Urology - Renal Tumours

Question 1

What is most common renal tumour?

Answer 1

• Renal cell carcinoma (80% of renal tumours) - arise from renal tubules)
• Malignant tumours can be 1ry or 2ry but secondary tumours are rare (anatomy - higher up than rest of urology system)

Question 2

RCC: epidemiology

Answer 2

• 80-90% of renal tumours
• age: 55ya
• Sex: M>F = 2:1

Question 3

RCC: risk factors

Answer 3

• obesity
• smoking
• then
• dialysis: 15% of pts develop RCC
• 4% heritable

Question 4

RCC: pathology

Answer 4

• Adenocarcinomas from proximal renal tubular epithelium

- Subtypes: clear cell (70%), papillary (15%), chromophobe (5%) and collecting duct (1%)

Question 5

RCC: Presentation

Answer 5

• 50% of pts are discovered as incidental finding - have USS/CT for unrelated reason
• Triad (rare): haematuria, loin pain and loin mass
• Systemic: anorexia, malaise, wt loss
• Clot retention
• Invasion of left renal vein: varicocele (1%)
• Cannonball mets: SOB

Question 6

RCC: paraneoplastic features

Answer 6

• EPO: polycythaemia
• PTHrP: hypercalcaemia
• Renin: HTN
• ACTH: Cushing’s syndrome
• Amyloidosis

Question 7

RCC: potential avenues of spread

Answer 7

• direct: renal vein (varicocele on LHS)
• lymph
• haematogenous: bone, liver and lung

Question 8

Ix

Answer 8

• Blood: FBC (check polycythaemia), ESR, U+E, ALP, Ca
• Urine: dip and cytology
• DRE!!
• Imaging: CXR (cannonball mets), US (mass), IVU (filling defect), staging CT/MRI CAP

Question 9

What is the name of staging system for RCC and outline the steps

Answer 9

• Robson staging
  1. Confined to kidney
  2. Involves perinephric fat but not Garota’s fascia
  3. Spread into renal vein
  4. Spread to adjacent/distant organs

Question 10

RCC: Mx - medical and surgical

Answer 10

• *These cancers are very resistant to chemotherapy and radiotherapy - v rarely used
• Medical: reserved for pts with poor prognosis
• Surgical: radical nephrectomy or consider partial if pt only has 1 kidney, very poor kidney function or small tumour

Question 11

TCC/Pelviureteric tumours: epidemiology and risk factors

Answer 11

• 2nd most common renal cancer
• Age: 50-80
• Risk factors: smoking, amine exposure (rubber industry), cyclophosphamide

Question 12

TCC/Pelviureteric tumours: pathology

Answer 12

• same as TCC of bladder but account for less than 20% of renal tumours
• highly malignant
• location: bladder, ureter and pelvis

Question 13

TCC/Pelviureteric tumours: presentation

Answer 13

• Painless haematuria
• frequency, urgency, dysuria
• urinary tract obstruction

Question 14

TCC/Pelviureteric tumours: Ix

Answer 14

• Urine cytology
• same bloods as RCC
• CT/MRI (KUB or staging CAP)
• IVU: look for filling defect

Question 15

TCC/Pelviureteric tumours: Mx

Answer 15

• Nephro-uretectomy

- need very regular follow up b/c 50% subsequently develop bladder tumours :(

Question 16

Wilm’s tumour: what is it? When does it present? What mutations is it associated with?

Answer 16

• Aggressive childhood tumour of primitive renal tubules and mesenchymal cells
• May be associated with: Chr 11 mutation or WAGR syndrome
• commonest intra-abdo tumour in <10ya, if caught early survival is high but can be rapid/aggressive and metastasise to lungs (Rx is radical nephrectomy and stage-dependant post-op Chemo)

Question 17

Wilm’s tumour: presentation

Answer 17

• 2-5ya
• 5-10% are bilateral
• Abdo mass/pain
• haematuria
• HTN
• Aggressive: mets to lungs?

Question 18

Other neoplasms: benign

Answer 18

• Cysts are very common
• Renal papillary adenomas
• Oncocytoma: eosinophilic cells with numerous mitochondria
• Angiomyolipoma: seen in tuberous sclerosis
• *Bening tumours commonly require nephrectomy to exclude malignancy

Question 19

Other neoplasms: malignant

Answer 19

-SCC associated with infected staghorn calculus