Renal cell cancer

Question 1

Definition

Answer 1

Adenocarcinoma of the proximal convoluted tubule

Question 2

Common presentation

Answer 2

Incidental finding on imaging

- often patient is asymptomatic

Question 3

Who gets it

Answer 3

Elderly
Males
Obesity (central)
Smoking

Question 4

Types

Answer 4

Clear cell
Papillary
Chromophobe
Collecting duct

Question 5

Which type of RCC is most common?

Answer 5

Clear cell

Question 6

Types - clear cell

Answer 6

Large vacuoles in the cytoplasm

Question 7

Which type of RCC is the most aggressive?

Answer 7

Collecting duct

Question 8

Pathology

Answer 8

Large well circumscribed mass on the cortex
Yellow
Solid, cystic, necrotic and haemorrhage areas

Question 9

Renal tumours have the ability to neovascularise - true or false?

Answer 9

True

Question 10

Clinical features

Answer 10

Asymptomatic 
Abdominal mass 
Haematuria
Flank pain
Weight loss

Question 11

Paraneoplastic manifestations

Answer 11

Polycythaemia
- tumour secretes erythropoietic which stimulates RBC formation
Hypercalcaemia

Question 12

What does RCC secrete?

Answer 12

Erythropoetin

Question 13

Investigations

Answer 13

US
X-ray - cannon ball mets
CT contrast
Biopsy - not indicated in all pts

Question 14

Which staging is used

Answer 14

Robson

Question 15

Spread?

Answer 15

Lymphatic
Haematogenous
Usually grows into the renal hilum -> invades veins -> IVC -> heart -> lungs

Question 16

Metastasis to ____ is most common?

Answer 16

Lungs

Question 17

Management (high risk)

Answer 17

Radical nephrectomy

Question 18

Adrenal glands are routinely removed in surgery? true or false

Answer 18

FALSE

- only removed if diseased

Question 19

Management (low-mod risk)

Answer 19

Partial nephrectomy

Question 20

Management (low risk)

Answer 20

RF ablation

Cryoablation

Question 21

Management (metastatic disease)

Answer 21

Tyrosine kinase inhibitors

VEGF or PDGF inhibitors

Question 22

Associated conditions

Answer 22

Von Hippel Lindau syndrome

• young pt
• multiple tumours
• AD

Question 23

Nephroblastoma (wilms tumour) - definition

Answer 23

Commonest intra-abdominal tumour in children