Renal Cancer

Question 1

What percentage of adult cancers do renal cell carcinomas account for.

Answer 1

3% of all adult cancers worldwide.

Question 2

What are the types of renal tumours. (3)

Answer 2

Renal cell carcinoma.
Transitional cell carcinoma.
Wilms’ tumour.

Question 3

What is the incidence of men:women who get renal cell carcinoma.

Answer 3

2:1.

Question 4

What is the average age of diagnosis of renal cell carcinoma.

Answer 4

55.

Question 5

What part of the world has a high incidence of renal cancer.

Answer 5

The West.

Question 6

What part of the world has a low incidence of renal cancer.

Answer 6

Asia.

Question 7

What risk factors are associated with renal cancer. (3)

Answer 7

Smoking.
Obesity.
Chronic renal disease needing dialysis.

Question 8

What are most renal tumours.

Answer 8

Adenocarcinomas.

Question 9

What are the renal adenocarcinomas usually known as.

Answer 9

Renal cell carcinoma (RCC).

Question 10

What symptom is seen in 40% of patients presenting with renal cancer.

Answer 10

Haematuria.

Question 11

Haematuria is present in ____% of patients presenting with renal cancer.

Answer 11

40%

Question 12

What is the classic triad that renal cancer presents with.

Answer 12

Loin pain.
Haematuria.
Palpable mass.

Question 13

How often do you see the classical triad of renal cancer.

Answer 13

Hardly ever (in about 10% of cases).

Question 14

What is the classical triad of renal cancer indicative of.

Answer 14

Advanced disease.

Question 15

What are the clinical features of renal cancer. (14)

Answer 15

They are very varied: 
Anaemia. 
Polythcthaemia. 
Hypercalcaemia. 
Anorexia.
Loin pain. 
Abdominal mass. 
Hypertension. 
Malaise. 
Fever.
Neuropathy (rarely).
Raised ESR. 
Coagulopathies. 
Abnormal plasma proteins and LFTs. 
Unexplained weight loss. 
Classical triad: loin pain, haematuria, palpable mass.

Question 16

What percentage of renal cancers are incidental findings.

Answer 16

60% due to increased use of imaging techniques.

Question 17

Where can renal cancer spread to. (local structures) (3)

Answer 17

Renal vein.
Inferior vena cava (IVC).
Adrenals.

Question 18

Where does renal cancer tend to metastasize to. (4)

Answer 18

Bones.
Lung (cannon ball lesions).
Lymph nodes.
Brain.

Question 19

What do renal cancer metastases look like in bone.

Answer 19

Canon ball lesions.

Question 20

How are renal tumours imaged. (2)

Answer 20

Ultrasound is more sensitive than IVU for renal lesions.

CT is gold standard for staging.

Question 21

When would you do a bone scan in a patient with renal cancer. (2)

Answer 21

If symptomatic disease.

If raised alkaline phosphatase. (ALP)

Question 22

What is a T1 renal tumour. (2)

Question 23

What is a T2 renal tumour. (2)

Answer 23

> 7cm.

Confined to kidney.

Question 24

What is a T3 renal tumour.

Answer 24

Extends beyond the kidney. (eg renal vein, IVC or adrenal gland).

Question 25

What is a T4 renal tumour.

Answer 25

Extends beyond Gerota's fascia.

Question 26

What is Gerota's fascia.

Answer 26

Connective tissue capsule of the kidney.

Question 27

What percentage of renal tumours are renal cell carcinomas.

Answer 27

90%

Question 28

What percentage of patients on HD will develop renal cell carcinoma.

Answer 28

15%

Question 29

What percentage of renal cell carcinomas are found incidentally.

Answer 29

50%

Question 30

What is a rare associated features of renal cell carcinoma. Why.

Answer 30

Varicocele. | Rarely, invasion of the left renal vein compresses the left testicular vein, causing a varicocele.

Question 31

What percentage of renal cell carcinomas have metastases at presentation.

Answer 31

25%

Question 32

Where do renal cell carcinomas arise from.

Answer 32

Proximal renal tubular epithelium.

Question 33

Why may the BP be raised with a renal cell carcinoma.

Answer 33

Due to the excretion of renin.

Question 34

Why might there be polycythaemia with renal cell carcinoma.

Answer 34

Due to erythropoietin secretion.

Question 35

How is spread of renal cell carcinoma classified. (2)

Answer 35

Direct. | Indirect.

Question 36

What is the route of direct spread of renal cell carcinoma. (2)

Answer 36

Renal vein. | Lymph.

Question 37

What is the route of indirect spread of renal cell carcinoma. (3)

Answer 37

Haematogenous (bone, liver, lung).

Question 38

Where does transitional cell carcinoma occur. (3)

Answer 38

Bladder (50%). Ureter. Renal pelvis.

Question 39

What is the average age of onset of transitional cell carcinoma.

Answer 39

>40.

Question 40

What is the ration of men:women who develop transitional cell carcinoma.

Answer 40

4:1

Question 41

What is the usual presentation of transitional cell carcinoma. (5)

Answer 41

``` Painless haematuria. Frequency. Urgency. Dysuria. Urinary tract obstruction. ```

Question 42

What is a Wilms' tumour.

Answer 42

A nephroblastoma.

Question 43

When do Wilms' tumour occur.

Answer 43

Usually in childhood (first three years of life).

Question 44

What is the prevalence of Wilm's tumours.

Answer 44

1:100,000. | It is the chief abdominal malignancy in children.

Question 45

What is the 5 year survival rate for transitional cell carcinomas.

Answer 45

10-80% (varies with clinical stage/histological stage)

Question 46

Where do Wilms' tumours arise from.

Answer 46

A tumour of the primitive renal tubules and mesenchymal cells.

Question 47

How do Wilms' tumours present. (2)

Answer 47

Abdominal mass. | Haematuria.

Question 48

What is the prevalence of renal adenocarcinomas.

Answer 48

16/100,000.

Question 49

What is the most common histological subtype of renal adenocarcinomas.

Answer 49

Clear cell carcinomas.

Question 50

What is the main problem with clear cell carcinomas. (3)

Answer 50

There is early spread of the tumour into the renal pelvis - causing haematuria. Also along the renal vein, often extending into the IVC.

Question 51

What is the first line investigation if a renal adenocarcinoma is suspected.

Answer 51

Ultrasound - this can differentiate between a renal cyst and a solid tumour.

Question 52

What condition is characterised by bilateral renal cell carcinomas, haemangioblastomas, phaechromocytomas and renal cysts.

Answer 52

Von Hippel-Lindau disease.

Question 53

What is Von Hippel- Lindau disease.

Answer 53

An autosomal dominant disorder.

Question 54

What percentage of patients present with metastases from renal cell carcinomas.

Answer 54

33%

Question 55

Are Wilm's tumours unilateral or bilateral.

Answer 55

They may be bilateral.

Question 56

What is the 5 year survival rate for children with Wilm's tumours.

Answer 56

90%