W4L1 Renal Cell Carcinoma

Question 1

Aetiology

Answer 1

1. Demographic factors
   - Age(6-7th decade)
   - Sex(2:1,M:F)
2. Toxic substances
   - smoking
   - cadmium, steel
3. Obesity and Nutritional factors
   - bmi
4. Genetic changes
   - von hipple
   - MET
   - FH
   - BHD

Question 2

von Hippel-Lindau?

Answer 2

• tumor suppressor gene on chromosome 3
• autosomal dominant hereditary multisystem
  syndrome
• retinal angioma.
• Inner ear tumor

Question 3

Hereditary Papillary Renal Carcinoma?

Answer 3

1. cp HRPC
   - bilateral, multifocal RCC
   - type 1 papillary rc
2. Diagnosis
   - c-met gene germline
   - abd ct & us

Question 4

Birt-Hogg-Dube syndrome

Answer 4

• cutaneous nodule
• pulmonary cyst
• bilateral renal tumor

Question 5

Hereditary Leiomyomatosis RCC

Answer 5

• cutaneous leiomyomas
• uterine fibroid
• uterine leiomyosarcoma
• renal tumor(type 2 PRCC)
  
  • solitary
  • early meta
  • lethal

Question 6

CP

Answer 6

• variety symp(most asymp)
• hematuria(40%)
• classic triad(flank pain, hematuria, abd mass)
• localized disease(45%), locally advance dis(25%), meta dis(30%)

Question 7

Paraneoplastic syndrome?

Syndrome(causes)

Answer 7

• HTN 40%(renin)
• Hypercalcemia 10-20%(PTH-like)
• Stauffer syn 3-20%(CSF)
• Polycythemia 3-10%(erythropo)
• Cushing(ACTH)

Question 8

Physical examination?

Answer 8

-Limited role

• Radiological
  
  • palpable abd mass
  • palpable cx lymph node
  • non reducing varicocele
  • bilateral lower limb oedema

Question 9

INVESTIGATIONS

Answer 9

1. Urine analysis
2. CBC
3. Genetic
4. Ultrasonography
5. IVP
6. CXR
7. CT(gold standard)
8. MRI
9. Selective renal angiography
10. Bone scan

Question 10

Indications for Renal Mass Biopsy

Answer 10

1. Lymphoma
2. Unresectable/mRCC
3. Cryotherapy & RFA
4. Abscess

Question 11

Benign renal masses

Answer 11

1. Simple cyst(most common)
   - >50%, >50y -round
   - radiolucent -regular
   - refusing -rim & claw sign
2. Solid mass
   - adenoma. -oncocytoma
   - AML (Hamartoma) -lipoma
   - Leiomyoma -Hemangioma

Question 12

Prognostic Variables RCC?

Answer 12

1. Tumor related
   - anatomical
   - pathological
2. Pt related
   - cachexia, platelet, LDH, ESR
3. Molecular marker
   - CA IX, Ki-67,p53
4. Therapeutic
   - only surgery

Question 13

Surgical Management of Kidney Cancer

Answer 13

1. Localized renal cancer
   - Radical nephrectomy
   - Nephron-sparing surgery
   - Tumour ablation
2. Locally advanced renal cancer
   - Radical nephrectomy +
3. Metastatic renal cancer
   - Role nephrectomy– metastatectomy– targeted therapy

Question 14

Radical Nephrectomy?

Answer 14

• Standard ttt RCC with normal opposite kidney

1-Early ligation of renal vessels.
2-Excise Gerota’s fascia include kidney, adrenal gland & proximal ureter
3-Extensive lymph node dissection