Urology: Renal cancer Flashcards
What is the most common type of renal cell cancer? [1]
Clear cell carcinoma: 80%
What are the 3 most common types of renal cell cancer? [3]
Clear cell (75%)
Papillary (10%)
Chromophobe (5%)
Clear cell renal cell cancer is commonly due to a mutation in which gene? [1]
VHL tumour supressor gene: occurs in Von Hippel-Lindau syndrome.
What are the classic triad of symptoms for renal cancer? [3]
Name two more important clinical signs [2]
Classic triad:
* Loin pain
* Haematuria
* Loin mass
Also important:
Scrotal varicocele: usually left sided due to obstruction of the left gonadal vein
Lower limb oedema: due to compression of the inferior vena cava
NB: 50% are asymptomatic
What investigations should you provide if suspect renal cancer? [4]
BP increased from increased renin
FBC:
- Polycythaemia from EPO secretion
- ESR
- U&E
- ALP
- LDH
Urine:
- RBC
Imaging:
- USS
- CT w contrast: definitive test
- MRI
Patients receiving which form of treatment increaese their risk of RCC? [1]
15% of haemodialysis patients develop RCC
What is the difference in renal cancer staging between 1-4? [4]
Stage 1: < 7cm; no spread
Stage 2: > 7cm; no spread
Stage 3: > 7cm; spread locally
Stage 4: Spread to abdomen; adrenal glands; lymph nodes
Treatment for localised renal cancer?: T1 [2] & T2 [1]
T1 tumours:
- < 3 cm: ablative therapies
- up to 7 cm: partial nephrectomy
T2:
Radical nephrectomy (open, laporoscopic, open)
Treatment for locally advanced disease: T3 & T4? [1]
Radical nephrectomy
Treatment for metastatic RCC? [6]
Debulking surgery
Adjuvent chemotherapy
Immunotherapy tyrosine kinase inhibitors:
* ipilimumab
* nivolumab
* Sunitinib: inhibitor of tyrosine kinase receptors
* Pazopanib: inhibitor of tyrosine kinase receptors
* Temsirolimus: inhibitor of the mammalian target of rapamycin (mTOR)
* Everolimus: inhibitor of the mammalian target of rapamycin (mTOR)
Where patients are not suitable for surgery, which les invasive procedures can be used to treat the RCC? [3]
Arterial embolisation,
- cutting off the blood supply to the affected kidney
Percutaneous cryotherapy,:
- injecting liquid nitrogen to freeze and kill the tumour cells
Radiofrequency ablation,
- putting a needle in the tumour and using an electrical current to kill the tumour cells
RCC is generally resistant to which treatment types? [2]
Radiotherapy and chemotherapy
What is the name of the score created to predict prognosis of RCC patients? [1]
Mayo prognostic risk score
Describe the spread of RCC [2]
Renal cell carcinoma tends to spread to the tissues around the kidney, within Gerota’s fascia. It often spreads to the renal vein, then to the inferior vena cava.
Describe characteristic finding of metastatic RCC on CXR [1]
Cannonball
Name 4 differential diagnosises of cannonball metastasis
- renal
- choriocarcinoma
less commonly, with prostate, bladder and endometrial cancer.
