Renal Cell Carcinoma

Charles H. Matthews and Thomas J. Guzzo

 Background

Order the following 5 tissues from outermost to innermost: renal cortex, Gerota fascia, adrenal gland, perirenal fat, and renal capsule.

From outermost to innermost:

1. 
   

   Gerota fascia

   
   
2. 
   

   Perirenal fat

   
   
3. 
   

   Adrenal gland (which is embedded in the perirenal fat sup to the kidney)

   
   
4. 
   

   Renal capsule

   
   
5. 
   

   Renal cortex

Name 3 environmental risk factors for renal cell carcinoma (RCC).

Environmental risk factors for RCC:

1. 
   

   Cigarette smoking

   
   
2. 
   

   Phenacetin exposure (found in analgesics)

   
   
3. 
   

   Heavy metal exposure

Familial RCC makes up what % of RCC cases? Name 5 familial syndromes.

Familial RCC makes up ~4% of RCC cases. Familial syndromes:

1. 
   

   Von Hippel-Lindau

   
   
2. 
   

   Birt-Hogg-Dube syndrome

   
   
3. 
   

   Tuberous sclerosis

   
   
4. 
   

   Hereditary papillary RCC

   
   
   
   
   1. 
      

      HRCC (met proto-oncogene)

      
      
   2. 
      

      Familial leiomyomatosis

      
      
   3. 
      

      RCC (fumarate hydratase)

   
   
5. 
   

   Familial clear cell RCC

What is the estimated annual incidence of new RCC cases in the U.S.?

~51,000 cases/yr of new RCC in the U.S.

Has the incidence of RCC been increasing or decreasing over the last 30 yrs? Is there a predilection based on sex?

The incidence of RCC has been increasing by 2%/yr over the last 30 yrs according to NCI SEER data. Men appear to be more commonly diagnosed with RCC than women.

In which decade of life is RCC typically diagnosed?

RCC is typically diagnosed in the 7^th decade of life.

In what ethnic population is the incidence of RCC significantly higher?

People endemic to the Balkan nations have a 50–100-fold increased incidence of RCC. This is thought to be related to the high levels of nephropathy from heavy metal exposure.

RCC represents what % of all urinary tract tumors?

RCC represents ~6% of all urinary tract tumors.

What benign tumors can exist in the kidney?

Benign tumors of the kidney:

1. 
   

   Angiomyolipomas

   
   
2. 
   

   Fibromas

   
   
3. 
   

   Lipomas

   
   
4. 
   

   Lymphangiomas

   
   
5. 
   

   Oncocytomas

   
   
6. 
   

   Hemangiomas

What % of RCC pts will present with a palpable mass on physical exam?

~10% of RCC pts will have a palpable mass at the time at presentation.

RCC pts are at increased risk of having what other type of synchronous urinary cancer?

RCC pts have an RR of 1.5 of having a synchronous bladder cancer, though the authors do not screen for bladder cancer in RCC pts. This increased risk may be related to smoking.

What is the classic triad of RCC? With what other clinical Sx can pts with RCC present?

Pts with RCC present with classic triad Sx of hematuria, flank pain, and a palpable mass. Sx of fever, night sweats, and weight loss suggest the presence of metastatic Dz.

What are some paraneoplastic syndromes associated with RCC? In what % of pts would these syndromes be found?

Paraneoplastic syndromes associated with RCC:

1. 
   

   Hypercalcemia

   
   
2. 
   

   Hepatic impairment

   
   
3. 
   

   Hypertension

These paraneoplastic syndromes arise in 20% of pts.

What % of RCC pts present with bilat kidney involvement?

3% of RCC pts will have bilat involvement at Dx.

What are 4 pathologic subtypes of RCC?

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