Urology - Renal cell carcinoma

Question 1

Presentation of renal cell carcinoma

Answer 1

Classic triad of:
Haematuria
Flank pain/vague loin pain
Palpable mass on examination

Also non-specific cancer Sx

Question 2

What is a RCC? What are the subtypes?

Answer 2

An adenocarcinoma that arises from the renal tubules

Subtypes:

• Clear cell (80%)
• Papillary (15%)
• Chromophobe (5%)

Question 3

Risk factors for RCC

Answer 3

Smoking
Obesity
Hypertension
End-stage renal failure
Von Hippel-Lindau Disease
Tuberous sclerosis

Question 4

What are the 2WW referral criteria for RCC?

Answer 4

Aged over 45 with unexplained visible haematuria, either without a UTI or persisting after treatment for a UTI

Question 5

How does RCC spread?

Answer 5

Often spreads to renal vein and then IVC

“Cannonball metastases” in the lungs is a classical feature of metastatic renal cell carcinoma (also occur due to choriocarcinoma - cancer in the placenta, and, even less commonly, with prostate, bladder and endometrial cancer.)

Question 6

Paraneoplastic features of RCC?

Answer 6

Polycythaemia – due to secretion of unregulated erythropoietin

Hypercalcaemia – due to secretion of a hormone that mimics the action of parathyroid hormone

Hypertension – due to various factors, including increased renin secretion, polycythaemia and physical compression

Stauffer’s syndrome – abnormal liver function tests (raised ALT, AST, ALP and bilirubin) without liver metastasis

Hypercalcaemia can also be caused by bony mets