renal tumours
Download
Skip this Video
Download Presentation
Renal Tumours

Loading in 2 Seconds...

play fullscreen
1 / 21

Renal Tumours - PowerPoint PPT Presentation


  • 180 Views
  • Uploaded on

Renal Tumours. Mr C Dawson MS FRCS Consultant Urologist Fitzwilliam Hospital Peterborough. Classification of Renal Tumours. Benign Renal tumours. Cysts account for 70% asymptomatic renal masses Cortical adenoma Oncocytoma Angiomyolipoma (80% associated with tuberous sclerosis).

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Renal Tumours' - justin


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
renal tumours
Renal Tumours
  • Mr C Dawson MS FRCS
  • Consultant Urologist
  • Fitzwilliam Hospital
  • Peterborough
benign renal tumours
Benign Renal tumours
  • Cysts account for 70% asymptomatic renal masses
  • Cortical adenoma
  • Oncocytoma
  • Angiomyolipoma (80% associated with tuberous sclerosis)
renal cell carcinoma
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
familial rcc 1
Familial RCC (1)
  • 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
Familial RCC (2) - Von Hippel Lindau disease
  • Von Hippel Lindau Disease - an autosomally-inherited, multisystem disorder characterised by;
    • 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
Familial RCC (3) - Von Hippel Lindau disease
  • 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
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
investigation
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
treatment
Treatment
  • Radical nephrectomy remains the only effective method of treating primary renal carcinoma
tumour in a solitary kidney or bilateral tumours
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
treatment of metastatic disease
Treatment of metastatic disease
  • Generally poor prognosis
  • Renal cancer remains refractory to treatment with Chemotherapy
  • Hormonal therapy
  • Immunotherapy
  • Palliative nephrectomy
prognosis
Prognosis
  • 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
ad