Renal tumours - adults Flashcards
1
Q
What is the most common kidney cancer in adults?
A
Renal cell carcinoma
2
Q
Where do renal cell carcinomas arise from?
A
Proximal tubular epithelium
3
Q
Discuss the basic histology of a renal cell carcinoma
A
- Highly vascular
- Most are composed of large cells with clear cytoplasm
4
Q
What are the risk factors for RCC
A
- Smoking
- Male
- Aged 55-84
- Black/ American Indian
- Obesity
- Hypertension
- Family hx
5
Q
Discuss the clinical features of RCC
A
- Often asymptomatic
- Haematuria, loin pain and a flank mass may be present
- 5% have polycythemia 30% have hypertension due to the tumour secreting renin
- 30% will have anaemia due to depression of EPO
- Rarely a left sided varicocele may be present if left side renal vein tumours obstruct the drainage of the left testicular vein
6
Q
Discuss treatment of RCC
A
- Generally resistant to chemotherapy and xRT
- Nephrectomy remains first line unless the tumours are bilateral or the contralateral kidney is functioning poorly
- Nephrectomy recommended if mets present as this has been show to cause met regression
- Local ablation therapy for small renal masses <4cm or a tumour confined to the kidney
7
Q
Discuss Heng criteria for RCC
A
0 risk factors = 75% survival at 2 years
1-2 risk factors = 53% survival at 2 years
3+ risk factors = 7% survival at 2 years
8
Q
What is the mainstay (non surgical) treatment for RCC?
A
Tyrosine kinase inhibitors
Sunitinib has a 30-40% response rate
Pazopanib is similar to sunitinib but is better tolerated
9
Q
How do tyrosine kinase inhibitors work?
A
