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Y3M - Urology > Renal Cancer > Flashcards

Flashcards in Renal Cancer Deck (22)
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1

What is the most common form of adult renal cancer?

Renal cell carcinoma RCC

It is the 9th most common cancer worldwide

2

Epidemiology of RCC

High incidence in developed countries

M 1.5:1 F

Peak incidence in 50-70 years

3

Other renal cancers

TCC (urothelial tumours)

Nephroblastoma in children (Wilm's tumour)

Squamous cell carcinoma (chronic inflammation secondary to renal calculi, infection and schistosomiasis)

 

These flashcards will however focus on RCC

4

Pathophysiology of RCC

Adenocarcinoma of the renal cortex, usually arise from the proximal convoluted tubules.

Most often appearing in the upper pole of the kidney.

They can spread through direct invasion to perinephric tissues, adrenal gland, renal vein or IVC.

RCC can also spread via lympathics to pre-aortic and hilar nodes or via blood to bones, liver, brain and lung.

5

What is tumour thrombosis?

RCCs have a distinct features where they can invade through the renal vein wall and into the lumen.

6

Microscopic findings

Polyhedral clear cells

Dark staining nuclei and cytoplasm rich with lipid and glycogen granules

7

Risk factors

Smoking

Industrial exposures like cadmium, lead or aromatic hydrocarbons

Dialysis (30x increase)

HTN

Obesity

Anatomical abnormalities like polycystic kidney or horseshoe kidney

von Hippel-Lindau

BAP1 mutant disease

Birt-Hogg-Dube syndrome

8

Clinical features

Haematuria visible or non-visible

Flank pain

Flank mass

Non-specific symptoms like lethargy or weight loss.

 

Around 50% are detected incidentally on abdo imaging.

Classic triad is supposed to be haematuria, mass and flank pain but only present in 15% of cases.

9

Examination findings

Large RCC can be palpated in the flank or hypochondrial regions

Left-sided masses may also present with a left varicocoela.

10

Paraneoplastic syndromes of RCC

Polycythaemia (EPO)

Hypercalcaemia

Hypertension (renin)

Pyrexia of unknown origin

11

Dx

Urological malignancy

Renal stones

UTI

12

Lab tests

Routine bloods with FBC, U&Es, calcium, LFTs and CRP

Urinalysis + cytology

 

There are no serum tumour markers avaiable to aid in diagnosis of RCC

13

Imaging

As for most cases of haematuria -> USS or CT is done first

CT abdo-pelvis pre and post IV contrast is gold standard for suspected cases

Additional CT abdo-chest-pelvis is done for staging.

 

Biopsy of renal lesions, particularly small masses can be done.

14

When is renal biopsy done

In small renal masses when surveillance or minimally invasive ablative therapies are being considered.

15

Staging of RCC

American Joint Committe on Cancer AJCC

16

Explain AJCC

TNM staging

S1 - T1N0M0 with tumour 7cm or less and confined to renal capsule

S2 - T2N0M0 with tumour >7cm or invading the renal capsule but confined to Garota's fascia

S3 - T3 or N1M0 with tumour extending into renal vein, vena cava or spread to 1 local LN

S4 - T4N2 or M1 with tumour extending beyond Garota's fascia, >1 LN, involvement of ipsilateral adrenal gland or perinephric fat or distant metastases.

17

Management of localised disease

Surgical management either through laparoscopy or open approach.

18

Management of localised small tumours

Partial nephrectomy may be suitable

19

Management of localised large tumours

Radical nephrectomy with removing the kidney, perinephric fat and local LN

20

If the patient isn't suitable or fit for surgical management in localised disease, what can be done?

Percutaneous radiofrequency ablation or laparoscopic/percutaneous cryotherapy.

Renal artery embolisation can also be done prior.

 

Surveillance of slow growing small renal masses can be employed in patients unfit or unwilling to undergo surgery with a limited life expectancy.

21

Management of metastatic disease

Nephrectomy + immunotherapy with IFN-alpha or IL-2 agents is often recommended

Biological agents like Sunitinib and pazopanib can be used

Metastasectomy is recommended where it can be done

Chemotherapy is considered ineffective.

22

Prognosis

25% have metastases at presentation

Survival underogone nephrectomy is around 70% at 3 years and 60% at 5 years.