Condition- Renal Cell Carcinoma

Question 1

which part of the kidney does renal cell carcinoma arise from?

Answer 1

Proximal renal tubular epithelium

Question 2

List some common histological types of renal cell carcinoma- which of these is the most common?

Answer 2

Renal clear cell carcinoma (80%)

Papillary carcinoma (10%)

Transitional cell carcinoma (10%)

Question 3

List some risk factors of renal cell carcinoma

Answer 3

• Smoking
• FHx of RCC
• Hereditary syndromes
  
  • Von Hippel Lindau Syndrome
  • Tuberous sclerosis
• Polycystic kidney disease

Question 4

Name a common hereditary neoplastic syndrome that RCC is associated with

Answer 4

Von Hippel Lindau Syndrome

Question 5

What is Von Hippel Lindau syndrome?

• mutation
• effects of body
• inheritance

Answer 5

• Inheritance: Autosomal dominant
• Mutation: Mutation of VHL gene which is a TSG on Chr3 which leads to increased HIF expression=> increased PDGF + VEGF+ cell proliferation and vasculogenesis
• Effects: Multiple cancers e.g.

Question 6

List some tumour caused by mutuation in the VHL gene

Answer 6

HARP3

• Hemangioblastomas in CNS causing ataxia, headaches, nausea and vomitting
• hemangioblastomas in retina causing retinal detachment and blindness
• cystAdenoma- ears, epididymis, broad liagement, liver, lung, kidney
• Metastatic carcinomas- clear cell RCC, pancreatic neuroendocrine tumours
• Phaeochromocytomas and paragangliomas = catecholamine producing tumours

Question 7

List the triad of symptom experienced by people with renal cell carcinoma

Answer 7

• Haematuria
• loin pain
• Abdominal mass

Question 8

What is Stauffer syndrome?

Answer 8

paraneoplastic hepatic dysfunction syndrome

presents as cholestasis/hepatosplenomegaly

Thought to be secondary to increased levels of IL-6

Question 9

What testicular sign condition may RCC present with? why?

Answer 9

Left varicocoele due to compression of left testicular vein as it joins the left renal vein

Question 10

Which hormones might an RCC secrete?

Answer 10

• erythropoietin => polycythaemia
• PTH => hypercalcaemia
• ACTH => cushing’s syndrome
• Renin => hypertension

Question 11

What might you see in the FBC of someone with RCC? and why?

Answer 11

• Elevated RBC= polycythaemia from EPO secretion
• Low Hb= ACD

Question 12

What might you look for in the bloods of someone with RCC?

Answer 12

• FBC- high RBC and low Hb
• ALP- bony mets
• LFTs- Stauffer’s syndrome/ liver mets
• U+Es: kidney function
• Calcium- hyperPTH
• High ESR

Question 13

Which investigations might you conduct on someone with RCC?

Answer 13

• Urinalysis- haematuria, cytology
• Bloods
• Abdo US- ID solid masses vs cysts (first line imaging)
• CT/ MRI - staging