Makindo Medical Notes

Related Subjects: |Urothelial tumour s |Haematuria |Acute Urinary Retention |Anuria and Oliguria |Bladder cancer |Renal cell carcinoma |Benign Prostatic Hyperplasia |IgA nephropathy |Prostate Cancer |Henoch-Schonlein purpura |Glomerulonephritis

About

• Commonest renal tumour in adults
• Seen in those aged 50+ commoner in males

Aetiology

• Genetic Factors:
  • Von Hippel-Lindau (VHL) syndrome is a hereditary condition associated with RCC.
  • Hereditary papillary renal carcinoma (HPRC) and other genetic syndromes.
• Lifestyle Factors:
  • Smoking significantly increases the risk of RCC.
  • Obesity is a known risk factor for developing RCC.
• Medical Conditions:
  • Hypertension (high blood pressure) is associated with an increased risk of RCC.
  • Chronic kidney disease and dialysis are also risk factors.
• Occupational Exposures:
  • Exposure to certain chemicals, such as asbestos and cadmium, can increase the risk of RCC.

Histology

• Originates in renal tubular epithelium and 10% are bilateral
• The disease encompasses >10 histological and molecular subtypes
• Clear cell RCC (ccRCC) is most common and accounts for most cancer-related deaths

Risks

• Male > Women
• Obesity, HTN, Smoking, Chronic kidney disease
• Haemodialysis, Kidney transplantation
• Acquired kidney cystic disease, A previous RCC diagnosis
• Possibly, diabetes mellitus

Clinical

• Abdominal mass causing flank pain and Haematuria,
• Weight loss, Polycythaemia, Fever and PUO, Hypertension
• Left sided varicocele (left testicular vein drains into the left renal vein)
• Lung, liver, bone and brain metastases
• Spread can occur into the renal vein and grow up into the inferior vena cava and involve the heart and can spread haematogenously
• Paraneoplastic effects - Produces Ectopic EPO, ACTH, PTHrp, Prolactin and renin

Investigations

• Urinalysis + cytology - Blood + malignant cells
• FBC - anaemia or polycythaemia
• USS - mass is seen and clot extending into IVC
• IVU shows filling defect
• CXR - cannonball metastases
• CT to stage tumour. Provides detailed images and helps in staging the cancer.
• MRI: Used for further evaluation if needed, especially to assess the spread of the disease.
• Renal Biopsy

Management: 5-year survival is 60% for local disease and 5% for metastatic disease

• Treatment is a mix of Surgery, Radiation therapy, Chemotherapy, Immunotherapy and Targeted therapy. Stop smoking.
• Surgery: Partial or radical nephrectomy. Removal of the primary may improve outcome even with the presence of metastases. Radical nephrectomy removes adrenals and lymph nodes.
• External radiation therapy: treat renal cell cancer, and may also be used as palliative therapy to relieve symptoms and improve quality of life.
• Local treatments: Radiofrequency ablation: Uses heat to destroy cancer cells. Cryoablation: Uses extreme cold to destroy cancer cells.
• Chemotherapy: Generally less effective for RCC but may be used in specific cases.
• Immune checkpoint inhibitors (e.g., nivolumab, pembrolizumab) to boost the body's immune response against cancer cells.

References

• Renal cell carcinoma