8/4/2019 Summary of Renal Cell Carcinoma

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Summary of Renal Cell Carcinoma:

RCC:

y Lack of early warning signsy Diverse clinical manifestationsy Resistance to radiation/chemotherapy

Epidemiology:

y Accounts for 3% of adult malignanciesy Male:Female ratio = 6:1y Most commonly occurs in males aged between 65 -75 of Northern

European (Scandinavian) descent

y Can be hereditary or non-hereditary mutation of chromosome 3y Hereditary conditions:

1)Von-

Hippal

Lindau

2)Hereditary papillary renal carcinoma3)Familial renal oncocytoma4)Hereditary renal carcinoma

y 40% of Von-HippalLindau patients will develop renal carcinomaClinical Presentation:

Classic Triad:

1)Haematuria2)Flank pain3)Palpable abdominal mass

However only indicative of advanced disease. Other symptoms:

y Abnormal urine coloury Loin painy Weight lossy Varicoceley Anaemia

Pathophysiology:

y Tissue of origin = proximal renal tubular epithelium -adenocarcinoma

y Cytokines released by tumour produce paraneoplastic response:hypercalcaemia, erythrocytosis

y Classified histologically as either:o Clear cell renal cell carcinoma

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o Papillary renal cell carcinoma o Chromophobe renal cell carcinoma o Collecting duct carcinoma

Staging:

Stage I Tumour of 7cm. Limited to

kidney. No lymph nodes or

mets

Stage III: Tumour of any size with

lymph node involvement may

have spread to fatty tissue

+ large veins

Stage IV:

Any of following

y Spread directly tofatty tissue + fascia

surrounding kidney

y Involvement of >1 lymphnode near kidney

y Involvement of anylymph node not near

kidney

y Distant metastases

Initial diagnosis made via ultrasound and subsequent CT for staging

Prognosis:

5-year survival rate:

y 90% for stage 1y 51% for stage IIy 22% for stage IIIy 4.6% for stage IV

Treatment:

y If confined to kidneys can be cured with nephrectomyy If spread, adjunctive therapy is usedy RCC mostly resistant to radiotherapy and chemotherapy ->

responds well to immunotherapy

y Radical nephrectomy: also removes the perinephric fat , adrenalglands, upper ureter andl ocal nodes

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y Partial nephrectomy: if one functioning kidney, decreasedrenal function or bilateral cancer

y Arterial embolization: if patients are unsuitable for surgery.y Prognosis is 70% if there are no mets but 15 - 20% if there

are.

y Late recurrence is common.