Renal Cell Carcinoma

Question 1

What is renal cell carcinoma ( RCC)

Answer 1

Tumor of the renal parenchyma

Question 2

What are the types of RCC and what is the most common

Answer 2

Clear cell most common - 70%
Papillary 
Chromophobe 
Collecting duct (Very rare but very aggressive) 
Medullary

Question 3

Which condition is associated with CCRCC

Answer 3

Von - hippel lindau

Question 4

What is Von - hippel lindau

Answer 4

It is characterized by visceral cysts and benign tumors with potential for subsequent malignant transformation

Question 5

What is the classical triad of RCC presentation

Answer 5

Loin pain
Haematuria
Palpable mass

This triad is quite uncommon however

0ther ways they can present

• asymptomatic therefore incidental finding
• varicoele - left sided since this draining into the left renal vein
• manifestation of paraneoplastic symptoms

Question 6

what are the risk factors of RCC

Answer 6

Smoking
Obesity
FH
ADPKD

Question 7

What is a paraneoplastic syndrome

Answer 7

A collection of symptoms caused by hormones secreted by a cancer

Question 8

What are some paraneoplastic syndromes caused by RCC

Answer 8

Stauffers syndrome - abnormal LFTs
Hypercalcaemia - release of PTHrp
Hypertension - due to tumor causing renin secretion
Polycythaemia - tumor releases EPO

Question 9

What is the first line investigation of RCC

Answer 9

USS

Then use the Bosniak classification to classify what the cyst is

Question 10

What investigation to do after USS for RCC

Answer 10

CT CAP to stage with contrast

Question 11

What is the Bosniak classification

Answer 11

Classifies renal cysts and helps to categorise them into benign and malignant cysts

Question 12

Which staging system is used for RCC

Answer 12

TNM staging

T1 = early T4 = advanced

Question 13

What are the different treatment options of RCC

Answer 13

Partial nephrectomy - open or robotic
Radical nephrectomy - open or lapro
Surveillance in older people
Ablation

Question 14

What is partial nephrectomy

Answer 14

Tumor is cut out, rest of the kidney stays in place

Question 15

What is radical nephrectomy

Answer 15

Removal of kidney, adrenal gland, upper ureter and surrounding fat

Question 16

What can you do for tumor less than 4cm (t1a)

Answer 16

1. Partial nephrectomy ( robotic )
2. Lapro radical nephrectomy
3. Surveillance
4. Ablation

Question 17

What can you do for tumors 4-7cm ( T1b)

Answer 17

1. Partial nephrectomy- open

2. Laproscopic radical nephrectomy

Question 18

Treatment for T2a tumors : 7-10cm

Answer 18

1. Laparoscopic radical nephrectomy

Question 19

Treatment for T2b tumors - over 10cm

Answer 19

1. Open radical nephrectomy

Question 20

Treatment for kidney surrounding fat invasion + renal vein - 3a

Answer 20

Open radical nephrectomy

Question 21

What are the levels of t3b/c

Answer 21

Level 1 - 2cm in the IVC
Level 2 - up to the bottom of liver
Level 3 - into hepatic IVC
Level 4 - above diaphragm

Question 22

Treatment for 3b/c

Answer 22

Open radical nephrectomy + IVC thrombectomy + other things depend on the level

Question 23

what are the palliative care options

Answer 23

Biologics - sunitinab = inhibits VEGF