RCC & TCC

Question 1

Define TCC & RCC.

Answer 1

Transitional cell carcinoma - renal pelvis, ureters, bladder.
Renal cell carcinoma - parenchyma (body of kidney).

Question 2

Give 7 differentials of haematuria.

Answer 2

Renal cell carcinoma
Transitional cell carcinoma
Advanced prostate carcinoma
Stones
Infection
Inflammation
Benign prostatic hyperplasia

Question 3

Describe the investigations that you would undergo if carcinoma was suspected.

Answer 3

History - smoking, occupation, painful, FH.
Examinations - BP, abdominal mass, scrotal varicocele, leg swelling, prostate.
Radiology - USS progressing to CT if abnormal.
Urine - culture or cytology
Flexible cystoscopy.

Question 4

Describe the presentation of Renal cell carcinoma. (6)

Answer 4

Cells appear white on H+E because they’re full of glycogen. Often occurs in the PCT. never visible on cystoscopy.
Haematuria, often incidental findings. If advanced, megs, hypercalcaemia, scrotal varicocele.

Question 5

Describe the epidemiology of renal cell carcinoma. (4)

Answer 5

M>F, 30% metastatic at presentation, increased by smoking, obesity or dialysis, white > not white.

Question 6

Describe the metastatic spread of RCC. (3)

Answer 6

Perinephric, lymph nodes, IVC spread to right atrium via Renal vein.

Question 7

Describe the treatment of RCC (4)

Answer 7

Surveillance
Radical or partial nephrectomy
Ablation - cryoablation (removal by freezing) radiofrequency.
If it’s metastatic, palliative treatments targeting angiogenesis.

Question 8

Describe the presentation of bladder TCC. (4)

Answer 8

Haematuria, often incidental findings.

If advanced, weight loss, mets, DVT, lymphoedema.

Question 9

Describe the epidemiology of bladder TCC (4)

Answer 9

M>F, white > non-white, smoking, occupational (printers), plastic manufacture.

Question 10

Describe the treatment of bladder TCC (5)

Answer 10

TURBT - transurethral resection of bladder tumour.
Muscle invasive - neoadjuvant chemo and radical cystectomy.
Low-risk non-muscle - intravesicular chemo
High-risk non-muscle - intravesicular immunotherapy.
Cystectomy - ileal conduit or reconstruction using bowel.

Question 11

Describe the epidemiology of upper tract TCC. (3)

Answer 11

Unusual, smoking, drug abuse.

Question 12

Describe the investigations for upper tract TCC. (3)

Answer 12

Ultrasound - hydronephrosis
CT urogram - filling defect, ureteric stricture.
Ureteroscopy - biopsy or cytology sampling.

Question 13

Describe the treatment of metastatic TCC. (5)

Answer 13

Systemic chemo - cisplatin based, but needs good renal function.
Biological immunotherapy - antibodies to block the cancers’ defence against the immune system so the immune system can fight it. Can be given in low renal function.