Renal - Renal Cancer

Question 1

Renal cell cancer is also known as hypernephroma and accounts for 85% of primary renal neoplasms. It arises from proximal renal tubular epithelium

Answer 1

Associations*

• more common in middle-aged men
• smoking
• von Hippel-Lindau syndrome
• tuberous sclerosis

Question 2

Features?

Answer 2

• classical triad: haematuria, loin pain, abdominal mass
• pyrexia of unknown origin
• left varicocele (due to occlusion of left testicular vein)
• endocrine effects: may secrete erythropoietin (polycythaemia), parathyroid hormone (hypercalcaemia), renin, ACTH
• 25% have metastases at presentation

Question 3

Management?

Answer 3

• for confined disease a partial or total nephrectomy depending on the tumour size
• alpha-interferon and interleukin-2 have been used to reduce tumour size and also treat patients with metatases
• receptor tyrosine kinase inhibitors (e.g. sorafenib, sunitinib) have been shown to have superior efficacy compared to interferon-alpha

Question 4

Coronal CT scan of a middle-aged woman with renal cell cancer. Note the heterogeneously enhancing mass at the upper pole of the right kidney

Answer 4

Question 5

Left: normal kidney. Right: ‘clear-cell’ pattern of renal cell carcinoma

Answer 5