Renal cell carcinoma

Question 1

What is RCC

Answer 1

Adenocarcinoma arising from renal parenchyma/cortex

Usually in PCT, upper pole of kidney

Question 2

What are Sx of RCC?

Answer 2

Classically a triad of flank pain, mass, and haematuria

80% incidental findings

Systemic e.g. weight loss, night sweats, fatigue

Lower limb oedema (IVC compression), varicocoele (left testicular vein invasion)

paraneoplastic: EPO, PTH, renin

Question 3

What are DDx for RCC?

Answer 3

Bladder cancer
UTI
Renal stones
Prostate cancer

Question 4

What Ix in RCC?

Answer 4

Routine. ALP - bony mets
LDH and Ca are prognostic

Urinalysis: blood and protein, urine cytology too for malignancy cells

US can look for lesions

CT AP contrast: gold standard for diagnosis.

CT to stage

Biopsy: often not needed

Question 5

How is RCC staged?

Answer 5

1 = <7cm confined to renal capsule
2 = >7cm or invading to renal capsule
3 = in renal vein/IVC/lymph node
4 = beyond Gerota's fascia, > 1 lymph node

Question 6

What is Rx of RCC for localised disease?

Answer 6

Partial or radical nephrectomy

If not fit for surgery, radiofrequency ablation or cryotherapy can be done.

Small renal masses can get surveillance.

Question 7

What are risk factors for RCC?

Answer 7

Smoking, male, aged 40-70
HTN
Renal cystic disease
Von-Hippel Lindau
Carcinogens e.g. hydrocarbons

Question 8

What Rx in metastatic RCC?

Answer 8

Nephrectomy + immunotherapy e.g. IFNa, IL2 agents.

TKI e.g. sunitinib

Resection of solitary mets.

Chemo doesn’t work!

Question 9

What are complications of RCC?

Answer 9

• Anaemia
	• Hypercalcaemia
	• SIADH
	• Hepatic dysfunction
	• Erythrocytosis
Adverse effects from targeted therapies