Expansion
Renal cell carcinoma in adults, Wilms tumour in children, urothelial carcinoma in the collecting system
Mnemonic
Match the tumour to the age and the syndrome:
- Renal cell carcinoma - adults, from proximal tubule. The triad of haematuria, loin pain and a mass occurs in under 10 per cent. Spreads along the renal vein, and causes a left varicocele that does not empty on lying down. Associated with von Hippel-Lindau and smoking. Paraneoplastic: EPO (polycythaemia), PTHrP (hypercalcaemia), renin, ACTH, and Stauffer’s syndrome (deranged liver tests without metastases)
- Transitional cell carcinoma - renal pelvis, ureter and bladder. Painless haematuria. Risk from smoking, aniline dyes, rubber, cyclophosphamide
- Wilms tumour (nephroblastoma) - children under 5, an abdominal mass that does not cross the midline. Associated with WAGR and Beckwith-Wiedemann
- Angiomyolipoma - benign, associated with tuberous sclerosis
“Renal cell in adults, Wilms in children, transitional cell anywhere along the urothelium.”
Painless visible haematuria in an adult is urothelial cancer until proven otherwise, and warrants urgent cystoscopy and imaging regardless of a negative dipstick on repeat testing.
Expansion
Renal cell carcinoma (adults, from proximal tubule)
- Clear cell is the commonest type; associated with VHL gene loss and von Hippel-Lindau syndrome
- Classic triad of haematuria, loin pain and a mass occurs in only about 10 per cent
- Invades the renal vein and grows into the inferior vena cava, and may present with a left-sided varicocele
- Paraneoplastic: polycythaemia (erythropoietin), hypercalcaemia (PTHrP), hypertension (renin), Stauffer syndrome
- Metastasises to lung (“cannonball” deposits) and bone
Wilms tumour (nephroblastoma) (children, peak 2 to 5 years)
- Abdominal mass, usually not crossing the midline
- Associated with WT1 gene, WAGR and Beckwith-Wiedemann syndromes
Urothelial (transitional cell) carcinoma (renal pelvis, ureter, bladder)
- Painless visible haematuria
- Risk factors: smoking, aromatic amines in dye and rubber industries, cyclophosphamide, chronic inflammation
- Field change means the entire urothelium is at risk, hence multifocality and recurrence
Squamous cell carcinoma of the bladder is associated with schistosomiasis and chronic stones or catheters.