SM_234b: Renal Cell Carcinoma Flashcards
____ is associated with an increased risk of renal cell carcinoma
Smoking is associated with an increased risk of renal cell carcinoma
- Obesity, ESRD, some exposures
Describe signs and symptoms of renal cell carcinoma
Signs and symptoms of renal cell carcinoma
- Hematuria
- Flank pain
- Palpable mass
- Bilateral
- Metastatic disease
- Mostly incidental
Classic triad of renal cell carcinoma is ____, ____, and ____
Classic triad of renal cell carcinoma is hematuria, flank pain, and palpable mass
Renal cell carcinoma may present with ____ syndromes
Renal cell carcinoma may present with paraneoplastic syndromes
- Cachexia / fever (cytokines)
- Nephropathy (Ig formation)
- HTN 9renin)
- Hypercalcemia
- Anemia (cytokine myelosuppression)
- Hyperglycemia
- Stauffer’s syndrome
- Erythrocytosis
- Amyloidosis
Describe diagnostic testing for renal cell carcinoma
Diagnostic testing for renal cell carcinoma
- Hematuria work-up: need to assess all of the GU system, urine culture, multiphase cross-sectional imaging, cystoscopy
- Triphasic CT scan (non-contrast, nephrogenic phase, and excretory phase)
- MR with and without contrast
- Ultrasound + pyelography
Describe Bosniak classification of cystic renal lesions
Bosniak classification of cystic renal lesions
- I: water density, homogeneous, no septa, calcification, no enhancement
- II: thin septa, thin curvilinear calcification, no enhancement, hyperdense lesion with no enhancement
- III: thick or irregular septa, thick or irregular calcification, mild to moderate heterogeneity, no enhancement
- IV: thick walls or nodular areas, marked heterogeneity, enhancement
Risk of malignancy increases as classification increases
Sporadic renal cell carcinoma is ____, ____, ____, and ____
Sporadic renal cell carcinoma is 95% of renal cell carcinomas, single tumors, unilateral, and develop at a later age
Clear cell carcinomas originate from the ___
Clear cell carcinomas originate from the proximal tubule
(75% of renal cell carcinoma)
Papillary renal cell carcinomas originate from the ___
Papillary renal cell carcinomas originate from the proximal tubule
(10-15% of renal cell carcinomas)
Chromophobe renal cell carcinomas originate from ____
Chromophobe renal cell carcinomas originate from intercalated cell of cortical collecting duct
(10% of renal cell carcinoma)
Oncocytoma is a ____ that originates from the ____
Oncocytoma is a benign entity that originates from the intercalated cells of the cortical collecting duct
Hereditary renal cell carcinomas are ____, ____, ____, ____, and ____
Hereditary renal cell carcinomas are 5% of all renal cell carcinomas, autosomal dominant, multifocal, bilteral, and onset in 3rd-5th decade
- VHL, HPRC, HLRCC, BHD
As renal cell carcinoma stage increases, survival ____
As renal cell carcinoma stage increases, survival decreases
Localized renal cell carcinoma can be managed with ____, ____, or ____
Localized renal cell carcinoma can be managed with surveillance, ablation, or surgical excision
- Surveillance: small masses, CKD, elderly or comorbidities, hereditary syndromes
- In situ ablation: cryoablation, radiofrequency ablation, percutaneous vs laparoscopic
- Surgical: radical nephrectomy, partial nephrectomy, open surgery, laparoscopic surgery w/ or w/o robotic assistance
Partial nephrectomy for renal cell carcinoma is performed if ____, ____, ____, or ____
Partial nephrectomy for renal cell carcinoma is performed if bilateral tumors, solitary kidney, global renal insufficiency, or polar tumors ≤ 4 cm
IVC tumor thrombus is managed with ____
IVC tumor thrombus is managed with IVC thrombectomy
Describe management of metastatic disease in renal cell carcinoma
Management of metastatic disease in renal cell carcinoma
- Poor survival
- Cytotoxic chemotherapy works poorly
- Immunotherapy: anti CTLA-4 (ipilimumab), anti PD1 (nivolumab, pembrolizumab), anti PDL1 (avelumab)
___, ___, and ___ are risk factors for renal cell carcinoma
Obesity, tobacco consumption, and ESRD are risk factors for renal cell carcinoma
____ is a paraneoplastic condition associated with renal cell carcinoma resulting from increased IL-6 production
Stauffer’s syndrome is a paraneoplastic condition associated with renal cell carcinoma resulting from increased IL-6 production
____ should be obtained if a renal US demonstrates a solid cortical mass
Triphasic CAT scan should be obtained if a renal US demonstrates a solid cortical mass
____ is NOT associated with any extra-renal manifestations
Hereditary papillary renal cell carcinoma is NOT associated with any extra-renal manifestations
Describe heritable syndromes associated with renal cell neoplasia
Heritable syndromes associated with renal cell neoplasia
____, ____, and ____ are conventional management options for small organ confined renal cell carcinoma
Surveillance, laparoscopic cryoablation, and robotic-assisted partial nephrectomy are conventional management options for small organ confined renal cell carcinoma
____ is the assigned level of a renal cell carcinoma tumor thrombus that is located above the hepatic vein confluence
Level 4 is the assigned level of a renal cell carcinoma tumor thrombus that is located above the hepatic vein confluence
Describe levels of renal cell carcinoma IVC thrombus
Levels of renal cell carcinoma IVC thrombus
- Level 1: < 2 cm from RV ostium
- Level 2: > 2 cm from RV ostium but below hepatic veins
- Level 3: intrahepatic IVC (not above hepatic veins)
- Level 4: above hepatic veins (including into right atrium)
Chemotherapy ____ beneficial for metastatic renal cell carcinoma
Chemotherapy is NOT beneficial for metastatic renal cell carcinoma
