Tumours of the Bladder and Kidneys Flashcards
(46 cards)
What are the types of renal tumours?
Benign
Malignant
What is the malignant type we need to know all about?
Clear cell renal carcinoma (75% of tumours that arise)
Who gets Renal Cell Carcinoma most commonly?
50% more in men
Usually between 50 and 70 years of age
Risk factors: Smoking Hypertension Obesity Occupational exposure to toxins Genetic factors
Where do renal cell carcinomas come from?
The renal cortex
What does a tumour composed of clear cells look like under the microscope?
It is clear because cytoplasm is filled with carbohydrates and lipids and so the tumour looks yellow microscopically
What is Von Hippel-Lindau disease?
Disease in which people are unable to suppress tumours effectively due to a mutation in the VHL gene:
What happens to people with Von Hippel-Lindau disease?
People develop visceral cysts and tumours
Angiomas Haemangioblastomas Phaeochromocytomas Renal cell carcinoma Pancreatic cysts
What molecular mechanism causes sporadic clear cell RCC?
Loss of short arm of chromosome 3 either by deletion or unbalanced translocation and loss of one VHL gene.
Then other VHL gene undergoes mutation or hypermethylation
Which chromosome is the VHL gene on?
Chromosome 3
What happens when VHL is inactive?
IGF-1 is increased causing dysregulated cell growth.
IGF-1 upregulates hypoxia inducible factors which upregulate vascular endothelial growth factor (VEGF) and receptor causing new blood vessels to form
How do people present when they have RCC?
It was a silent cancer until very late in the disease.
Modern imaging means they often get picked up incidentally when other scans are being conducted
What are the classical symptoms of RCC?
Haemoturia
Abdominal mass
Flank pain
Weight loss, fever, scrotal varices (Veins in the scrotum start to engorge)
Abdominal masses can be palpated in skinny patients and feels firm non-tender and moves with respiration
Costovertebratl angle pain
When does haematuria occur?
When the carcinoma invades the collecting system which means its pretty bad at that stage.
What is a potential complication with haematuria?
Clots can form that get stuck in the ureter which results in colicky pain
Why do scrotal varices occur?
IVC can be blocked by the carcinoma at the gonadal vein causing blood to pool at the scrotum.
This condition is very rare
What is renal cell carcinoma associated with? What other carcinoma is associated with this?
Paraneoplastic syndromes
Small cell carcinoma of the lung can cause this to occur too
What are some paraneoplastic syndrome effects?
Hypercalcaemia (from overproduction of parathyroid hormone or metastasis to the bone)
Erythrocytosis (overproduction of erythropoietin)
Hypertension (overproduction of renin)
Cushing syndrome (overproduction of ACTH)
Other cytokines cause fever and weight loss
What is a common association between Renal Cell Carcinoma and veins?
As the carcinoma grows it gains access to the veins in the renal sinus which then goes to the IVC which makes it spread to lung, bone, and brain :(
What work is done when Renal Cell Carcinoma is suspected?
Abdominal CT
Chest CT
Biopsy
Bone scan if patient has bone pain
How is renal cell carcinoma staged?
On the basis of presence of absence of regional lymph node metastasis
M0 or M1 on the basis of presence or absence of distant metastasis
T1 or T2 is how big its getting and whether or not its accessed the veins of the renal sinus or IVC
T4 is when it invades into gerotas fascia
How is renal cell carcinoma treated typically?
Surgery as RCC is resistant to traditional chemotherapy and radiotherapy.
What are the types of therapies taking place at the moment?
Immunomodulatory therapies eg PD1 inhibitors and IL-2
Targeted therapies (block VEGF pathway)
Summary of RCC:
75% of cancers of the kidneys are clear cell renal cell carcinomas
Risk factors are smoking, obesity, and hypertension
Associated with inherited syndromes (VHL)
A silent cancer which may be present late or picked up incidentally
Classic triad: Haematuria, flank pain and palpable mass
Staged using the TNM system
What are the most common bladder tumours?
Urothelial carcinoma (90%)
Small percentage of them are squamous cell carcinomas
