Tumours and Stones Flashcards
1
Q
Prognosis of renal cancer
A
- Five-year survival :
- Stage: Ta - 94%, T1 - 69%, T2 - 40%, T3 - 31%, T4 - 0%
- Worse with increasing grade, and increased grade and stage associated with increased risk of metastatic disease.
2
Q
Renal cell cancer features
A
- Aka, hypernephroma, clear-cell cancer
- Incidence: 2-3% of all adult cancers.
- Most are renal cell carcinomasàadenocarcinomas arising from PCT
- Also-papillary carcinomas, transitional cell carcinoma, sarcoma
- Peak age 40-70y/o. More in men than woman
3
Q
Risk factors for renal carcinoma
A
- Urban dwelling, Low socio-economic group, Smoking, Obesity, Hypertension.
- Renal failure/dialysis – increases chance x30
- Anatomicalàpolycystic and horseshoe
- Genetics-VHL, tuberous sclerosis
4
Q
Von hippel Lindau syndrome
A
- AD inheritance
- Tumour suppressor gene on p3
- Mutations inactivate VHL gene product
- Also at risk of: phaeochromocytoma, renal and pancreatic cysts, cerebellar hemangioblastoma
- Multi-focal renal tumoursàleads to enhancing lesions on CT
5
Q
Presentation of renal cell carcinoma
A
- 80% incidental. <25% systemic symptoms-
- Night sweats, Fever, Fatigue, Weight loss, Haemoptysis.
- 10% have Classic triadàmass, flank pain and haematuria
- Incidental now due to CTs etc
- Paraneoplastic and systemic issuesà night sweats, fever, fatigue, weight loss and haemoptysis
- Varicocele, lower limb oedemaàpressure from tumour
6
Q
Paraneoplastic syndromes
A
- Polycythaemia (3-10%)-from increase EPO
- Hypercalcaemia (3-13%) - due to production of PTH-like substance or from Osteolytic hypercalcaemia
- Hypertension (up to 40%)- increased renin
- Deranged LFTs- stauffer’s syndrome, from hepatotoxic tumour products
- Rarely- cushing’s syndrome (acth), enteroglucagon (protein enteropathy) prolactin (galactorrhoea) insulin (hypoglycaemia) and gonadotrophins.
7
Q
Diagnosis of renal cell carcinoma
A
- First- FBC, U&Es, LFTS
- CTIVP (CT-intravenous pyelogram), Ultrasound
- midstream urine sample
- Staging- Full body CT, Isotope bone scan
- Rarelyàrenal arteriography, biopsy etc.
8
Q
Histology of renal cell carcinoma
A
- Convention/ clear cell- 80% -vascular, glandular and clear (lipids)
- Papillary-10%-solid and often multifocal
- Chromophobe 5%- large polygonal
- Collecting duct and medullary cell is rare
9
Q
Staging of renal cell carcinoma
A
- T1a <4cm, T1b 4-7cm
- T2 >7cm
- T3a - into renal vein, T3b -IVC below diaphragm. T3c IVC above diaphragm
- T4 - beyond Gerota’s and/or adrenal gland
- Importantly it spreads down up vascular tree àinto renal vein, IVC and atrium
- M-liver, lung and bone
- Surgically Challenging. Perioperative mortality 3% in I. 9% in II/IV
- Down staging is of great surgical importance e.g. IV to III
10
Q
Treatment of renal cell carcinoma
A
- Tailor to patient:
- If fit and able the answer is surgery
- Open (large) or laparoscopic
- Partial (nephron sparing) vs. total
- Used to be radical nephrectomy- removed kidney, gerota’s fascia, extended LN dissection and adrenal gland
- Nephron sparing surgeryàjust remove tumour and correct BV etc. Shows that maintaining the GFR/renal function is a better long term outcome
Metastatic disease -Tyrosine kinase inhibitors- Sunitinin, everolimus, etc
11
Q
Risk factors for testicular cancer
A
- cryptorchidism
- hiv
- caucasian population
12
Q
Clinical presentation of testicular cancer
A
- Painless lump
- Incidental following trauma
13
Q
Investigations for testicular cancer
A
Investigation:
- Scrotal ultrasound
- Tumour markers:
- Alpha-fetoprotein (50-70% Teratoms and Yolk Sac Tumours)
- Beta hCG (40% Teratoma, 15% Seminoma)
- LDH (10-20% Seminoma)
- Regular Testicular Self Examination advised
14
Q
Classification of testicular cancer
A
Germ cell tumours (most common)
- seminoma
- teratoma
- mixed
- yolk sac
Stromal tumours
- leydig
- sertoli
Other
- lymphoma
- metastasis
15
Q
Treatment of testicular cancer
A
- Radical orchidectomy – offer testicular prosthesis.
- Chemoà90% cured
- Para-aortic nodal radiotherapy
- Retroperitoneal LN dissection
