Kidney Flashcards
epidemiology
7th most common in the UK
1.7:1 M:F ratio
50-89 years
aetiology
smoking
obesity
cadmium exposure
phenacetin abuse
small family link
Von Hoppel- Lindau syndrome
coffee
investigations
haematology: FBC, U&E, LFT
radiography: MRI, angiography, IVO, plain film, chest x-ray
CT, US
urine cytology: malignant cells
pathology types
renal cell carcinoma
transitional cell carcinoma of renal pelvis
wilms tumour (nephroblastoma)
treatment types
RT, surgery, chemo and immunotherapy
T1
<7cm limited to kidney
T2
> 7cm limited to kidney
T3a
invades adrenal gland or perinephric fat doesn’t extend beyond the renal capsule
T3b
extension into the renal vein or IVC below the diaphragm
T3c
extension into the IVC above the diaphragm
T4
beyond the renal capsule
N1
single regional LN
N2
more than one
M0
no distant mets
M1
evidence of distant mets
is RCC resistant or sensitive
resistent (for Palliative)
what types of surgery are there
radical nephrectomy
partial nephrectomy
nephrourectomy
cryotherapy
chemo
limited use
vinblastine: single agent <10% response rate
hormonal drug: medroxyprogesterone
immunotherapy
interferon and interleukin 2 have been used
15% response rate to interferon
20-30% rate with interleukin 2
combo with 5FU showed enhances activity but its very toxic
advanced disease trials
tyrosine kinase inhibitors, sunitab and sorafenib appear beneficial
SE: fatigue, diarrhoea, nausea, stomatitis
what is prognosis dependent on
stage and grade
stage 1 prognosis
65%, five year survival drops to 30% if LN are involved
stage 4 prognosis
very few survivors
what is the five year survival if confined to kidney
50-80%
when is the most loss of life?
in the first two years after diagnosis
