Sunday, 19 September 2010

MRCP revision battle 15.1: Renal cell carcinoma

I've had a day off in which I've covered literally hundreds of miles and drank excessive amounts of tea and cider and seen far more gingham than any one person ever should.  Net result has been a restoration in my energy levels and so today is going to be a blockbuster of a set of battles, with 8 separate topics to cover including two that I'd never even heard of in my preceding 8 years of studying medicine.  So lets get started!

MRCP revision battle 15.1: Renal cell carcinoma
MRCP revision battle 15.2: Von Hippel Lindau
MRCP revision battle 15.3: Neuralgic amyotrophy
MRCP revision battle 15.4: Porphyrias
MRCP revision battle 15.5: Kearns-Sayre
MRCP revision battle 15.6: Klinefelters
MRCP revision battle 15.7: Pellegra
MRCP revision battle 15.8: Neuroleptic malignant syndrome

MRCP revision battle 15.1: Renal cell carcinoma

Renal cell carcinoma, also known as hypernephroma or Gravitz Tumour, is a cancer arising in the proximal renal tubular epithelium.

It accounts for 85-90% of primary renal cancer.

The classic triad for renal cell carcinoma is:
  1. haematuria
  2. loin pain
  3. abdominal mass
(NB: classic triads of course rarely exist, but may kindly present themselves during MRCP questions)

Renal cell carcinoma may also be linked to pyrexias of unknown origin.
Another clinical sign to look out for is left variocele - caused by invasion of the left renal vein causing compression of the left testicular vein.

Factors associated with developing renal cell carcinoma include:
  • smoking
  • middle aged males (male:female 2:1)
  • Von-Hippel Lindau syndrome (wait for the next battle if you don't know that that is)
  • tuberous sclerosis
  • acquired cystic kidney disease in renal failure

25% of patients with renal cell carcinoma have mets at presentation.  The commonest mets are bone, liver and lung.

Endo effects associated with renal cell carcinoma include:
  • erythropoietin --> polycythaemia
  • PTH --> raised calcium
  • renin --> raised BP
  • ACTH

Treatment is surgery.  If mets are present IL-2 or interferon alpha may also be considered.

There is a 45% 5 yr survival.

Now on to meet Von-Hippel-Lindau syndrome...