renal cell carcinomas

Question 1

what is a renal cell carcinoma?

Answer 1

a tumour of the renal parenchyma/cortex

clear cell is the commonest type, others include papillary and chromophobe.

Question 2

how do renal cell carcinomas present?

Answer 2

may cause haematuria, but triad of loin pain, haematuria and palpable mass seem in less than 10% of cases

Question 3

what are the risk factors for renal cell carcinoma?

Answer 3

heavy smoking
obesity
family history/genetic syndromes

Question 4

what are the common paraneoplastic syndromes associated with RCC?

Answer 4

hypercalacaemia
hypertension
polycythemia/anaemia
pyrexia
amenorrhoea/baldness/cushings

Question 5

what is a paraneoplastic syndrome?

Answer 5

They are defined as clinical syndromes involving nonmetastatic systemic effects that accompany malignant disease

Question 6

how are renal cysts classified?

Answer 6

Bosniak classification 1 = simple, IV = definite RCC

Question 7

how are RCC staged and treated?

Answer 7

T1a and T1b = partial nephrectomys, usually robotic if possible

T2A onwards = radial nephrectomy

T4 = Into adjacent structures, open nephrectomy and resection of other structures as needed

N1 = regional lymph nodes dissection needed also

M1 = nephrectomy and resection of mets if possible

Question 8

how can people unfit for surgery be managed?

Answer 8

For those not suitable or fit enough for surgical management, percutaneous radiofrequency ablation or laparoscopic/percutaneous cryotherapy may be considered.

Renal artery embolisation may be required for haemorrhaging disease, prior to any radiofrequency ablation, or for unresectable palliative cases.