see also:

• renal masses and cysts
• neoplasia / cancer / tumours
• renal medicine (nephrology)
• wikipedia - RCC

• most malignant tumours of the kidney in adults are renal cell carcinoma
• the other main primary cancer in adults is urothelial cell carcinoma (UCC) of the renal pelvis (transitional cell carcinoma or TCC)
• paediatric cancers of the kidney include:
  • Wilm's tumour or nephroblastoma
    • most occur in ages 3-3.5yrs with children of African descent having highest incidence
    • see wikipedia
  • congenital mesoblastic nephroma - usually found prenatal or before 3 months of age
• see also wikipedia for other types of kidney cancer
• while most renal cysts can just be observed, a major medical pitfall is ignoring a solid renal mass and failing to provide appropriate follow-up care

• 90-95% of renal malignancies
• 3% of all adult malignancies
• usually presents late
• median age at diagnosis is 64yrs but may occur in much younger, particularly if familial clustering
• after radical nephrectomy for stage I renal cell carcinoma, the 5-year survival rate is approximately 94%.
  • patients with stage II lesions have a survival rate of 79%.

• arises from the proximal renal tubular epithelium
• more common in people of Northern European ancestry and North Americans than in those of Asian or African descent.
• sporadic (nonhereditary) and a hereditary form, and both forms are associated with structural alterations of the short arm of chromosome 3 (3p)
• at least 4 hereditary syndromes associated with renal cell carcinoma are recognized:
  • Von Hippel-Lindau (VHL) syndrome
    • AD with increased risk of phaeochromocytoma, pancreatic cysts and islet cell tumours, retinal angiomas, CNS haemangioblastomas, endolymphatic sac tumours, epididymal cystadenomas as well as 40% developing RCC
  • hereditary papillary renal carcinoma (HPRC)
    • AD, individuals develop bilateral, multifocal papillary renal carcinoma
  • familial renal oncocytoma (FRO) associated with Birt-Hogg-Dube syndrome (BHDS)
  • hereditary renal carcinoma (HRC)
  • hereditary leiomyomatosis and renal cell cancer (HLRCC)
    • 100 families worldwide
    • cutaneous leiomyomas typically develop in the third decade of life
    • most women develop uterine leiomyomas (fibroids) - generally larger, more numerous and at an earlier age than usual
    • 10-16% develop renal cell cancer
    • AD genetics due to fumarate hydratase FH gene
• environmental risk factors:
  • smoking ⇒ 2x risk in a dose-dependent manner
  • obesity ⇒linear risk with body weight, esp. women
  • hypertension
  • long term dialysis ⇒ acquired cystic disease of kidney ⇒ 30x increased risk RCC
  • hysterectomy ⇒ 2x risk
  • ?tuberous sclerosis
  • renal transplant recipients

• usually presents late, with 30% having mets at diagnosis, and 30% will have spread into ipsilateral renal vein, while 5-10% this will have already spread to the IVC
• classic triad of flank pain, hematuria, and flank mass only occurs in 10% at diagnosis
• 25-30% are found incidentally on radiologic examination
• common presentations include:
  • haematuria (40%)
  • flank pain (40%)
  • palpable mass (25%)
  • LOW (33%)
  • fever (20%)
  • hypertension (20%)
  • hypercalcaemia (5%)
  • night sweats
  • malaise
  • varicocele
• paraneoplastic syndromes are common including:
  • hypercalcaemia
  • erythrocytosis
  • liver dysfunction
  • polyneuromyopathy
  • amyloidosis
  • anaemia
  • fever, cachexia, LOW, dermatomyositis, raised erythrocyte sedimentation rate (ESR), hypertension
• metastases:
  • lung (75%)
  • soft tissues (36%)
  • bone (20%)
  • liver (18%)
  • skin and CNS (8% each)
  • supraclavicular LN's

• the most common type of cancer of the urinary bladder, ureters, urethra and urachus in the developed world (SCC is more common in un-developed countries) but only accounts for 5-10% of all primary urologic cancers
• TCCs are often multifocal with 30-40% having more than one tumour at diagnosis
• they may be papillary or sessile
• 40-50% have invasive disease at diagnosis

• smoking contributes 50% of risk
• chemical exposure - petroleum workers, aniline dyes, agrochemicals
• medications eg. cyclophosphamide, phenacetin
• long urine dwell time in the bladder
  • long haul truck drivers
  • inadequate daily fluid intake
• chronic physical irritation such as chronic urinary stone disease, chronic IDC, chronic UTIs
• radiation exposure
• genetic factors

• bone (35%) - 40% of these are in the spine