Renal Cell Carinoma

Question 1

Types of Carcinoma of Kidney

Answer 1

• adenocarcinoma of Proximal Convoluted tube
• Papiloma
• Transitional Cell Carcinoma of renal pelvis

Question 2

Clinical Features of RCC

Answer 2

Most are incidental findings
Loin pain, Palpable Mass in loin/abdomen and Haematuria (painless)
Hypertension
Others - Weight loss, night sweats/PUO, fatigue, testicular swelling (left testicular vein blockage)

Question 3

Investigations for RCC

Answer 3

Bloods -
FBC (Polycythemia/raised Hb, Increased RBCs) U+Es (renal failure, hyperkalaemia/natraemia) LFTs deranged.

Calcium(raised due to PTHrP) Renin increased

Urine dip/analysis = +++Blood, RBCs seen.

Question 4

Imaging for RCC

Answer 4

Renal USS - picks up tumours
CT KUB/ CAP
Renal Biopsy not performed regularly.

Question 5

Treatment

Answer 5

Nephrectomy for Stage T2-3, partial nephron sparing.
Can be open or laproscopic. need to have functioning normal kidney.

Palliative Chemotherapy and Radiotherapy for T4 disease
= Tyrosine Kinase Inhibitors termailomus

Question 6

Complications of RCC

Answer 6

excess EPO - polycythemia
PTHrH - hypercalcaemia
Renin excretion - Hypertension
Left renal vein invasion in T3 tumours can lead to inferior vena cava obstruction. 
Deranged LFTs

Question 7

Risk Factors for RCC

Answer 7

Smoking, Hypertension, Obesity
Renal failure and dialysis 
Asbestosis
Polycystic/horseshoe kidney
Von hippel Lindau

Question 8

Prognosis

Answer 8

Mayo scoring system used. Low scores 0-1 are 95% curable.

High scores have poor prognosis and survival rates.