Renal cell carcinoma

Question 1

Define renal cell carcinoma

Answer 1

A malignant growth originating in the kidney

Question 2

Which part of the kidney do RCC’s originate from usually?

Answer 2

The epithelial cells of the proximal convulated tubule (the cortex)

Question 3

What are risk factors for RCC?

Answer 3

1. Smoking
2. Male
3. Fhx of RCC
4. Polycystic kidney disease
5. von Hippel-lindau disease

Question 4

Mutations in which chromosome is linked to RCC?

Answer 4

mutations in Chromosome 3

Question 5

What does a mutation in the chromosome linked to RCC result in?

Answer 5

Increased IGF-1 pathway activity resulting in:

1. Dysregulated cell growth
2. Angiogenesis

Question 6

What is the epidemiology of RCC?

Answer 6

Uncommon

3% of all adult cancers

Question 7

What are the presenting symptoms of RCC?

Answer 7

1. Usually asymptomatic until very late
2. Blood in urine
3. Pain in flank

Question 8

What are the signs of RCC on physical examination?

Answer 8

1. Palpable abdo mass
2. Flank pain
3. Hypertension
4. Left sided varicocoele
5. fever
6. weight loss

Question 9

What are examples of paraneoplastic syndromes associated with RCC? What do they result in?

Answer 9

Paraneoplastic syndromes are caused by tumour generating hormones.
Examples are:
 -EPO - polycythaemia 
 -Renin - hypertension
 -PTHrP - hypercalcaemia
 -ACTH - cushing's syndrome

Question 10

What are the appropriate investigations for RCC?

Answer 10

1. Bloods - increased RBC, calcium, ALP (bony mets)
2. Urinanalysis - haematuria
3. USS of kidney
4. CT of kidney