Tumours of the Urinary System - Renal Cancer

Question 1

What are two benign tumours of the kidney?

Answer 1

Oncocytoma (tumour of oncocytes of epithelium) and angiomyolipoma

Question 2

Name a malignancy tumour of the kidneys?

Answer 2

Renal adenocarcinoma

Question 3

Where do most renal adenocarcinomas arise?

Answer 3

Proximal tubules

Question 4

What are the histological subtypes of renal adenocarcinoma?

Answer 4

• Clear cell (85%)
• Papillary (10%)
• Chromophobe (4%)
• Bellini type ductal carcinoma (1%)

Question 5

What are the risk factors for renal adenocarcinoma?

Answer 5

• FH (autosomal dominant; familial clear cell RCC, hereditary papillary RCC)
• Smoking
• Anti-hypertensive meds
• Obesity
• End-stage renal failure
• Acquired renal cystic disease

Question 6

Describe the presentation of renal adenocarcinoma

Answer 6

• Asymptomatic (found incidentally)
• Classic triad: flank pain, was and haematuria

Paraneoplastic syndrome:
• Anorexia, cachexia and pyrexia
• Hypertension, hypercalcaemia and abnormal LFTs
• Anaemia, polycythaemia and raised ESR

Question 7

Describe the different stages in TNM staging of renal cancer

Answer 7

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 renal fascia

Question 8

Name ways the renal adenocarcinoma can spread

Answer 8

• Direct spread (invasion) through renal capsule
• Venous invasion to renal vein and vena cava
• Haematogenous spread to lungs and bone
• Lymphatic spread to paraccaval node

Question 9

What are investigation of renal adenocarcinoma?

Answer 9

• CT scan of abdomen and chest mandatory
• Bloods: U+Es, FBC

Optional tests:
• USS (differentiate tumour from cyst)
• DMSA or MAG-3 venogram to assess split renal function

Question 10

What is the benefit of CT scan?

Answer 10

• Provides radiological diagnosis and complete TNM staging

* Assesses contralateral kidney

Question 11

What is the treatment for renal adenocarcinoma?

Answer 11

Surgical (i.e. radical nephrectomy)
• Laparoscopic radical nephrectomy (for T1)
• Even with major venous invasion (>T3b))
• Curative if

Question 12

What is the management of renal adenocarcinoma with metastases?

Answer 12

Palliative cytoreductive nephrectomy beneficial even with mets from primary tumour

Multitargeted receptor tyrosin kinase inhibitors
• New
• Sunitinib, sorefenib

Immunotherapy
• Interferon alpha
• Interleukin-1