RENAL CELL CARCINOMA

Question 1

RCC dx

Answer 1

• gross or microscopic hematuria
• flank pain or mass in some pts
• systemic sx (fever, wt loss)
• solid renal mass on imaging

Question 2

• what age does RCC have peak incidence
• ratio male to female

Answer 2

• peak incidence in 60s
• male to female ratio 2:1

Question 3

RCC RFs

Answer 3

• physical inactivity
• obesity
• DM
• cig smoking

Question 4

RCC sporadic v hereditary
- which is MC

Answer 4

• hereditary syndromes with autosomal dom pattern that include RCC
• there is some assoc with dialysis related acquried cystic ds and specific genetic aberrations (ACD-RCC)
• sporadic/spontaneous is MORE COMMON

Question 5

• where does RCC originate
• histological cell types

Answer 5

• originate in proximal tubules cells in renal cortex

histo types:
- clear cell, papillary, chromophobe, collecting duct, sarcomatoid

Question 6

RCC S+S

Answer 6

• triad of flank pain, hemturia, and mass in adv patients
• cough, bone pain (metastatic ds sx)
• fever as paraneoplastic sx

can have these Sx inidividually, triad is just MC in adv ds

Question 7

detection of tumors

Answer 7

since US and cross sectional imaging is used so commonly, renal tumors are freq detected in pts with no urologic sx

Question 8

stage IV kidney cancer can spread where

Answer 8

brain, distant LNs, lung, liver, adrenal glands, bone

Question 9

RCC lab findings

Answer 9

• hematuria (<50% pts)
• erthrocytosis from inc EPO, anemia MC
• hypercalcemia
• stauffer syndrome

Question 10

stauffer syndrome

Answer 10

NON METASTATIC
- reversible syndrome of hepatic dysfunc w elevated liver tests in ABSENCE of metastatic ds
- tumor induced inflamm response
- can resect tumor

Question 11

RCC imaging

Answer 11

• solid renal masses first identify with abd US or CT

CT MRI confirm mass, staging, and spread
- to LN, renal vein, vena cava tumor thrombus, adrenal or liver metastases
- identify function of contralat kidney and also bilat of neoplasm

Question 12

other imaging for RCC pts

Answer 12

• chest radiographs or CT to exclude pulm metastases
• bone scans for large tumors in pts with bone pain or elevated serum alk phos
• brain imaging in pts w high metastatic burden or pts w neuro deficits

Question 13

RCC tx
- primary tx
- single kidney, bilat lesions, or renal ds
- small cancer w good renal func
- cancer >7 cm
- cancer 3-4 cm w risk of occurence

Answer 13

• PRIMARY: surgical extirpation (localized RCC)
• pts with single kidney, bilat lesions, or medical renal ds–> partial nephrectomy
• small cancer w nl contralat kidney and good kidney func –> partial nephrectomy
• cancer >7cm –> radical nephrectomy
• cancer <3-4 cm + similar risk of metastatic progression and high risk of local recurrence —> radiofreq and cryopsurgical ablation (alt to surgery)

Question 14

RCC prognosis after radical or partial nephrectomy
- confined to renal capsule
- extended beyond capsule
- node pos tumors

Answer 14

• tumors confined to renal capsule—> 5 yr ds free, survival 90-100%
• tumors beyond renal capsule (T3 or 4) —> 5 yr ds free, survival rate 50-60%
• node pos tumors —> 5 yr ds free, survival rate 0-15%

Question 15

what subgroup has long term survival

Answer 15

pts with nonlocalized ds, especially w solitary resectable metastases

Question 16

prognosis radical nephrectomy w solitary metastasis

Answer 16

5 yr ds free, survival rate 15-30%