Renal Cell Carcinoma (RCC)

Question 1

How common is RCC?

Answer 1

RCC is 1-2% of all tumours

it is the most common renal tumour in adults

Question 2

What is RCC also known as??

Answer 2

Grawitz tumour

Question 3

Where does RCC arise from?

Answer 3

proximal renal tubular epithelium

Question 4

RCC starts in the lining of the tubules and can be divided into ….?

Answer 4

• clear cell carcinoma (75%)
• Papillary renal cell cancer (10%)
• Chromophobe RCC (5%)

Question 5

What is the mean age of patients with RCC?

Answer 5

55 yrs

with a Male : female ratio of 2:1

Question 6

what % of renal cancers does transitional cell carcinoma of the renal pelvis represent?

Answer 6

8%

Question 7

What are the features of RCC?

Answer 7

• haematuria
• loin pain
• abdominal mass
• anorexia + weight loss
• malaise
• Pyrexia

Question 8

Rarely RCC presents as varicocele - how does this happen?

Answer 8

invasion of the left renal vein compresses the left testicular vein causing varicocele.

Varicocele is enlargement of veins in the scrotum.

Question 9

What % of RCC of mets at presentation?

Answer 9

25% have mets at presentation.

Question 10

What are the clinical signs of RCC?

Answer 10

• polycythaemia
• hypertension (due to renin secretion)
• anaemia (less erythropoetin production)
• pyrexial

-left sided varicocele (rare)

Question 11

What are the risk factors / causes of RCC?

Answer 11

• Von Hippel-Lindau disease it is inherited condition that causes multiple tumours : bilateral RCC, haemangioblastoma, phaeochromocytomas (adrenal tumour)
  renal cysts.

Question 12

What investigations are done for RCC?

Answer 12

• blood pressure (raised due to tumour secreting renin)

Bloods:

• FBC (polycythaemia due to erythropoeitin secretion), anaemia
• ESR / CRP
• U+E (kidney function)
• LFT ( liver mets)
• ALP (bony mets)

Urine micro, cytol –> RBC?

Imaging:
US
CT/MRI (mets?)
CXR (cannon ball mets)

Question 13

What is the management of RCC?

Answer 13

• Nephrectomy (if unilateral RCC)
• Medroxyprogesterone acetate (helps control met disease)
• IL-2 therapy (however 20% has remission)
• Termsirolimus (improves overall survival in metastatic RCC)

Question 14

What is the criteria for assessing prognosis of RCC?

Answer 14

Mayo Prognostic risk score - uses tumour stage, size, grade and necrosis.

10 yr survival is 96% for scores of 0-1, down to 20% for scores of 10+

Question 15

What is wilms’ tumour?

Answer 15

Wilms’ tumour is a nephroblastoma, a childhood tumour that jas a prevelance of 1 in 100,000.

Presents with mass and haematuria

Question 16

How does transitional cell carcinoma of renal tract present?

Answer 16

• painless haematuria
• frequency
• urgency
• dysuria
• urinary tract obstruction