Renal Cell Carcinoma (RCC)
A+E
Idiopathic. Mean age is 55y.o. ♂ 2X ↑. Blacks ↑
Risks:
smoking, obesity, LT dialysis (30X ↑ risk), HTN, heavy metals, tuberous sclerosis + VHL
P+P
Quantity:
Pathology:
Forms:
Prognosis:
Genetics:
Complications:
RCC 80% of renal carcinomas (aka hypernephroma)
Highly vascular tumours arising from the PCT lining. Most lethal of all GU tumours
Has tendency to invade the IVC
①Clear Cell (80%) ②Papillary (10%) ③Chromophobe (5%) ④ Collecting Duct (1%)
70% 5Y survival without mets, 20% 5Y survival with LN mets, 5% 5Y survival with distant mets
Mets to the lungs/bones in 25% at presentation. Radio and chemotherapy resistant
VHL association due to deletion of short arm of chrome 3
Polycythaemia/Hyperviscosity due to ↑ EPO, HyperCa2+ due to PTH production
S+S
Asymptomatic:
Classic Triad(15%):
Weight ↓:
HTN:
FUO:
Varicocele:
50% are incidental findings
①Haematurea (60%) ②Loin pain (40%) ③Abdominal mass (25%)
30%
30% due to rennin hyper secretion
DDx
Unilateral Kidney ↑:
Wilms HARP:
Wilms Tumour, Hydronephrosis, Acute renal vein thrombosis, acute
pyelonephritis, RCC, PKD + pyonephritis
Iф
Hx:
Ex:
FBC:
U+E:
Abdo CT:
Renal US:
Biopsy:
MRI:
Renal arteriography:
Urine cytology:
IVU:
HIP MUD GIT:
Unilateral palpable kidney
Anaemia (30%) due to ↓ EPO
HyperCa2+ as a paraneoplastic effect of ↑ PTH production by the Ca
Most RCC diagnosed from this alone, without requiring biopsy
Shows solid lesions, renal vein + IVC patency
Only in unusual cases
Tumour staging
Shows tumours circulation, rarely used
Assessment of contralateral renal function
Tx
Nephrectomy:
Sunitinib:
Radical or partial unless bilateral or contralateral kidney’s function is poor
MAb against tyrosine kinase. Hasn’t shown to ↑ survival.