(U)- Renal Cell Carcinoma Flashcards
What is the classic triad of renal cell carcinoma?
Haematuria
Flank pain
Palpable mass
What are the 3 most common types of renal cell adenocarcinoma?
Clear cell- 80%
Papillary- 15%
Chromophobe- 5%
Wilm’s tumour (children, < 5)
What are the risk factors of renal cell carcinomas?
Smoking
Obesity
Hypertension
End-stage renal failure
Von Hippel-Lindau disease
Tuberous sclerosis
How do patients with renal cell carcinoma present?
May be asymptomatic but can have:
- Haematuria
- Vague loin pain
- Non-specific cancer symptoms
- Palpable renal mass
What do NICE guidelines recommend for renal cancer?
Two week wait referral for
- Aged over 45 with unexplained visible haematuria without a UTI or persisting after UTI treatment
Where do renal cell carcinomas tend to spread?
Tissues around the kidney within Gerota’s fascia
Often spread to renal vein then IVC
What X-ray finding is a classic feature of metastatic renal cell carcinoma?
Cannonball metastases
What paraneoplastic features is renal cell carcinoma associated with?
Polycythaemia
Unregulated EPO secretion
Hypercalcaemia
Secretion of a hormone that mimics PTH
Hypertension
Increased renin + polycythaemia + physical compression
Stauffer’s syndrome
Abnormal LFTs without liver metastasis
Alongside TNM staging, what number staging is used for renal cell carcinoma?
Stage 1
Less than 7 cm, confined to kidney
Stage 2
Bigger than 7 cm, confined to kidney
Stage 3
Local spread to nearby tissues or veins, not beyond Gerota’s fascia
Stage 4
Spread beyond Gerota’s fascia, including metastasis
What is the first-line management of renal cell carcinoma?
Partial nephrectomy
Radical nephrectomy
Kidney, surround tissue, lymph nodes, adrenal gland
When surgical intervention is not suitable, what procedures may be used to treat renal cell carcinoma?
Arterial embolisation
Cutting off blood supply to affected kidney
Percutaneous cyrotherapy
Liquid nitrogen to freeze and kill tumour cells
Radiofrequency ablation
Needle into tumour, electrical current to kill the tumour
Chemotherapy and radiotherapy