Renal Cancer

Question 1

What are two types of renal cancer?

Answer 1

• Wilms tumour (nephroblastoma)

- renal cell carcinoma

Question 2

Who is affected by Wilms tumours?

Answer 2

young children, usually between 3-5 years old

Question 3

Do Wilms tumours occur in one or both kidneys?

Answer 3

can be in one or both

Question 4

Do Wilms tumours occur with any other problems?

Answer 4

yes - often occur with other congenital anomalies (aniridia - lack of iris, hemihypertrophy - enlargement of one side of face or body)

Question 5

What causes Wilms tumours?

Answer 5

• gene mutation, several chromosomes involved

- includes abnormality of Wilms tumour gene (WT1) on chromosome 11

Question 6

Describe a Wilms tumour.

Answer 6

• composition similar to normal fetal tissue (blastemic, stromal, epithelial tissue)
• usually a solitary mass, sharply demarcated
• may be encapsulated
• can grow to large size

Question 7

How are Wilms tumours staged?

Answer 7

• stage 1 - limited to kidney (can be excised)
• stage 2 - extends to renal capsule (can still be excised)
• stage 3 - tumour extends to abdomen
• stage 4 - metastasis via blood, usually to lung

Question 8

What are signs and symptoms of a Wilms tumour?

Answer 8

• large asymptomatic abdominal mass
• hypertension
• may have abdominal pain, vomiting
• hematuria (gross or microscopic)

Question 9

Where does renal cell carcinoma normally arise?

Answer 9

any portion of the kidney but most commonly in the upper pole

Question 10

What are risk factors for renal cell carcinoma?

Answer 10

• heavy smoking
• obesity, especially in women
• exposure to petroleum products, heavy metals, asbestos
• acquired cystic kidney disease associated with chronic renal insufficiency

Question 11

What are 5 categories of renal cell carcinoma?

Answer 11

1) clear cell carcinoma - most common
- have clear cytoplasm
- usually have chromosome 3 deletion
- usually arise from proximal tubular epithelial cells
2) papillary tumours
3) chromophobic tumours
4) oncocytomas
5) collecting duct tumours

Question 12

Is there a bias in incidence of renal cell carcinoma?

Answer 12

more common in men

Question 13

What are the signs and symptoms of renal cell carcinoma?

Answer 13

• usually asymptomatic

- when advanced: hematuria (can be intermittent and microscopic), flank pain, palpable flank mass

Question 14

How is renal cell carcinoma diagnosed?

Answer 14

• often incidental

- ultrasound, CT, MRI

Question 15

How is renal cell carcinoma treated?

Answer 15

• surgery (radical nephrectomy with lymph node dissection is treatment of choice, if both kidneys involved though, nephronsparing surgery)
• chemo
• immunotherapy

Question 16

What is the prognosis for renal cell carcinoma?

Answer 16

5 year survival rate is 90% if tumour not extended beyond the renal capsule but drops to 30% if metastasized