SM_234b: Renal Cell Carcinoma

Question 1

____ is associated with an increased risk of renal cell carcinoma

Answer 1

Smoking is associated with an increased risk of renal cell carcinoma

• Obesity, ESRD, some exposures

Question 2

Describe signs and symptoms of renal cell carcinoma

Answer 2

Signs and symptoms of renal cell carcinoma

• Hematuria
• Flank pain
• Palpable mass
• Bilateral
• Metastatic disease
• Mostly incidental

Question 3

Classic triad of renal cell carcinoma is ____, ____, and ____

Answer 3

Classic triad of renal cell carcinoma is hematuria, flank pain, and palpable mass

Question 4

Renal cell carcinoma may present with ____ syndromes

Answer 4

Renal cell carcinoma may present with paraneoplastic syndromes

• Cachexia / fever (cytokines)
• Nephropathy (Ig formation)
• HTN 9renin)
• Hypercalcemia
• Anemia (cytokine myelosuppression)
• Hyperglycemia
• Stauffer’s syndrome
• Erythrocytosis
• Amyloidosis

Question 5

Describe diagnostic testing for renal cell carcinoma

Answer 5

Diagnostic testing for renal cell carcinoma

• Hematuria work-up: need to assess all of the GU system, urine culture, multiphase cross-sectional imaging, cystoscopy
• Triphasic CT scan (non-contrast, nephrogenic phase, and excretory phase)
• MR with and without contrast
• Ultrasound + pyelography

Question 6

Describe Bosniak classification of cystic renal lesions

Answer 6

Bosniak classification of cystic renal lesions

• I: water density, homogeneous, no septa, calcification, no enhancement
• II: thin septa, thin curvilinear calcification, no enhancement, hyperdense lesion with no enhancement
• III: thick or irregular septa, thick or irregular calcification, mild to moderate heterogeneity, no enhancement
• IV: thick walls or nodular areas, marked heterogeneity, enhancement

Risk of malignancy increases as classification increases

Question 7

Sporadic renal cell carcinoma is ____, ____, ____, and ____

Answer 7

Sporadic renal cell carcinoma is 95% of renal cell carcinomas, single tumors, unilateral, and develop at a later age

Question 8

Clear cell carcinomas originate from the ___

Answer 8

Clear cell carcinomas originate from the proximal tubule

(75% of renal cell carcinoma)

Question 9

Papillary renal cell carcinomas originate from the ___

Answer 9

Papillary renal cell carcinomas originate from the proximal tubule

(10-15% of renal cell carcinomas)

Question 10

Chromophobe renal cell carcinomas originate from ____

Answer 10

Chromophobe renal cell carcinomas originate from intercalated cell of cortical collecting duct

(10% of renal cell carcinoma)

Question 11

Oncocytoma is a ____ that originates from the ____

Answer 11

Oncocytoma is a benign entity that originates from the intercalated cells of the cortical collecting duct

Question 12

Hereditary renal cell carcinomas are ____, ____, ____, ____, and ____

Answer 12

Hereditary renal cell carcinomas are 5% of all renal cell carcinomas, autosomal dominant, multifocal, bilteral, and onset in 3rd-5th decade

• VHL, HPRC, HLRCC, BHD

Question 13

As renal cell carcinoma stage increases, survival ____

Answer 13

As renal cell carcinoma stage increases, survival decreases

Question 14

Localized renal cell carcinoma can be managed with ____, ____, or ____

Answer 14

Localized renal cell carcinoma can be managed with surveillance, ablation, or surgical excision

• Surveillance: small masses, CKD, elderly or comorbidities, hereditary syndromes
• In situ ablation: cryoablation, radiofrequency ablation, percutaneous vs laparoscopic
• Surgical: radical nephrectomy, partial nephrectomy, open surgery, laparoscopic surgery w/ or w/o robotic assistance

Question 15

Partial nephrectomy for renal cell carcinoma is performed if ____, ____, ____, or ____

Answer 15

Partial nephrectomy for renal cell carcinoma is performed if bilateral tumors, solitary kidney, global renal insufficiency, or polar tumors ≤ 4 cm

Question 16

IVC tumor thrombus is managed with ____

Answer 16

IVC tumor thrombus is managed with IVC thrombectomy

Question 17

Describe management of metastatic disease in renal cell carcinoma

Answer 17

Management of metastatic disease in renal cell carcinoma

• Poor survival
• Cytotoxic chemotherapy works poorly
• Immunotherapy: anti CTLA-4 (ipilimumab), anti PD1 (nivolumab, pembrolizumab), anti PDL1 (avelumab)

Question 18

___, ___, and ___ are risk factors for renal cell carcinoma

Answer 18

Obesity, tobacco consumption, and ESRD are risk factors for renal cell carcinoma

Question 19

____ is a paraneoplastic condition associated with renal cell carcinoma resulting from increased IL-6 production

Answer 19

Stauffer’s syndrome is a paraneoplastic condition associated with renal cell carcinoma resulting from increased IL-6 production

Question 20

____ should be obtained if a renal US demonstrates a solid cortical mass

Answer 20

Triphasic CAT scan should be obtained if a renal US demonstrates a solid cortical mass

Question 21

____ is NOT associated with any extra-renal manifestations

Answer 21

Hereditary papillary renal cell carcinoma is NOT associated with any extra-renal manifestations

Question 22

Describe heritable syndromes associated with renal cell neoplasia

Answer 22

Heritable syndromes associated with renal cell neoplasia

Question 23

____, ____, and ____ are conventional management options for small organ confined renal cell carcinoma

Answer 23

Surveillance, laparoscopic cryoablation, and robotic-assisted partial nephrectomy are conventional management options for small organ confined renal cell carcinoma

Question 24

____ is the assigned level of a renal cell carcinoma tumor thrombus that is located above the hepatic vein confluence

Answer 24

Level 4 is the assigned level of a renal cell carcinoma tumor thrombus that is located above the hepatic vein confluence

Question 25

Describe levels of renal cell carcinoma IVC thrombus

Answer 25

Levels of renal cell carcinoma IVC thrombus

• Level 1: < 2 cm from RV ostium
• Level 2: > 2 cm from RV ostium but below hepatic veins
• Level 3: intrahepatic IVC (not above hepatic veins)
• Level 4: above hepatic veins (including into right atrium)

Question 26

Chemotherapy ____ beneficial for metastatic renal cell carcinoma

Answer 26

Chemotherapy is NOT beneficial for metastatic renal cell carcinoma