Renal Tract Cancer

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management

Definition

Renal tract cancer refers to malignancies affecting the kidneys, ureters, bladder, or urethra. The most common types include renal cell carcinoma (RCC) in the kidney and urothelial carcinoma in the bladder or ureters.

Aetiology

Types of Renal Tract Cancer:

  • Renal Cell Carcinoma (RCC): the most common kidney cancer, arising from the renal tubules.
  • Urothelial Carcinoma (Transitional Cell Carcinoma - TCC): affects the bladder, ureters, and renal pelvis.
  • Squamous Cell Carcinoma: rare, associated with chronic inflammation (e.g., schistosomiasis).
  • Adenocarcinoma: are type, linked to chronic irritation and metaplasia.

Pathophysiology

  • Genetic mutations in tumour suppressor genes (e.g., VHL gene in RCC).
  • Exposure to carcinogens (e.g., smoking, occupational chemicals).
  • Chronic inflammation leading to dysplasia and malignant transformation.
  • Urothelial carcinoma spreads via direct invasion, lymphatics, or haematogenous routes.

Risk Factors

  • Smoking (strongest risk factor for bladder cancer).
  • Occupational exposure to industrial chemicals (e.g., aromatic amines).
  • Chronic urinary tract infections and inflammation.
  • History of kidney stones or bladder stones.
  • Family history of renal tract cancer.
  • Long-term use of analgesics (e.g., phenacetin).
  • Schistosomiasis (linked to squamous cell carcinoma of the bladder).

Signs and Symptoms

  • Haematuria: most common symptom, can be microscopic or macroscopic.
  • Flank pain: more common in renal cancers.
  • Loin mass: suggestive of an advanced renal tumour.
  • Lower urinary tract symptoms (LUTS): frequency, urgency, dysuria (common in bladder cancer).
  • Unexplained weight loss and fatigue: suggests systemic involvement.
  • Recurrent UTIs: may indicate bladder cancer.
  • Paraneoplastic syndromes: hypercalcaemia, polycythaemia (in RCC).

Investigations

  • Urinalysis: detects haematuria.
  • Urine cytology: identifies malignant cells in urothelial carcinoma.
  • Blood tests: FBC, U&Es, liver function tests (assess systemic involvement).
  • Renal Ultrasound: first line imaging for renal masses.
  • CT Urogram: gold standard for urothelial cancer, detects filling defects.
  • Cystoscopy: direct visualisation of bladder lesions.
  • Biopsy: confirmatory for histological diagnosis.
  • Staging CT or MRI: assesses local and distant spread.

Management

1. Renal Cell Carcinoma (RCC):

  • Localised disease: partial or radical nephrectomy.
  • Advanced/metastatic disease: targeted therapies (e.g., tyrosine kinase inhibitors such as Sunitinib).
  • Immunotherapy: checkpoint inhibitors (e.g., Nivolumab).

2. Bladder Cancer (Urothelial Carcinoma):

  • Non-muscle invasive: transurethral resection of bladder tumour (TURBT) ± intravesical chemotherapy (Mitomycin C or BCG).
  • Muscle-invasive: radical cystectomy with urinary diversion or radiotherapy.
  • Metastatic disease: systemic chemotherapy (e.g., Cisplatin-based regimens).

3. Ureteric and Renal Pelvis Cancer:

  • Nephroureterectomy: gold standard treatment.
  • Adjuvant chemotherapy: considered in high-risk cases.

4. Palliative Care:

  • Pain management with opioids.
  • Radiotherapy for symptom relief in metastatic cases.
  • Supportive care for advanced disease.
RenalmypanotesRenal Tract Cancer