Renal Cancer Flashcards
Kidney cancer accounts for a 3rd of all cancers with a higher incidence in west countries. What is the incidence of kidney cancer?
1 - 1000 new cases
2 - 10,000 new cases
3 - 100,000 new cases
4 - 1,00,000 new cases
3 - 100,000 new cases
- slightly more common in men
- 10 year survival = 52%
Which of the following is NOT a typical risk factor for kidney cancer?
1 - Obesity
2 - Alcohol
3 - Smoking
4 - Diabetes
5 - Asbestos/Cadmium/Lead
6 - Family history
2 - Alcohol
- moderate alcohol and exercise are protective factors
The Von Hippel-Lindau (VHL) gene is associated with renal cancer. Which of the following is NOT true about VHL?
1 - tumour suppressor gene located on short arm chromosome
2 - up regulates hypoxia inducible factors (HIFs) that enhances tumour growth
3 - HIFs increase endothelial growth factor (VEGF) and Platelet-derived growth factor (PDGF)
4 - only causes renal cancers
4 - only causes renal cancers
- VHL syndrome can cause benign and malignant tumours in the eye, brain, spinal cord, kidney, pancreas and adrenal glands
- autosomal dominant inheritance
There are a large number of renal cell cancers. Which of the following is by far the most common?
1 - Clear cell
2 - Papillary
3 - Chromophobe
4 - SDH-deficient
1 - Clear cell
- accounts for around 80% of all renal cancers
Papillary (around 15%)
Chromophobe (around 5%)
- these typically arrive from the renal tubules
The 3 most common renal cancers are:
- Clear cell
- Papillary
- Chromophobe
Of these which has the worst prognosis?
- Clear cell
There are a variety of symptoms associated with renal cancer, which of the following is NOT part of the typical triad of symptoms?
1 - palpable mass
2 - haematuria
3 - proteinuria
4 - flank pain
3 - proteinuria
- patients can also be asymptomatic including:
- vague loin pain
- non-specific symptoms of cancer (e.g., weight loss, fatigue, anorexia, night sweats)
NICE guidelines advise that patients with unexplained visible haematuria, UTI or recurrent UTI be referred on a two week wait referral for suspicion of renal cancer. What age does this typically need to be above though?
1 - >25
2 - >35
3 - >45
4 - >55
3 - >45
If renal cancer spreads, it typically spreads to the kidneys and into Gerota’s fascia of the kidneys. However, it can spread to the renal vein and inferior vena cava. Here is can metastasise into a common sign cause cannonball metastasis. Where are these typically located?
1 - heart
2 - liver
3 - lungs
4 - pancreas
3 - lungs
- classic feature of metastatic renal cell carcinoma. These appear as clearly-defined circular opacities scattered throughout the lung fields on a chest x-ray.
Why can renal cancers cause Varicocoele?
1 - block inferior vena cava so blood backs up
2 - metastasis can obstruct veins in spermatic cord
3 - blockage of the left renal vein
4 - blockage of the right renal vein
3 - blockage of the left renal vein
- left testes drains into the left renal vein
- a large tumour could make this happen
Renal cell cancer is also associated with paraneoplastic effects. Which of the following is the definition of polycythaemai?
1 - secretion of a hormone that mimics the action of parathyroid hormone
2 - secretion of unregulated erythropoietin (high RBCs)
3 - abnormal liver function tests (raised ALT, AST, ALP and bilirubin) without liver metastasis
4 - increased renin secretion, polycythaemia and physical compression
2 - secretion of unregulated erythropoietin (high RBCs)
Renal cell cancer is also associated with paraneoplastic effects. Which of the following is the definition of hypercalcaemia?
1 - secretion of a hormone that mimics the action of parathyroid hormone
2 - secretion of unregulated erythropoietin (high RBCs)
3 - abnormal liver function tests (raised ALT, AST, ALP and bilirubin) without liver metastasis
4 - increased renin secretion, polycythaemia and physical compression
1 - secretion of a hormone that mimics the action of parathyroid hormone
- Hypercalcaemia can also be caused by bony metastases
Renal cell cancer is also associated with paraneoplastic effects. Which of the following is the definition of hypertension due to renal cancer?
1 - secretion of a hormone that mimics the action of parathyroid hormone
2 - secretion of unregulated erythropoietin (high RBCs)
3 - abnormal liver function tests (raised ALT, AST, ALP and bilirubin) without liver metastasis
4 - increased renin secretion, polycythaemia and physical compression
4 - increased renin secretion, polycythaemia and physical compression
Renal cell cancer is also associated with paraneoplastic effects. Which of the following is the definition of Stauffer’s syndrome due to renal cancer?
1 - secretion of a hormone that mimics the action of parathyroid hormone
2 - secretion of unregulated erythropoietin (high RBCs)
3 - abnormal liver function tests (raised ALT, AST, ALP and bilirubin) without liver metastasis
4 - increased renin secretion, polycythaemia and physical compression
3 - abnormal liver function tests (raised ALT, AST, ALP and bilirubin) without liver metastasis
What is the 1st line imaging to assess for renal cancer?
1 - CT-PET
2 - CT
3 - ultrasound
4 - MRI
3 - ultrasound
- CT renal, pelvis and chest confirms and stages the renal cancer
- ultrasound guided biopsy as well
Which of the following match stage 1 renal cancer?
1 - tumour in renal veins and/or adrenal gland (5 years survival 59%)
2 - >7cm at greatest dimension but confined to kidney (5 year survival = 88%)
3 - tumour beyond gerotas fascia (5 years survival 20%)
4 - <7cm at greatest dimension and confined to the kidney (5 year survival = 95%)
4 - <7cm at greatest dimension and confined to the kidney (5 year survival = 95%)
Which of the following match stage 2 renal cancer?
1 - tumour in renal veins and/or adrenal gland (5 years survival 59%)
2 - >7cm at greatest dimension but confined to kidney (5 year survival = 88%)
3 - tumour beyond gerotas fascia (5 years survival 20%)
4 - <7cm at greatest dimension and confined to the kidney (5 year survival = 95%)
2 - >7cm at greatest dimension but confined to kidney (5 year survival = 88%)
Which of the following match stage 3 renal cancer?
1 - tumour in renal veins and/or adrenal gland (5 years survival 59%)
2 - >7cm at greatest dimension but confined to kidney (5 year survival = 88%)
3 - tumour beyond gerotas fascia (5 years survival 20%)
4 - <7cm at greatest dimension and confined to the kidney (5 year survival = 95%)
1 - tumour in renal veins and/or adrenal gland (5 years survival 59%)
Which of the following match stage 4 renal cancer?
1 - tumour in renal veins and/or adrenal gland (5 years survival 59%)
2 - >7cm at greatest dimension but confined to kidney (5 year survival = 88%)
3 - tumour beyond gerotas fascia (5 years survival 20%)
4 - <7cm at greatest dimension and confined to the kidney (5 year survival = 95%)
3 - tumour beyond gerotas fascia (5 years survival 20%)
