Renal Cell Carcinoma

Question 1

What is Renal Cell Cancer?

Answer 1

Primary malignancy of the kidneys

Arises from proximal renal tubular epithelium

Question 2

Describe the aetiology of Renal Cell Cancer

Answer 2

Renal clear cell carcinoma (80%): UNKNOWN
Papillary carcinoma (10%): UNKNOWN
Transitional cell carcinoma (10%): occur at renal pelvis, ureter or bladder
Wilms tumour

Question 3

What is a Wilms tumour?

Answer 3

Nephroblastoma
Malignant tumour derived from embryonic mesodermal tissues.
Commonest intra-abdominal tumour in children, rare in adults.
Sx: loin mass, weight loss, anorexia + fever.

Question 4

List 8 risk factors for developing Renal Cell Cancer

Answer 4

von Hippel-Lindau disease 
Tuberous sclerosis  
FHx 
PKD
Smoking  
Chronic dialysis  
Obesity  
HTN

Question 5

Describe the epidemiology of Renal Cell Cancer

Answer 5

UNCOMMON
M > F
3% of all adult malignancies
Peak incidence: 55-84yrs

Question 6

What triad of symptoms is seen in Renal Cell Carcinoma?

Answer 6

Haematuria
Flank pain
Abdominal mass

Question 7

List 5 signs of Renal Cell Cancer

Answer 7

Palpable renal mass  
HTN
Plethora 
Anaemia  
Left-sided varicocoele (left-sided tumour obstructing left testicular vein as it joins left renal vein)

Question 8

How do renal cell cancers spread? Classically, where to?

Answer 8

Haematogenously

Lungs (Cannon ball mets)

Question 9

What is von Hippel-Lindau disease?

Answer 9

Mutation in von Hippel-Lindau protein

Causes headaches, balance issues, dizziness, limb weakness, vision problems + high BP

Question 10

What is Tuberous sclerosis?

Answer 10

Rare genetic disease

Causes benign tumours to grow in brain + other organs (e.g. skin, kidneys, lungs, eyes)

Question 11

How do renal cell carcinomas usually present?

Answer 11

Usually present LATE
Asymptomatic in 90%
25% have mets at presentation

Question 12

How do transitional cell carcinomas usually present?

Answer 12

Presents EARLIER with haematuria

Question 13

What unusual blood result may be caused by renal cell cancers? What is this phenomenon called?

Answer 13

Abnormal LFTs in the absence of liver mets

= Strauffer’s Syndrome

Question 14

List 3 systemic signs of Malignancy that may be seen in renal cell cancer

Answer 14

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

Question 15

Describe urinalysis in renal cell cancer

Answer 15

Haematuria

Cytology

Question 16

What blood results are seen in renal cell cancer?

Answer 16

FBC: polycythaemia from EPO secretion 
U+Es 
ALP: bony mets 
Calcium: if raised=> poor prognosis marker 
LFTs  
LDH: if raised=> poor prognosis marker 
High ESR (in 75%)

Question 17

What is the best first line investigation in suspected renal cell cancer? How is this different to practice?

Answer 17

Abdominal US
In practice do a CT urogram straight away
Can distinguish between solid masses + cystic structures

Question 18

Why are CTUs performed in renal cell cancer?

Answer 18

For staging

Staging system: Robson Staging

Question 19

What investigation is performed for grading in renal cell cancer?

Answer 19

Uteroscopy + biopsy

Question 20

What investigations may be performed for renal cell cancer depending on symptoms?

Answer 20

CXR: Cannon ball mets
MRI brain/ spine: if neuro Sx
Isotope bone scan: if mets likely

Question 21

What is the treatment for transitional cell carcinomas?

Answer 21

Nephrouretectomy (kidney, ureter, + small piece of bladder where ureter + bladder connect)

Question 22

What is the treatment for renal cell carcinomas?

Answer 22

Radical nephrectomy (Whole kidney + surrounding fatty tissue)