Andy (42 years old)

Andy, 42 years old, is a bit of a coffee snob. He is considering moving house to live closer to his favourite coffee place.

He recently presented with haematuria and asthenia.

Assessment summary:

• CT scan: revealed a left renal mass and diffuse liver lesions, cT3bN0M1
• Kidney mass biopsy: WHO/ISUP grade 4 clear-cell RCC (ccRCC), sarcomatoid features
• ECOG PS: 1
• KPS: 80%
• No relevant medical history
• No family history of cancer
• Blood work:
  • Haemoglobin: 11.2 g/dl (12-13 g/dl)
  • Neutrophils: 8.2x10⁹/l (2.0-7.0x10⁹/l)
  • Platelets: 680x10⁹/l (150-400x10⁹/l)
  • Calcium: 9.0 mg/dl (8.5-10.2 mg/dl)
  • LDH: 420 U/l (135-225 U/l)
• Liver function tests
  • Alkaline phosphatase: 163 U/l (41-117 U/l)
  • Alanine transaminase (ALT): 22 U/l (7-55 U/l)
  • Aspartate transaminase (AST): 23 U/l (8-48 U/l)
  • Gamma-glutamyl transferase: 46 U/l (5-40 U/l)