CUA GL FU of non-metastatic RCC after treatment Flashcards
When should patient be referred to nephrologist post Nx?
GFR<45 or progressive CKD that develops after surgery especially if associated with proteinuria
what are predictors of disease relapse after NX?
Tumor grade, local extent of primary tumor, presence of nodal metastasis, histological subtype
What subtypes of RCC have better prognosis which ones are worse
Better: chromophobe RCC and papillary type 1
Worse, Medullary, collecting duct, Sarcomatoid and rhabdoid differentiation
What is the risk of disease recurrence with T1 disease?
less than 7%
What are the most common sites for RCC to mets?
lung > nodes > bone > liver
What are fU recommendations for T1 disease ?
CXR, blood work annually, CT/MRI/US at year 2 and 5. beyond that up to you and the patient. Also, if you did a partial can do a scan earlier to assess residual kidney
What is the recommended FU for T2 disease
CXR, BW and clinical assessment q 6 months x 3 years then yearly. CT/US/MRI at 12,24,36, 60 months.
What is the recurrence rate for T3 and T4 patients ?
42, 47%
What FU is recommended for T3/T4 or N+ disease?
exam, CXR(or CT), Blood work @ 3 months then Q 6 for 3 years. then yearly. CT/MRI at 6,12,18,24,36, 60 months. If there is node positive disease then CT/MRI Q 6 months x 3 years ( do one right away after 3 months) then yearly
What does tumor ablation look like on MRI after?
T1 hyperintense , T2 hypo-intense
on Ct hypoattenuating
What is recommended fU after ablation of T1a tumors?
CT/MRI @ 3,6,12 months then annually for 5 years. CXR and blood work and exam with each visit.
EXCEPTION: if pre tx biopsy showed oncocytoma and post tx imaging shows success then no further imaging is needed
