What are the major types of malignant RCC?
Renal Adenocarinoma (primarily in the proximal tubule)
85% - Clear Cell
10% - Papillary
What are the risk factors for renal cell carinoma?
FH (lots of inherited disorders incl. Von Hippal-Lindau Syndrome) Smoking Obesity Anti-hypertensive treatment ESRF Acquired renal cystic disease
How does a RCC present?
Mostly asymptomatically, they’re found incidentally on imaging.
10% show the classic triad of flank pain, mass and haematuria.
30% can have paraneoplastic syndromes
30% can have metastatic disease
Where does RCC metastasize to?
Describe some paraneoplastic syndrome resulting from RCC?
- Anorexia, cachexia & Pyrexia
- Hypertension, hypercalcaemia & deranged LFTs
- Anaemia, Polycythaemia & raised ESR
How does renal cell carcinoma tend to spread?
Directly –> Surrounding tissue & occasionally bowel
Haematogenously –> Lungs & Bone
Venous –> Renal vein/IVC
Lymphatically –> Paracaval Nodes
What tests would you do to diagnose and stage renal cancer?
CT abdo & Chest - Confirms diagnosis, stages and assesses contralateral kidney
What other tests can be done to assess the contralateral kidneys function?
DMSA or MAG-3 isotope testing
What bloods would you run if you suspect RCC?
FBC & U&Es
How is RCC treated?
Mainly Laparoscopic Radical Nephrectomy
Patients with small no of metastases can get palliative Cytoreductive Nephrectomy to prolong life
Some immunotherapy (e.g. with interferon-alpha) or Tyrosine Kinase Inhibitors (e.g. Sorafenib)
Why isnt RT / Chemo used in RCC?
RCC is largely chemo and RT resistant
How is RCC staged?
T1 - in capsule <7cm T2 - In capsule >7cm T3 - Outside capsule T3a - In fat T3b - Renal Vein or IVC below diaphragm T3C - IVC above diaphragm T4 - Beyond Gerota's Fascia
Prognosis for RCC?
Depends on stage:
T1 - very good 95% 5 yr survival
T4 - Very bad 20% 5 yr survival
M1 - 12-18months