Renal cell carcinoma

Question 1

Risk factors for renal cell carcinoma

Answer 1

smoking
overweight/obesity
hypertension
haemodialysis

Question 2

Subtypes of renal cell carcinomas and which parts of nephron each affects

Answer 2

clear - proximal convoluted tubule
papillary - distal convoluted tubule
chromophobe - intercalated cells
medullary - distal collecting ducts
collecting duct - collecting ducts

Question 3

What are the stages on Bosniak classification system for renal cysts?

Answer 3

based on contrast-enhanced CT
1) benign simple cyst
2) minimally complex cyst
3) indeterminate cystic mass
4) clearly malignant cystic mass

Question 4

Presentation of renal cell carcinoma

Answer 4

many are asymptomatic and non-palpable until they are advanced

often incidental findings

classic triad = flank pain, gross haematuria, palpable abdominal mass (less common now)

Question 5

Work up for suspected renal cell carcinoma

Answer 5

bloods:
- FBC
- U&E
- LFTs
- clotting
- INR
- LDH
- calcium
- CRP

imaging:
- contrast CT CAP - early arterial phase + nephrogenic phase
- CT urogram (delayed phase)
+/- biopsy
USS/MRI not routinely used but have a role

Question 6

Renal cell carcinoma management

Answer 6

surveillance
partial nephrectomy
laparoscopic radical nephrectomy
open nephrectomy
cytoreductive nephrectomy
systemic treatment (tyrosine kinase inhibitors/immunotherapy)

Question 7

When is surveillance appropriate management for renal cell carcinoma?

Answer 7

small renal masses <3cm
asymptomatic elderly
high surgical risk
competing comorbidities
monitor 6-12 monthly

Question 8

What score is used to predict metastases after radical nephrectomy in clear cell RCC?

Answer 8

Leibovich score