Kidney tumours Flashcards
What are the two main types of malignancy kidney tumours?
Renal cell carcinoma (80-90%)
Transitional cell carcinoma
Who is likely to develop RCC?
RCC arise from proximal renal tubular epithelium. These account for approx. 80-90% of renal cancers and typically occur above the age of 55 in men (2:1 ratio). 15% of haemodialysis patients develop RCC
What are the features of RCC?
• Asymptomatic – incidental finding • Haematuria • Loin pain • Abdominal mass • Anorexia • Malaise • Weight loss • PUO • Invasion of left renal vein can compress testicular vein to cause a varicocele. • 25% have metastasis at presentation. o Spread may be direct (Renal vein), via lymph or haematogenous (bone, liver, lung)
How are RCCs diagnosed?
Increased BP due to increased renin secretion
Bloods: FBC (polycythaemia from erythropoietin section), CRP, U&E, ALP (bony metastasis)
Urine: RBC’s, Cytology
Imaging: USS, CTM/MRI, IVU (filling defect +/- calcifications), CXR (cannon-ball metastasis)
How are RCCs treated?
Radial nephrectomy (nephron-sparing surgery is as good for T1 tumours + preserves renal function)
RCCs are generally resistant to radiotherapy and chemotherapy
Biological therapies e.g. sunitinib, bevacizumab, sorafenib (unresectable or metastatic disease)
Temsirolimus - 1st line treatment for patients with multiple poor-risk factors.
What is the prognosis like for RCC?
Mayo prognostic risk score (SSIGN) is used to predict survival uses information on tumour Stage, SIze, Grade and Necrosis.
Prognosis: 10yr survival ranges from 96.5% (SSIGN score = 0-1) to 19.2% (SSIGN score = >10)
Where can TCC arise?
Transitional cell carcinoma (TCC) may arise in the bladder (50%), ureter or renal pelvis
Who does TCC normally affect and how does it present?
They normally occur above the age of 40 and are 4x more likely to occur in men. They present with painless haematuria, frequency, urgency, dysuria or urinary tract obstruction.
