Renal cell cancer

Question 1

Define

Answer 1

DEFINITION: primary malignancy of the kidneys

Question 2

Causes

Answer 2

Renal clear cell carcinoma (80%) - UNKNOWN CAUSE

Papillary carcinoma (10%) - UNKNOWN CAUSE

Transitional cell carcinoma (10%)

NOTE: these occur at the renal pelvis

Question 3

Risk factors

Answer 3

Associated with certain inherited conditions:

• von Hippel-Lindau disease

Mutation in the von Hippel-Lindau protein, which causes headaches, balance issues, dizziness, limb weakness, vision problems and high blood pressure

• Tuberous sclerosis

A rare genetic disease that causes benign tumours to grow in the brain and other organs (e.g. skin, kidneys, lungs, eyes)

• Polycystic kidney disease
• Familial renal cell cancer

Smoking

Chronic dialysis

NOTE: renal cell cancer can cause abnormal LFTs in the absence of liver metastases = Strauffer’s Syndrome

Question 4

Epidemiology

Answer 4

UNCOMMON

3% of all adult malignancies

Peak incidence: 40-60 yrs

Question 5

Symptoms

Answer 5

Renal Cell Carcinoma

• Usually present LATE
• Asymptomatic in 90%
• Triad of Symptoms:
• Haematuria
• Flank pain
• Abdominal mass

Transitional Cell Carcinoma

• Presents EARLIER with haematuria

Systemic Signs of Malignancy

• Weight loss
• Malaise
• Paraneoplastic syndromes (e.g. fever, hypercalcaemia, polycythaemia)

Question 6

Signs

Answer 6

Palpable renal mass

Hypertension

Plethora

Anaemia

A left-sided tumour can obstruct the left testicular vein as it joins the left renal vein, and cause a left-sided varicocoele

Question 7

Investigations

Answer 7

Urinalysis

• Haematuria
• Cytology

Bloods

• FBC
• U&Es
• Calcium
• LFTs
• High ESR (in 75%)

Abdominal Ultrasound

• Best first-line investigation
• Can distinguish between solid masses and cystic structures

CT/MRI

• Useful for staging

Staging system: Robson Staging