19/11/2025
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What is RCC?
Renal Cell Carcinoma(RCC) is the most common type of kidney cancer in adults, originating in the lining of the proximal convoluted tubule within the renal cortex. It comprises a group of heterogeneous malignancies, with clear cell RCC being the predominant and most aggressive histological subtype.
Basics:
The pathogenesis often involves the inactivation of the VHL tumor suppressor gene,leading to dysregulated cellular proliferation and angiogenesis. Major risk factors include smoking, obesity, hypertension, and specific hereditary syndromes.
Symptoms:
Classically,RCC presents with the triad of hematuria, flank pain, and a palpable abdominal mass, though this complete presentation is now uncommon. More frequently, patients are asymptomatic initially or exhibit nonspecific systemic symptoms such as unintentional weight loss, fever, or paraneoplastic syndromes. A significant number of cases are now incidentally discovered on imaging performed for unrelated reasons.
Investigation:
1. Complete Blood Count (CBC):
· Why it's recommended: RCC can cause a paraneoplastic syndrome, leading to distinct abnormalities.
· What it looks for:
Anemia (low red blood cell count): A very common finding, often resulting from chronic disease or blood loss due to tumor-related hematuria that may not be visible to the eye (microscopic hematuria).
Polycythemia
(high red blood cell count): In some cases, the tumor can inappropriately produce erythropoietin, leading to an overproduction of red blood cells.
2. Comprehensive Metabolic Panel (CMP) / Renal Function Panel:
Why it's recommended: This is essential for evaluating kidney function and detecting other paraneoplastic phenomena.
What it looks for:
Kidney Function (Blood Urea Nitrogen - BUN & Creatinine): Determines how well the kidneys are working, which is vital for planning treatment, especially if surgery is considered.
Liver Function Tests
(AST, ALT, Alkaline Phosphatase): Abnormalities can indicate the presence of metastases to the liver. They can also be part of a paraneoplastic syndrome called Stauffer's syndrome, where liver function is impaired without actual liver metastasis.
Calcium Levels
(Hypercalcemia): High blood calcium is another common paraneoplastic syndrome caused by RCC, which can cause symptoms like fatigue, nausea, and confusion.
3. Erythrocyte Sedimentation Rate (ESR) and/or C-Reactive Protein (CRP):
· Why it's recommended: These are non-specific markers of inflammation. They are often elevated in RCC and can correlate with tumor burden and activity. A high level can be a poor prognostic indicator.
4. Lactate Dehydrogenase (LDH):
· Why it's recommended: LDH is a cellular enzyme that can be released when tumors are rapidly growing or breaking down. A high LDH level is associated with a higher tumor burden and is a recognized poor prognostic factor in metastatic RCC.
