urological malignancies

Question 1

Who gets RCC?

Answer 1

M>W (2:1) and in the sixth decade

Question 2

Aetiological factors of RCC

Answer 2

Smoking, obesity, HTN

• Genetic variant on the short arm of chromosome 3
• Von Hippel Lindau Disease (AD): RCC @ young age

Question 3

Most common form of RCC

Answer 3

Clear Renal Cell Carcinoma (65%)

Papillary (10-15%)

Question 4

How do RCC tumours spread locally

Answer 4

Local spread by direct invasion, however invasian of other organs is uncommon as Gerota’s fascia acts as a barrier.

-Invasian of Renal vein > tumour thrombus > IVC > Right atrium

Question 5

Metastatic disease of RCC

Answer 5

Lungs
Lymph nodes
Bones

Question 6

Clinical features of RCC

Answer 6

• flank pain
• haematuria
• WL
• **Night sweats

However with early detection most are now asymptomatic and the classic triad is no longer as common

-30% present with symptoms of metastatic disease (eg; bony pain, dysponea)

Question 7

How does RCC relate to Paraneoplastic syndromes

Answer 7

20-30% of RCC wil have PNP syndromes

-include elevaed ESR, weightloss, fevers, anaemia, HTN, hypertension, deranged LFTs

Question 8

Best imaging of RCC

Answer 8

CT of chest and abdo for staging (local and distant)

If bone pain +/or inc ALP then a bone scan

If mets symptoms MRI or CT of brain

Question 9

Treatment of localised RCC ir RCC with limited metastatic disease?

***What if they have renal impairment or bilateral masses

Answer 9

Radical nephrectomy

if <7cm laproscopic removal

• *then a partial nephrectomy to leave some viable tissue may be done
• radiation for bony metasts if not diffuse

Question 10

Treatment for small renal masses <3cm with no symptoms?

Answer 10

Less aggressive Tx. As chemo and radiation have poor response, things like TKinhibitors or m TR inhibitiors.