Tumours of the Urinary System 2: Urothelial and Renal Cancers Flashcards

Question

what will IVU/CT-IVU show in UTUC?

Answer 1

shows filling defect in renal pelvis

Answer 2

renal pelvis or collecting system commonest ureter less commonly tumours are often high-grade and multifocal on one side high risk of local recurrence if treated endoscopically or by segmental resection low risk of having contralateral disease difficult to follow up if treated endoscopically hence, most upper tract TCCs are treated by nephro-ureterectomy

Answer 3

If unfit for nephro-ureterectomy or has bilateral disease - absolute indication for nephron-sparing endoscopic treatment (i.e. ureteroscopic laser ablation); needs regular surveillance ureteroscopy If unifocal and low-grade disease - relative indication for endoscopic treatment In ALL cases, high risk of synchronous and metachronous bladder TCC (40% over 10 years); hence need surveillance cystoscopy

Answer 4

oncocytoma, angiomyolipoma

Answer 5

renal adenocarcinoma commonest adult renal malignancy synonyms : hypernephroma or Grawitz tumour most arise from proximal tubules histological subtypes : clear cell (85%) papillary (10%) chromophobe (4%) Bellini type ductal carcinoma (1%)

Answer 6

Family history (autosomal dominant e.g. vHL, familial clear cell RCC, hereditary papillary RCC; can be bilateral and/or multifocal) Smoking Anti-hypertensive medication Obesity End-stage renal failure Acquired renal cystic disease

Answer 7

Asymptomatic (i.e. incidentally noted on imaging for unrelated symptoms) : 50% ‘Classic triad’ of flank pain, mass and haematuria : 10% Paraneoplastic syndrome : 30% anorexia, cachexia and pyrexia hypertension, hypercalcaemia and abnormal LFTs anaemia, polycythaemia and raised ESR Metastatic disease : 30% bone, brain, lungs, liver

Answer 8

T1 - Tumour < 7cm confined within renal capsule T2 - Tumour >7cm & confined within capsule T3 - Local extension outside capsule T3a - Into adrenal or peri-renal fat T3b - Into renal vein or IVC below diaphragm T3c - Tumour thrombus in IVC extends above diaphragm T4 - Tumour invades beyond Gerota’s fascia

Answer 9

Direct spread (invasion) through the renal capsule Venous invasion to renal vein and vena cava Haematogenous spread to lungs and bone Lymphatic spread to paracaval nodes

Answer 10

CT scan (triple phase) of abdomen and chest is mandatory provides radiological diagnosis and complete TNM staging assesses contralateral kidney Bloods : U&E, FBC Optional tests : Ultrasound differentiates tumour from cyst DMSA or MAG-3 renogram to assess split renal function if doubts about contralateral kidney

Answer 11

Treatment is surgical – i.e. radical nephrectomy laparoscopic radical nephrectomy is standard of care for T1 tumours (T2 tumours in laparoscopic centres) worthwhile even with major venous invasion (≥T3b) curative if ≤T2 Even in patients with metastatic disease who have symptoms from primary tumour, palliative cytoreductive nephrectomy is beneficial (prolongs median survival by 6 months)

Answer 12

Metastases - little effective treatment since RCC is radioresistant and chemoresistant multitargeted receptor tyrosine kinase inhibitors relatively new sunitinib, sorafenib, panzopanib,temsirolimus superior response rates to immunotherapy trials ongoing immunotherapy Interferon alpha Interleukin-1

Answer 13

T1 – 95% 5-year survival T2 – 90% 5-year survival T3 – 60% 5-year survival T4 – 20% 5-year survival N1 or N2 – 20% 5-year survival M1 – Median survival 12-18 months