Urinary Cancers

Renal Cell Carcinoma (RCC)

This refers to a malignant proliferation of kidney cells. It can be sporadic which is associated with increased age, but it is also seen in young children (genetic causes).

The most common form is a clear cell carcinoma as the cells look clear on histology

Symptoms

Triad of painless hematuria, loin mass and lumbar pain

Systemic symptoms e.g., weight loss, fever

Paraneoplastic syndromes – due to hormone release, e.g., ACTH, renin, PrPTH

Can cause a left-sided varicocele as the tumour may compress the left renal vein

Key tests

Ultrasound and CT scan show a mass on the kidneys

Definitive diagnosis is by a biopsy

Management

Surgery to remove cancerous tissue, e.g., radical/partial nephrectomy

Chemo/radiotherapy may also be used in conjunction

Wilms’ tumour (Nephroblastoma)

This is a malignant tumour of mesodermal precursors of the renal parenchyma. 

It is a very common abdominal cancer in children, presenting around the age of 3.

Histology of Wilms’ tumours show stromal, epithelia and blastemal components.

Causes

Most cases are sporadic, but it is also associated with hereditary disorders:

WAGR syndrome – Wilms tumour, Aniridia (absence of iris), Genital problems, Mental disabilities

Beckwith-Wiedemann syndrome – Wilms tumour and Organomegaly due to mutations in IGF-2

Denys-Drash syndrome – Wilms tumour, renal glomerulonephritis and male pseudohermaphrotidis

Symptoms

Similar to adults (Triad of painless hematuria, loin mass and lumbar pain)

Weight loss/failure to thrive

Enlarged kidneys

Management

Nephrectomy +/- chemotherapy depending on tumour stage

Bladder Cancer

Transitional Cell Carcinoma (TCC)

This is a malignant proliferation of the transitional epithelium which lines the urinary tract. It is the most common type of bladder cancer.

It is usually seen in elderly with a key symptom painless macroscopic haematuria

Squamous Cell Carcinoma

This is malignant tumour made of squamous cells occurring after metaplasia.

This is much rarer, and it is associated with repeated urinary tract infections or chronic infection with the parasite Schistosoma haematobium.

Adenocarcinoma

This is a malignant tumour of glandular tissue in the bladder

It is a much rarer form which could be due embryological defects and other rare causes.

Risk factors

Working with rubber

Cigarette smoking

Chemicals – dyes and naphthylamine

Drugs – cyclophosphamide

Symptoms

Painless macroscopic hematuria

Recurrent UTIs, voiding irritability

Systemic signs, e.g., pain, weight loss

Key tests

Urine cytology to visualise cells

Cystoscopy with biopsy is diagnostic

CT urogram and MRI for staging

Staging

The cancer is graded on 3 variables: T = tumour, N = nodes and M = metastases

T1 (in submucosa), T2 (in muscle), T3 (in perivesical fat), T4 (invades other organs)

N0 (no nodes) to N3 (many nodes)

M0 (no metastases) to M1 (metastases present)

Management

T1 – can be excised, e.g., transurethral resection of the bladder tumour (TURBT)

T2/3 – radical cystectomy (removal of bladder) with ileal conduit

T4 – options are limited and more likely to be offered palliative radio/chemotherapy