Renal Cell Carcinoma

Question 1

Define:

Answer 1

Primary malignancy of the kidneys

Renal cell carcinoma arises from proximal renal tubular epithelium

Question 2

Aetiology:

Answer 2

Renal clear cell carcinoma - 80% => UNKNOWN CAUSE

Papillary carcinoma - 10% => UNKNOWN CAUSE.

Transitional cell carcinoma = 10%

Question 3

Risk factors:

Answer 3

Inherited conditions:
-Von Hippel-Lindau (headaches, balance issues, dizziness, limb weakness and vision problems due to increased BP)

Tuberous sclerosis

Polycystic kidney disease

Familial renal cell cancer

Smoking

Chronic dialysis

Question 4

Epidemiology:

Answer 4

Uncommon

3% of all adult malignancies

Peaks at 40-60 years

Question 5

Symptoms:

Answer 5

Presents late

Triad:

• Haematuria
• Flank pain
• Abdo mass

Transitional cell presents earlier

Malignancy signs:

• Weight loss
• Malaise
• Paraneoplastic syndrome

Question 6

Signs:

Answer 6

Palpable renal mass
Hypertension 
Plerthora 
Anaemia 
Left sided tumours lead to a varicocele

Question 7

Investigations:

Answer 7

Urinanalysis = haematuria + cytology

Bloods: FBC (polycycathemia due to the increased EPO), U+Es, ALP, Calcium, LFTS and increased ESR

Abdo USS - 1ST LINE (distinguishes between solid masses and cystic masses)

CT/MRI for staging

CXR –> canon ball metastases.