Renal carcinoma Flashcards
What is renal cell carcinoma?
Renal cell carcinoma:
=> arises from proximal tubular epithelium
=> highly vascular tumours
=> microscopically, most are composed of
=> most common renal tumour in adults
Who does renal cell carcinoma commonly affect?
Men > women
Present >50 years
15% of haemodialysis patients
Most common renal carcinoma in adults
What are the clinical features of renal cell carcinomas?
Most asymptomatic & discovered incidentally
Haematuria
Loin pain
Mass in the flank area
Malaise, fatigue, weight loss (30%)
Polycythaemia (5%)
Hypertension (30%) => renin secretion by the tumour
Anaemia => depression of erythropoietin
Pyrexia (20%)
Metastases (33%)
Invasion of left renal vein compresses left testicular vein => varicocele
25% of renal cell carcinoma patients have metastases on presentation.
How does renal cell carcinoma spread?
Spread may be:
Direct (via renal vein)
via lymph
Haematogenous (bone, liver, lung)
What investigations are carried out to diagnose renal cell carcinoma?
High BP => due to increased renin secretion
Bloods: FBC (polycythaemia from erythropoietin secretion), raised ESR, U&E, ALP
Urine blood ; cytology
Imaging:
Ultrasound => shows mass
CT => renal lesion + involvement of renal vein or inferior vena cava
MRI > CT for tumour staging
How is renal cell carcinoma confined to the kidney managed?
Nephrectomy is performed => unless bilateral tumours present
=> preservation of as many nephrons as possible is beneficial in the long term ; partial nephrectomy advised where possible
Cryotherapy or radiofrequency ablation for unfit patients who cannot undergo surgery
For patients with renal cell carcinoma metastases, prognosis is predicted on the basis of the International Metastatic renal cell carcinoma Database Consortium (IMDC). A point is scored for each of the poor prognostic feature.
List the features.
=> Impaired fitness (<80% on Karnofsky performance score)
=> Haemoglobin below lower limit of normal
=> Neutrophils above the upper limit of normal
=> Platelets above the upper limit of normal
=> Serum calcium above the upper limit of normal
=> <12 months from diagnosis to the requirement for systemic chemotherapy
3 factors or more = poor prognosis
How is metastatic renal cell carcinoma managed?
Tyrosine kinase inhibitors (TKI), also anti-angiogenesis agents = sunitinib, pazopanib
Good prognosis: TKI given as mainstay treatment or high-dose IL-2
Poor prognosis: TKI + monoclonal antibody (which targets PD-1)
T-cell activation therapies
Anti-angiogenesis agents
mTOR inhibitors e.g Temsirolimus
Why is renal cell carcinoma not generally treated with chemo or radiotherapy?
RCC chemo/radio-resistant
What is Wilm’s tumour?
How does it present?
Wilm’s tumour is a nephroblastoma => childhood tumour of primitive renal tubules and mesenchymal cells seen within first 3 years of life.
Main abdominal malignancy in children
Presents with abdominal mass and haematuria
Diagnosis via ultrasound, CT, MRI
Combination of nephrectomy, radiotherapy and chemotherapy => increases survival rate
