Renal Cell Carcinoma

Question 1

What is kidney cancer?

Answer 1

A malignant tumor of the kidney, also known as renal cell carcinoma (RCC), hypernephroma, or Grawitz tumor.

Question 2

What percentage of adult malignancies does kidney cancer account for?

Answer 2

3% of all adult malignancies in the Western world.

Question 3

What are the benign renal neoplasms?

Answer 3

Benign renal cyst, papillary adenoma, renal oncocytoma, metanephric adenoma, and angiomyolipoma.

Question 4

What are the malignant renal neoplasms?

Answer 4

Conventional (clear cell) renal carcinoma, papillary renal carcinoma, chromophobe renal carcinoma, collecting duct carcinoma, and unclassified renal cell carcinoma.

Question 5

What is the most common type of renal cell carcinoma (RCC)?

Answer 5

Conventional (clear cell) renal carcinoma.

Question 6

What genetic mutations are associated with renal cell carcinoma?

Answer 6

VHL gene (clear cell RCC), c-Met gene (type 1 papillary RCC), fumarate hydratase gene (type 2 papillary RCC), and Birt-Hogg-Dubé (BHD) gene (chromophobe RCC).

Question 7

What environmental risk factors are associated with kidney cancer?

Answer 7

Tobacco use, high-fat diet, low fruit and vegetable intake, coffee & tea, dairy products, dry cleaning chemicals, trichloroethylene, cadmium, asbestos, arsenic, and phenacetin exposure.

Question 8

What medical conditions increase the risk of kidney cancer?

Answer 8

Sickle cell trait (medullary RCC), chronic dialysis, obesity, hypertension, diuretic use, polycystic kidney disease, and radiation exposure.

Question 9

What are the clinical features of kidney cancer?

Answer 9

May be incidental or present with local tumor growth, hematuria, paraneoplastic syndrome (20% of patients), or metastatic disease.

Question 10

What is the classic triad of renal cell carcinoma?

Answer 10

Flank pain, gross hematuria, and a flank/abdominal mass.

Question 11

What laboratory investigations are done for kidney cancer?

Answer 11

Full blood count (FBC), erythrocyte sedimentation rate (ESR), electrolytes & urea (E&U), creatinine, liver function tests, urinalysis.

Question 12

What imaging studies are used in kidney cancer diagnosis?

Answer 12

Ultrasound (USS) of the abdomen, CT scan (native and contrast), MRI, chest X-ray (CXR), intravenous urogram (IVU), isotope nephrogram, and bone scintigraphy.

Question 13

What is the role of fine needle aspiration cytology (FNAC) in kidney cancer diagnosis?

Answer 13

It is controversial and not commonly used for diagnosis.

Question 14

What are the staging systems used for kidney cancer?

Answer 14

Robson and TNM (2002) staging systems.

Question 15

What are the treatment options for kidney cancer?

Answer 15

Observation (for small localized tumors in elderly patients), partial nephrectomy, radical nephrectomy, palliative/cytoreductive nephrectomy, immunotherapy, anti-angiogenesis agents, chemotherapy, radiotherapy, and gene therapy (future potential).

Question 16

What is the role of chemotherapy and radiotherapy in kidney cancer?

Answer 16

They have a very poor response except for bone and brain metastases.

Question 17

What emerging treatment modalities are being considered for kidney cancer?

Answer 17

Multi-drug resistance gene targeting, Cyclin B1 elaboration (Ikuerowo et al 2006), and gene therapy.

Question 18

What is the importance of follow-up in kidney cancer management?

Answer 18

To monitor for recurrence, metastasis, and response to treatment.

Question 19

What is another name for renal cell carcinoma?

Answer 19

Hypernephroma or Grawitz tumor.

Question 20

What is the most common primary renal malignancy?

Answer 20

Renal cell carcinoma (RCC).

Question 21

What is the incidence trend of kidney cancer?

Answer 21

It has been increasing in recent years.

Question 22

What are the main types of papillary renal carcinoma?

Answer 22

Type 1 and Type 2 papillary renal carcinoma.

Question 23

Which genetic mutation is associated with clear cell RCC?

Answer 23

VHL (Von Hippel-Lindau) gene mutation.

Question 24

What genetic mutation is associated with type 1 papillary RCC?

Answer 24

c-Met gene mutation.

Question 25

Which genetic mutation is associated with type 2 papillary RCC?

Answer 25

Fumarate hydratase gene mutation.

Question 26

Which genetic mutation is associated with chromophobe RCC?

Answer 26

Birt-Hogg-Dubé (BHD) gene mutation.

Question 27

What lifestyle factor is a major risk factor for kidney cancer?

Answer 27

Tobacco use (smoking).

Question 28

How does obesity contribute to kidney cancer?

Answer 28

It increases the risk due to hormonal and metabolic changes.

Question 29

What is the relationship between chronic dialysis and kidney cancer?

Answer 29

Long-term dialysis increases the risk of renal cell carcinoma.

Question 30

What occupational exposures increase the risk of kidney cancer?

Answer 30

Dry cleaning chemicals, trichloroethylene, cadmium, asbestos, arsenic, and phenacetin.

Question 31

What is paraneoplastic syndrome in kidney cancer?

Answer 31

A syndrome where tumors produce hormones or cytokines causing systemic effects like hypertension, polycythemia, and hypercalcemia.

Question 32

How common is paraneoplastic syndrome in kidney cancer?

Answer 32

It occurs in about 20% of patients.

Question 33

What is the most common symptom of kidney cancer?

Answer 33

Hematuria (blood in the urine).

Question 34

What percentage of kidney cancers are detected incidentally?

Answer 34

A significant proportion, often during imaging for unrelated conditions.

Question 35

What is the role of ultrasound in kidney cancer diagnosis?

Answer 35

It helps detect renal masses and differentiate between cystic and solid tumors.

Question 36

Why is contrast-enhanced CT scan important in kidney cancer?

Answer 36

It provides detailed imaging of the renal mass and its vascular involvement.

Question 37

When is MRI preferred over CT in kidney cancer evaluation?

Answer 37

When a patient has contraindications to contrast agents or for better soft tissue characterization.

Question 38

Why is chest X-ray performed in kidney cancer patients?

Answer 38

To check for lung metastases.

Question 39

What is the purpose of bone scintigraphy in kidney cancer?

Answer 39

To detect bone metastases in patients with bone pain or elevated alkaline phosphatase.

Question 40

What is the Robson staging system used for?

Answer 40

To classify kidney cancer based on the extent of tumor spread.

Question 41

What is the TNM staging system for kidney cancer?

Answer 41

A system that classifies tumors based on Tumor size (T), Node involvement (N), and Metastasis (M).

Question 42

What is the primary treatment for localized kidney cancer?

Answer 42

Radical or partial nephrectomy.

Question 43

What is a partial nephrectomy?

Answer 43

A surgical procedure that removes only the tumor and preserves kidney function.

Question 44

When is radical nephrectomy indicated?

Answer 44

For larger tumors or when the entire kidney is involved.

Question 45

What is cytoreductive nephrectomy?

Answer 45

A palliative surgery to reduce tumor burden in metastatic kidney cancer.

Question 46

What is the role of immunotherapy in kidney cancer?

Answer 46

It helps enhance the immune response against cancer cells.

Question 47

What are examples of anti-angiogenesis agents used in kidney cancer?

Answer 47

Drugs like sunitinib and bevacizumab that inhibit tumor blood vessel growth.

Question 48

Why is chemotherapy generally ineffective in kidney cancer?

Answer 48

RCC is resistant to most traditional chemotherapy agents.

Question 49

What is the role of radiotherapy in kidney cancer?

Answer 49

It is mainly used for palliative treatment of bone and brain metastases.

Question 50

What is the emerging role of gene therapy in kidney cancer?

Answer 50

Potential future treatment targeting specific genetic mutations in RCC.

Question 51

What is multi-drug resistance in kidney cancer?

Answer 51

A phenomenon where tumor cells become resistant to multiple chemotherapy drugs.

Question 52

What protein is linked to chemotherapy resistance in kidney cancer?

Answer 52

Cyclin B1, which promotes tumor cell proliferation.

Question 53

What is the importance of follow-up in kidney cancer?

Answer 53

To detect recurrence, metastasis, or complications after treatment.

Question 54

What imaging modalities are used for kidney cancer follow-up?

Answer 54

CT scans, MRI, and chest X-rays.

Question 55

What is the prognosis of localized kidney cancer after surgery?

Answer 55

Good, with high survival rates if detected early.

Question 56

What factors indicate poor prognosis in kidney cancer?

Answer 56

Advanced stage, metastasis, large tumor size, and poor histologic differentiation.