Surg: Renal Cell Cancer: Free MSRA Podcast

🎧MSRA Podcast: RenalCell Cancer – From Tubules to TNMRenal cell cancer(RCC) accounts for the majority of adult kidney cancers and often presents late— making early understanding crucial. Inthis deep dive, we strip back the complexity and walk you through everythingyou need to know for the MSRA. 🧠What You’ll Learn:✅Definition &Basics• RCC = cancer ofthe renal tubular epithelium• Makes up ~85–90%of all adult kidney cancers• Most commonsubtype = clear cell RCC• Linked to chromosome 3p deletion (esp. clear cell)🧠 Mnemonic: "3P = clear" ⚠️Causes & RiskFactors• 🚬 Smoking• ⚖️Obesity• 🩺 Hypertension• 🧬 Family history• 🧠 Genetic syndromes: von Hippel-Lindau• 🧪 Chronic kidney disease, renal cysts, transplant status🧠 Mnemonic: SOH-Family-G 🔬Pathophysiology• Genetic mutationsdisrupt oncogenes/tumour suppressors• Leads touncontrolled proliferation in renal tubules• May produce EPO (→ polycythaemia) or PTHrP (→ hypercalcaemia) 📋Differentials• Benign tumours:oncocytoma, angiomyolipoma• Transitional cellcarcinoma• Wilms tumour (inchildren)• Abdo mass causes,metastases, or retroperitoneal disease 📊Epidemiology (UK)• 7th most common cancer in the UK• Mostly in patients>60; peak = 85–89 age group• 2–3% of RCCs arehereditary• Incidence ↑ 3.1%annually (1993–2014)• 15% ↑ expectedbetween 2023–2025 🩺Clinical Features• Classic triad: HALP – Haematuria – Abdominal mass – Loin pain• BUT 50%asymptomatic early• Other: weightloss, fatigue, pyrexia, varicocele (L-sided)• Metastatic signs:cough, bone pain, lymphadenopathy• Sites of spread:lungs, bones, liver, brain🧠 Mnemonic: HALP = Haematuria, Abdo mass, Loin Pain 🧪Investigations• 🖼️ Imaging: CT abdomen (main), MRI, USS• 📉 CT chest for staging• 🧫 Biopsy confirms histology• 🧪 Bloods: FBC (polycythaemia), U&Es, Ca²⁺, LFTs• 🔎 Consider genetic testing (e.g. VHL) if relevant🧠2WW Referral Criteria• Age ≥45 withvisible haematuria• Non-visiblehaematuria persisting after UTI treatment• Incidental renalmass 📈Staging (TNM)• T1–2 = tumour confined to kidney• T3 = invades veins or perinephric fat• T4 = beyond Gerota’s fascia or adrenal• N1 = local lymphnodes• M1 = metastases🧠 Tip: T1/T2 = within kidney, T3/T4 = beyond 💉Management🩺Localised RCC (StageI/II):• Partial nephrectomy = preferred if feasible• Radicalnephrectomy if large/complex•Robotic/laparoscopic options = better recovery🩺Locally Advanced(Stage III):• Surgery ± lymphnode dissection• Tumour thrombus →surgical removal improves prognosis• Rarely:embolisation for unresectable bleeding masses🩺Advanced/Metastatic(Stage IV):• Cytoreductive nephrectomy if fit• Targeted therapy: Sunitinib, Pazopanib,Everolimus• Immunotherapy: Nivolumab ± Ipilimumab• Bone mets: bisphosphonates (Zoledronic acid)• Local control: surgery, radiotherapy forbone/lung symptoms 🧾Alternative Options• Active surveillance (low-risk, frail)• Ablative therapies: Cryoablation, RFA 📉Prognosis• Early-stage 5-yr survival: ~87%• Overall 5-yr survival: ~64%• 10-yr survival: ~52%• Outcomesimproving, but UK still trails EU average• Poorer outlook ifmetastasised ⚠️Complications• Metastases• Local invasion:IVC, adrenal, retroperitoneum• Paraneoplasticsyndromes: Polycythaemia, Hypercalcaemia• Surgical/therapycomplications• Recurrence 📚MSRA Study Resources📝 Revision Notes:https://www.passthemsra.com/topic/renal-cell-cancer-revision-notes/🃏 Flashcards:https://www.passthemsra.com/topic/renal-cell-cancer-flashcards/📂 Accordion Q&A:https://www.passthemsra.com/topic/renal-cell-cancer-accordion-qa-notes/🎯 Rapid Quiz:https://www.passthemsra.com/topic/renal-cell-cancer-rapid-quiz/🌐 More Platforms:https://www.passthemsra.comhttps://www.freemsra.com #MSRA#RenalCellCancer #RCC #MSRAFlashcards #MSRAQuiz #MSRARevisionNotes #HALP#TNMstaging #KidneyCancer #SurgeryMSRA #PassTheMSRA #FreeMSRA #OncologyMSRA