Updated: 10/28/2019

Renal Cell Carcinoma

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
5
0
0
0%
0%
Evidence
4
0
0
Topic
Overview
  • 65-year-old man with a 40 pack-year history of smoking presents with right costovertebral angle pain, hematuria, fever, and a palpable mass in the right lower quadrant. CT of the abdomen demonstrates a contrast enhancing lesion on the kidney.
Introduction
  • Overview
    • renal malignancy originating from the proximal renal tubular epithelium 
  • Epidemiology
    • incidence
      • represents 2-3% of all adult cancers
      • accounts for ~85% of adult renal cancers
      • clear cell carinoma is the most common type and other types include
        • papillary carcinoma
        • chromophobe carcinoma
        • collecting duct carcinoma
    • demographics
      • more common in men
      • mean age is 60 years of age
    • risk factors
      • tobacco smoking (most significant)
      • obesity
      • hypertension
      • genetic factors
      • acquired cystic renal disease
  • Pathogenesis
    • structural alterations in the short arm of chromosome 3 can result in sporadic or hereditary renal cell carcinoma in certain subtypes (e.g., clear cell)
  • Associated conditions
    • von Hippel-Lindau
    • tuberous sclerosis
    • paraneoplastic syndromes
    • hereditary papillary renal carcinoma
    • familial renal oncocytoma
    • paraneoplastic syndromes 
      • ectopic EPO, ACTH, PTHrP, and prolactin
  • Prognosis 
    • poorer prognosis
      • as the anatomic extent of the disease worsens
      • tumor grade
      • poor performance status
      • paraneoplastic syndrome
      • obesity
Presentation
  • Symptoms 
    • hematuria
      • occurs when the tumor invades the collecting system
    • flank pain
  • Physical exam
    • palpable abdominal renal mass 
      • the mass is typically found to be
        • firm
        • nontender
        • homogeneous
    • scrotal varicoceles
      • varicoceles do not empty with recumbancy
    • involvement of the inferior vena cava can result in
      • lower extremity edema
      • ascites
      • pulmonary emboli
      • hepatic dysfunction
Imaging
  • CT scan
    • indications
      • an essential initial radiographic test for the evaluation of renal cell carcinoma
      • for an accurate assessment of the extent of local and regional involvement
        • patients must be evaluated for metastasis prior to surgery
    • modality
      • CT scan of the abdomen and pelvis before and after contrast administration
    • findings
      • enhancing lesion with contrast
      • thickened irregular walls or septa
Studies
  • Serology 
    • polycythemia  
      • paraneoplastic syndrome due to EPO release
    • hypercalcemia
      • paraneoplastic syndrome due to PTH-related hormone
    • hypercortisolism
      • due to ACTH
    • hypertension
      • due to renin
  • Histology
    • indication
      • to make a tissue diagnosis of renal cell carcinoma
Differential
  • Bladder cancer
    • differentiating factor
      • evidence of bladder malignancy via cystoscopy
Treatment
  • Medical
    • systemic therapy
      • indication
        • used in patients with unresectable disease (e.g., metastasis and localy advanced)
      • modality
        • immunotherapy (e.g., interleukin-2)
  • Surgical
    • partial or radical nephrectomy
      • indication
        • considered definitive therapy in patients with localized renal cell carcinoma 
          • partial versus radical nephrectomy is dependent on a number of factors
Complications
  • Metastasis

Please rate topic.

Average 4.8 of 5 Ratings

Questions (5)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M1.ON.13.87) A 71-year-old male presents to your office with painless hematuria and left costovertebral angle pain. His body mass index is 33 kg/m^2. A renal biopsy is shown in Figure A. The patient’s mass is most likely a malignancy of which of the following:

QID: 101041
FIGURES:
1

Tubular epithelial cells

46%

(22/48)

2

Perirenal adipose cells

19%

(9/48)

3

Metastatic adrenocortical carcinoma

17%

(8/48)

4

Mesangial cells

17%

(8/48)

5

Visceral epithelial cells

2%

(1/48)

M 1 E

Select Answer to see Preferred Response

Evidence (4)
EXPERT COMMENTS (16)
Private Note