Renal Cell Carcinoma

Question 1

Define renal cell carcinoma

Answer 1

Malignancy arising from renal cortical parenchyma

Question 2

What are the causes/risk factors of renal cell carcinoma?

Answer 2

• Smoking
• Male
• Obesity
• Hypertension
• Family history
• Pelvic radiation
• Von Hippel Lindau syndrome (mutation in VHL tumour suppressor gene)

Question 3

What are the symptoms of renal cell carcinoma?

Answer 3

• Asymptomatic
• Haematuria
• Flank pain

Paraneoplastic
• Fever
• Weight loss
• Sweats

Question 4

What are the signs of renal cell carcinoma?

Answer 4

• Palpable abdominal mass
• Scrotal varicocele

Paraneoplastic
• Pallor
• Cachexia
• Myoneuropathy
• Ascites
• Hepatomegaly
• Spider naevi

Question 5

What investigations are carried out for renal cell carcinoma

Answer 5

• FBC - anaemia or paraneoplastic polycythaemia.
• LDH - poor prognostic marker in advanced RCC (Motzer Score)
• U&Es - elevated Cr due to CKD secondary to RCC.
• Calcium - poor prognostic marker in advanced RC (Motzer Score)
• LFTs - transaminitis (elevated liver transaminases, AST/ALT) and/or poor liver function may be indicative of metastatic lesions.
- RCC can be associated with abnormal LFT in the absence of liver metastases, a phenomenon known as Stauffer’s syndrome –Elevated BR, ALP, GGT.
• PT - prolonged due to liver metastasis and Stauffer’s syndrome.
• Urinalysis - haematuria and/or proteinuria
• USS Abdomen - abnormal renal cyst/mass, lymphadenopathy, and/or other visceral metastatic lesions
• CT - definitive test for diagnosis and staging of RCC.
-CT Chest: For Lung metastases.
• MRI Brain/ Spine - for Bone and Brain metastases.
• Bone Scan - only recommended if patient presents with localising bone pain and/or elevated ALP