Kidney

Question 1

What are the types of Kidney cancer? Incidence?

Answer 1

Clear cell (80%),
Papillary (12%),
Chromophobe (5%),
Other (3%): oncocytic, collecting duct, medullary and unclassified.

Question 2

Histologic and molecular features of Clear Cell, Papillary and Chromophobe?

Answer 2

Clear cell: compact nests of cells with clear cytoplasm, del 3p, VHL hypermethylation, 5q+, 8p-, 9p-, 14q-
Papillary: variable portions of papillae, tubulopapillae and tubules, trisomy 7 & 17. y-, 12+, 16+, 20+, rare MET mutations
Chromophobe: large polygonal cells with reticulated cytoplasm, atypical nuclear with perinuclear halo, eosinophilic cytoplasm, loss of chromosome Y, 1, 2, 6, 10, 13, 17 & 21

Question 3

Common risk factors?

Answer 3

smoking,
obesity,
cadmium, asbestos and petroleum products,
CKD and cystic renal disease

Question 4

Three factors in prognosis (measured by) for UCLA Integrated Staging System: UISS ?

Answer 4

• extent of disease (TNM)
• nuclear differentiation (Furhman grade)
• performance status (ECOG)

Question 5

Staging workup for RCC?

Answer 5

CT C/A/P w contrast;

optional: bone scan & MRI brain

Question 6

What dose radical nephrectomy in RCC include?

Answer 6

kidney,
perinephric fat,
regional nodes,
adrenal gland

Question 7

What is staging system summary?

Answer 7

I: 7cm
III: 1 node or invasion into veins or perinephric tissue
IV: >1 node or invasion into adrenal, beyond Gerota’s fascia, distal met

Question 8

Majority of recurrences for RCC occur within? Surveillance?

Answer 8

3 years, scans q 6 for 3 years, then annually

Question 9

Important negative factors in risk stratification, original + new? Catergories?

Answer 9

• KPS 1.5
• Ca >10
• anemia
• no nephrectomy or recurrence in

Question 10

Tx for limited or locally advanced RCC?

Answer 10

Nephrectomy followed by surviellance

Question 11

Tx for metastatic RCC first line?

Answer 11

• Select: IL-2 (only if lung limited, good PFS & clear cell histology)
• Good or Int (OS): Pazopanib (22.9), Sunitinib (26.4) or Bev + IFN (23.3)
• Poor:(OS): Temsirolimus (10.9) or Sunitinib

Question 12

Tx for metastatic RCC second line?

Answer 12

-Good or Int (OS): Nivolumab (25), Cabozantinib (PFS: 7.4), Axitinib (20.1), Sorafenib, Sunitinib or Pazopanib

Question 13

Is there a role for debulking nephrectomy?

Answer 13

Yes

Question 14

What do you give for metastatic non-clear cell RCC?

Answer 14

Temsirolimus, Sunitinib or Sorafenib

Question 15

New dx of RCC: questions to ask for considering hereditary workup?

Answer 15

• age