Transcript Renal tumours - Urology Information Site

Renal Tumours
Mr C Dawson MS FRCS
 Consultant Urologist
 Fitzwilliam Hospital
 Peterborough
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Classification of Renal
Tumours
Benign Renal tumours
Cysts account for 70% asymptomatic
renal masses
 Cortical adenoma
 Oncocytoma
 Angiomyolipoma (80% associated with
tuberous sclerosis)
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Oncocytoma
Oncocytoma
Angiomyolipoma
Renal cell carcinoma
3% adult cancers
 M:F 2:1
 Majority of patients diagnosed in 6th to
7th decade
 Sporadic and hereditary forms
 No specific causative agent detected smoking suggested as a significant risk
factor
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Familial RCC (1)
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Only 2% of cases of RCC are familial
Patients affected at an earlier age (mean 44
yrs)
Relatives may be at risk and should be
screened
Classified as
– RCC alone
– RCC with additional features (e.g. as with
Von Hippel Lindau disease)
Familial RCC (2) - Von
Hippel Lindau disease
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Von Hippel Lindau Disease - an autosomallyinherited, multisystem disorder characterised
by;
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high risk of RCC (>70% by the age of 60)
retinal and cerebellar haemangioblastomata
phaeochromocytomas
renal, pancreatic, and epididymal cyst
VHL is the most common cause of inherited
RCC, and RCC is the most common cause of
death in VHL
Familial RCC (3) - Von
Hippel Lindau disease
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All patients (and relatives) should undergo screening from
age 15
Tumours >3cm should be removed to prevent metastasis
Tumours are often bilateral and/or multifocal - so kidney
preserving surgery often required
Gene for VHL discovered in 1993 - acts normally as a tumour
suppressor gene. Loss of both copies therefore required.
Inactivation of both VHL genes is also the crucial step in the
development of most clear-cell type (non-familial) RCCs
Presentation of renal cell
carcinoma
Classic triad of pain, haematuria, and
flank mass (rare)
 More commonly just pain and
haematuria
 Symptoms of metastatic disease
 Paraneoplastic syndromes
 INCIDENTAL - discovered while
investigating another problem
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Investigation
Ultrasound - distinguish solid from
cystic mass
 CT - Staging, prior to surgery
 MRI - less sensitive than CT for lesions
less than 3cm
 Angiography - tumour in solitary kidney
if partial nephrectomy considered
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CT Scan of Renal tumour
MRI of lymph node from
renal tumour
Staging of renal carcinoma
Staging of renal carcinoma
Treatment
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Radical nephrectomy remains the only effective
method of treating primary renal carcinoma
Tumour in a solitary kidney
or bilateral tumours
Partial nephrectomy gives excellent
short term results (72% tumour free
survival at 3 yrs)
 Survival independent of whether
tumour present in other kidney
 Survival dependent on stage of local
tumour
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Treatment of metastatic
disease
Generally poor prognosis
 Renal cancer remains refractory to
treatment with Chemotherapy
 Hormonal therapy
 Immunotherapy
 Palliative nephrectomy
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Prognosis
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5 year survival
– 60-82% Stage I
– 47-80% Stage II
– 35-51% Stage III
Survival increased by pre-op radiotherapy in some
studies
Incidental tumours - 15-30% of all tumours
– Better prognosis (related to stage and grade)
– Significantly longer disease-free and overall
survival than with symptomatic tumours
Survival