1: Urological Malignancy - Renal Cell Carcinoma

Question 1

What is the most common cause of renal malignancy in adults

Answer 1

Renal cell carcinoma

Question 2

In which gender is RCC more common

Answer 2

Males

Question 3

What age does RCC typically onset

Answer 3

55-years

Question 4

What are 3 causes of RCC

Answer 4

• Sporadic
• Von Hippel Lindau Syndrome
• Tuberous sclerosis

Question 5

What is the inheritance pattern of von-hippel-lindau

Answer 5

Autosomal dominant

Question 6

what type of renal cancer does von-hippel-lindau cancer cause

Answer 6

Clear cell renal cell carcinoma

Question 7

what two neurological disorders does von-hippel-lindau cause

Answer 7

Cerebellar hemangiomas -SAH

Retinal hemangiomas - Vitreous haemorrhage

Question 8

what is the inheritance pattern of tuberous sclerosis

Answer 8

Autosomal dominant

Question 9

what are cutaneous features of tuberous sclerosis

Answer 9

• Ash-Leaf Spots (Under UV light)
• Shagreen patch - roughened skin over spine
• Angiofibromas over naso-labial folds
• Cafe au lait

Question 10

what are neurological features of tuberous sclerosis

Answer 10

Epilepsy
Learning difficulties
Developmental delay

Question 11

what are 3 risk factors for sporadic RCC

Answer 11

• Smoking
• Renal stones
• Acquire renal cysts

Question 12

what is problem with RCC

Answer 12

Asymptomatic during early-stages

Question 13

what is the triad of symptoms in RCC

Answer 13

Haematuria
Abdominal mass
Flank pain

Question 14

when should RCC always be investigated for in males and why

Answer 14

Left varicocele.

Left testicular vein drains into left renal vein - meaning a mass (cancer) obstructive drainage can cause varicocele

Question 15

what are 4 paraneoplastic syndromes of RCC

Answer 15

• PTHrp
• ACTH
• Renin
• EPO
• Stauffer syndrome

Question 16

what does EPO cause

Answer 16

Polycythaemia

Question 17

what does PTHrp cause

Answer 17

Hypercalcaemia

Question 18

what is stauffer syndrome

Answer 18

Paraneoplastic hepatic dysfunction syndrome

Question 19

what causes paraneoplastic hepatic dysfunction syndrome

Answer 19

Release of IL6

Question 20

how does stauffer syndrome present clinically

Answer 20

Hepatosplenomegaly and cholestasis

Question 21

what are renal cell carcinomas

Answer 21

adenocarcinomas that arise from the proximal convoluted tubule (PCT) of the kidney

Question 22

what is the most common variant of renal cell carcinoma

Answer 22

clear-cell renal cell carcinoma

Question 23

when should individuals be referred under 2WW for suspected renal carcinoma

Answer 23

> 45-years with:

• Unexplained macroscopic haematuria
• Haematuria persisting despite treatment for UTI

Question 24

what is the main symptom that should ring alarm bells for RCC referral

Answer 24

> 45 and haematuria

Question 25

what is the best investigation to diagnose RCC

Answer 25

CT-Abdomen

Question 26

what may be seen on CXR in RCC

Answer 26

Cannonball metastases

Question 27

when is a bone scan ordered in RCC

Answer 27

Raised ALP or bone pain

Question 28

what treatment are RCC resistant to by nature

Answer 28

chemotherapy

Question 29

if T1 what management is indicated for RCC

Answer 29

Partial nephrectomy

Question 30

if above T1 what management is indicated for RCC

Answer 30

Radical nephrectomy

Question 31

if unable to undergo nephrectomy, how is RCC managed

Answer 31

Cryotherapy or radio frequency ablation

Question 32

how will those with mets be managed

Answer 32

IL2

Tyrosine Kinase inhibitors

Question 33

what prognostic scoring system can be used in RCC

Answer 33

MAYO prognostic scoring system