Shauffer syndrome?
Patients with renal cell carcinoma can develop hepatic dysfunction but this is not due to metastases. It is therefore important to monitor LFTs in patients with renal cell carcinoma.
What investigations would you do if suspecting renal cell carcinoma?
Examination- Abdo mainly
Urine dip- Haematuria is key finding
Renal USS- Can assess if mass is cystic or solid. Biopsy may be indicated if considering targeted therapies.
CT/MRI- Assess extent of spread of tumour.
Bloods- FBC (Paraneoplastic EPO increase), U&Es, Creatinine, eGFR, Renin, Aldosterone
What are the NICE suspected cancer guidelines for urgent referral for suspected renal carcinoma?
Aged 45 or over and have blood in the urine without a UTI
Aged 45 or over and have blood in the urine which keeps coming back after a urine infection has been successfully treated.
What are the treatment options for renal carcinoma?
Surgery- Partial Nephrectomy or Radical Nephrectomy
Targeted therapies- Anti VEGF or tyrosine kinase inhibitors
Radiotherapy and chemotherapy less effective
Renal Artery Embolisation
