SU29.{6,8} | Renal Tumours and Bladder Cancer — Summary & Reflection

KEY TAKEAWAYS

Renal and bladder cancers are linked by haematuria and separated by their biology. Renal cell carcinoma (RCC) is the commonest adult renal malignancy; its clear-cell subtype is commonest and it arises from proximal tubular epithelium. Most are now found incidentally — the classic triad (haematuria, flank pain, palpable mass) is uncommon and means late disease. RCC shows paraneoplastic syndromes (polycythaemia, hypercalcaemia, hypertension, Stauffer's), a non-emptying varicocele with renal vein/IVC thrombus, and spread to lung ('cannonball') and bone; it is radio-/chemo-resistant. Staging is by contrast CT abdomen + CT chest. Management: partial (nephron-sparing) nephrectomy for small tumours (T1a, and selected T1b), radical nephrectomy for large/advanced, targeted therapy/immunotherapy for metastatic disease. Wilms' tumour (nephroblastoma) is the commonest renal tumour of children, treated by nephrectomy + chemotherapy +/- radiotherapy. Bladder cancer is usually transitional cell carcinoma (TCC) (risk factors: smoking, aromatic amines, cyclophosphamide, chronic inflammation); schistosomiasis causes squamous cell carcinoma. The hallmark is painless gross haematuria. Work-up: flexible cystoscopy (gold standard) + urine cytology + CT urogram + TURBT (giving grade and depth). Management is decided by muscle invasion: NMIBC -> TURBT + intravesical BCG/chemotherapy + surveillance cystoscopy; MIBC -> radical cystectomy with urinary diversion +/- neoadjuvant chemotherapy, or radical radiotherapy.

REFLECT

Recall a patient you have seen with haematuria, or imagine the next one you will clerk. If the blood was visible and painless, did you treat it as a red flag and arrange cystoscopy and upper-tract imaging, or were you tempted to wait because it had stopped? If a renal mass turned up incidentally on a scan, did you appreciate that a small mass is an opportunity to spare a kidney rather than remove it? Reflect on how the single question 'has the bladder tumour invaded muscle?' changes everything that follows, and on how the absence of the 'classic triad' should reassure you about stage rather than about the diagnosis. Consider how you would explain to an anxious patient why painless red urine, even once, deserves a camera test of the bladder.