Renal Cell Carcinoma

Question 1

Definition

Answer 1

Primary malignancy of the kidneys

Question 2

Aetiology

Answer 2

· Renal clear cell carcinoma (80%) - UNKNOWN CAUSE

· Papillary carcinoma (10%) - UNKNOWN CAUSE

· Transitional cell carcinoma (10%)
o NOTE: these occur at the renal pelvis

Question 3

Risk factors

Answer 3

o Associated with certain inherited conditions:

· von Hippel-Lindau disease
§ Mutation in the von Hippel-Lindau protein, which causes headaches, balance issues, dizziness, limb weakness, vision problems and high blood pressure

· Tuberous sclerosis
§ A rare genetic disease that causes benign tumours to grow in the brain and other organs (e.g. skin, kidneys, lungs, eyes)

· Polycystic kidney disease

· Familial renal cell cancer

· Smoking

· Chronic dialysis

o NOTE: renal cell cancer can cause abnormal LFTs in the absence of liver metastases = Strauffer’s Syndrome

Question 4

Epidemiology

Answer 4

· UNCOMMON

· 3% of all adult malignancies

· Peak incidence: 40-60 yrs

Question 5

Presenting symptoms (renal cell carcinoma)

Answer 5

o Usually present LATE

o Asymptomatic in 90%

o Triad of Symptoms:
· Haematuria
· Flank pain
· Abdominal mass

Question 6

Presenting symptoms (transitional cell carcinoma)

Answer 6

Presents EARLIER with haematuria

Question 7

Presenting symptoms (systemic signs)

Answer 7

o Weight loss
o Malaise
o Paraneoplastic syndromes (e.g. fever, hypercalcaemia, polycythaemia)

Question 8

Signs on physical examination

Answer 8

· Palpable renal mass
· Hypertension
· Plethora
· Anaemia
· A left-sided tumour can obstruct the left testicular vein as it joins the left renal vein, and cause a left-sided varicocoele

Question 9

Investigations (bloods)

Answer 9

o FBC
o U&Es
o Calcium
o LFTs
o High ESR (in 75%)

Question 10

Investigations (other)

Answer 10

· Urinalysis
o Haematuria
o Cytology

· Abdominal Ultrasound
o Best first-line investigation
o Can distinguish between solid masses and cystic structures

· CT/MRI
o Useful for staging
· Staging system: Robson Staging