Urinary Tract Malignancies

Ninja Nerds!
In this episode of the Ninja Nerd Podcast, Zach and Rob dive into the essential clinical and pathophysiologic features of urinary tract malignancies, beginning with renal cell carcinoma (RCC) and followed by urothelial carcinoma of the bladder.

We start with a patient case of renal cell carcinoma, exploring the epidemiology and risk factors such as smoking, obesity, hypertension, and inherited syndromes like von Hippel-Lindau disease. The discussion focuses on the pathophysiology of clear cell RCC, particularly the loss of VHL gene function and dysregulation of the HIF pathway, leading to increased angiogenesis.

We review the classic triad of RCC—flank pain, hematuria, and a palpable abdominal mass—along with common paraneoplastic syndromes, including polycythemia and hypercalcemia. Diagnostic evaluation includes CT imaging of the abdomen and pelvis, with treatment strategies ranging from partial or radical nephrectomy to immune checkpoint inhibitors and targeted therapies for advanced disease.

Next, we shift to a patient with urothelial carcinoma, highlighting epidemiologic risks like tobacco use, occupational exposures, chronic inflammation, and cyclophosphamide.

Clinical signs such as painless hematuria, irritative voiding symptoms, and hydronephrosis are discussed alongside the diagnostic approach: urine cytology, cystoscopy with biopsy, and CT urography. Management strategies include TURBT, intravesical BCG, radical cystectomy, and systemic chemotherapy, based on staging and risk.

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