Tumours of the kidney Flashcards
Most common type of renal cell cancer
Renal Cell Carcinoma
What is renal cell carcinoma
Adenocarcinoma of the renal cortex
Where did renal cell carcinoma arise from
proximal convoluted tubule
Risk factors of renal cell carcinoma
Smoking
Renal failure and dialysis
Obesity
Hypertension
Asbestos exposure
Genetics - Von Hippel Lindau syndrome
Renal cell carcinoma most commonly affect males / females
Males
What score is used to differentiate between RCC and polycystic kidney disease and why is this score needed
Bosniak score, because some RCC can have a cystic component
How does RCC usually spread
haematogenous spread
Where does RCC usually spread to
adrenal gland (direct invasion)
lungs
bone
brain
Symptoms of RCC
Haematuria
loin pain
mass
Varicocoele - enlargement of the veins within the loose bag of skin that holds the testicles
Hypertension
Hypercalcaemia
Polycythemia
What is polycythemia and how does RCC cause polycythemia
high concentration of red blood cells
Due to increase in production of erythropoietin
How does RCC cause hypercalcamia
PTHrPproduced by the tumour
Investigations for RCC
CT kidneys
CT abdomen, chest to look for metastases
Bloods
When is biopsy used in RCC
Before ablative therapies if nephrectomy is not planned
Biopsy is not routinely performed to look for RCC because most renal tumours are malignant
Management of RCC
T1 - partial nephrectomy
T2 and above - radical nephrectomy
Why is surgery the main treatment in RCC
Because RCC is relatively insensitive to chemotherapy and radiotherapy
What is transitional cell carcinoma
Rare malignancy of the transitional cells that line the renal pelvis
Which parts of the renal system are lined by transitional cells
renal pelvis, ureters, bladder and urethra
Transitional cell carcinoma mostly affects which part of the renal system
Mostly causes lower urinary tract malignancy instead of renal malignancy
Which gender is most commonly affected by transitional cell carcinoma
Males
Management of transitional cell carcinoma
radical nephroureterectomy (also removes the ureters)
Chemotherapy for partial resection of kidneys / palliative care
Which age group is most commonly affected by nephroblastoma (Wilm’s tumour)
Children under 15
Symptoms of nephroblastoma (Wilm’s tumour)
- Painless, palpable abdominal mass
- Loss of appetite
- Abdominal pain
- Fever
- Nausea and vomiting
- Haematuria
Investigations for Wilm’s tumour
US
CT
Management of Wilm’s tumour
Surgical resection combined with chemotherapy
What are the benign renal tumours
Oncocytoma
Angiomyolipoma
What is oncocytoma
Benign tumour made of oncocytes - cells with excess amount of mitochondria
Presentation of oncocytoma
Mostly asymptomatic, found incidentally
Loin pain
Haematuria
Investigations for oncocytoma
CT
Biopsy
Management for oncocytoma
Observation
Angiomyolipoma is a benign lesion consisting of
Blood vessels, immature smooth muscle, and fat
Most common aetiology of angiomyolipoma
80% sporadic
20% present with tuberous sclerosis
Symptoms of angiomyolipoma
May be asymptomatic, discovered incidentally
Loin pain
Haematuria
Mass
Wunderlich’s syndrome
What is Wunderlich’s syndrome
spontaneous, nontraumatic renal hemorrhage into perirenal space (behind the peritoneum)
What is the classic triad of symptoms for Wunderlich’s syndrome
acute loin pain
loin mass
hypovolemic shock
Investigations for angiomyolipoma
US
CT
Management of angiomyolipoma
> 4cm lesions usually cause symptoms so will require surgical resection
