Initial Evaluation Flashcards
When doing imaging for a suspicious renal mass, which is best: abdominal CT/MRI or abdominopelvic CT/MRI? Is contrast preferred?
CONTRAST IS PREFERRED
What are the ancillary procedures to be done only when there is clinical indication?
BONE SCAN
BRAIN MRI
CHEST CT
CORE NEEDLE BIOPSY
If renal biopsy is to be done, what needle is to be used?
When will you suspect urothelial carcinoma?
CORE NEEDLE because FNA is not sufficient
If urothelial carcinoma is suspected, what other procedures can you do for workup?
Ureteroscopy
Urine Cytology
Percutaneous Biopsy
If metastatic disease is present or the patient cannot tolerate ureteroscopy for the initial workup, what can you do?
Percutaneous biopsy
When will you consider genetic evaluation?
If the patient is 46 years old or younger
and positive family history
Stage 1 (T1a) size and preferred primary treatment?
Tumor is 4cm or less
Partial nephrectomy is the preferred treatment
Stage 1 (T1a) size and 3 other primary treatment?
Tumor is 4cm or less
Ablative techniques
AS for 2cm or less
Radical nephrectomy if partial nephrectomy is not feasible
Stage 1 (T1b) size and primary treatment?
> 4-7cm
Partial nephrectomy
Radical nephrectomy
AS in selected patients
When is active surveillance indicated in renal masses?
2cm or less
Stage 2 (T2a and T2b) sizes and primary treatment?
T2a >7-10 cm
T2b >10cm
Partial nephrectomy
or Radical nephrectomy
Stage 2 (T2a and T2b) adjuvant treatment?
May undergo clinical trial or surveillance
Which structures are affected in T3a masses? (4)
T3a masses affect
Renal vein
Segmental branches
Pelvicalyceal system
Perirenal/renal sinus fat
Which structure is affected in T3b masses?
IVC BELOW the diaphragm
Which structure is affected in T3c masses?
IVC ABOVE the diaphragm
Wall of the vena cava
What structures is affected in T4 masses?
Beyond the Gerota’s
Adrenal gland
Adjuvant treatment options for Stage II masses?
Clinical trial or surveillance
Preferred adjuvant treatment option for Stage III clear cell histology masses.
Clinical trial
Adjuvant option for non-clear cell histology patients?
Is surveillance an option in the adjuvant setting in clear cell histology Stage III masses?
Surveillance
What category III adjuvant agent can you give Stage III patients with clear cell histology?
Sunitinib (Category 3)
T1 N0 M0
STAGE I
T2 N0 M0
STAGE II
T1-T2 N1 M0
STAGE III
T3, NX/N0/N1, M0
STAGE III
T4, ANY N, M0
STAGE IV
ANYT ANY N M1
STAGE IV
G1
Nucleoli absent or inconspicuous and basophilic at 400x magnification
G2
Nucleoli conspicuous and eosinophilic at 400x magnification, visible but not prominent at 100x magnification
G3
Nucleoli conspicuous and eosinophilic at 100x magnification
G4
Marked nuclear pleomorphism and/or multinucleate giant cells and/or rhabdoid and/or sarcomatoid differentiation
