Kidney Ca

Question 1

Where are the Right and Left kidneys located (level)?

Answer 1

Left - T12-L3

Right - 2-4cm lower than the left, in contact with the liver.

Question 2

What are the 3 regions of the kidney?

Answer 2

• Medulla
• Cortex
• Renal Pelvis

Question 3

What are the 3 main functions of the kidney?

Answer 3

1. Maintains the body composition (regulates fluid volumes)
2. Excretion/production of enzymes and hormones
3. Escretion of metabolic byproducts and foreign wastes

Question 4

Epidemiology/ Aetiology

what is?

• Most common in adults
• Most common in children
• Rare

Answer 4

• Adults = renal tumour (renal cell carcinoma) aka. hypernephroma
• Children = nephroblastoma (Wilm’s tumour)
• Rare to get tumours of the renal pelvis.

Question 5

Risk Factors for kidney ca? (6)

Answer 5

• Being male
• 65 years of age
• obesity
• family history
• VOL (Von-Hippel) Syndrome
• Smoking

Question 6

What system is used for staging and what does it rely on?

Answer 6

TNM relies on surgical resection

Question 7

For renal cell adenocarcinoma, what is the most common type of tumour and what is the least common type?

Answer 7

• Most = clear cell carcinoma

- Least = chromophilic (papillary) carcinoma

Question 8

What is the diagnostic work-up for kidney Ca (3 stages)

Answer 8

1. Complete history and physical examination
   - Serum chemistries
   - Blood Count
   - Lactate Dehydrogenase
   - urinalysis
2. Radiological studies
   - chest radiography and CT
   - Brian MRI
   - Chest MRI
   - Abdo/pelvis CT or MRI (with intravenous gallium)
   - Bone scrintography
3. Additional Studies
   - Ultrasonography
   - MR angiography.

Question 9

What is the staging for kidney cancer (T1, T2, T3 and T4)?

Answer 9

T1 - Tumour <7cm, limited to kidney
T2 - Tumour >7cm, limited to kidney
T3 - Tumour invades adrenal glands, major vessels and perinephric tissue but not beyond Gerotas Fossa
T4 - Tumour invades beyond Gerotas Fossa.

Question 10

What are the signs and symptoms of Kidney Cancer (5)

Answer 10

• Haematuria
• Palpable flank mass/ abdo pain
• Hypertension and increased ca
• fatigue and weight loss
• pyrexia (fever)

Question 11

What are the patterns of spread for kidney ca?

Answer 11

• Direct invasion into the renal vein is common
• 25% evidence of distant mets
• local lymphatic and Heamatogenous spread common
• sometimes get direct invasion into the peri-renal tissue and LN mets.

Question 12

Is RT used in the primary management of Renal Cell Carcinoma?

Answer 12

No, no longer used as the primary management option. Used in a palliative setting for mets. (e.g. to relive bone pain).
Surgery is the primary management.

Question 13

What is the most effective way of reducing risk of getting RCC?

Answer 13

Cessation of smoking. (from the time you stop the risk decreases, after 15 years returns to that of a non-smoker).

• Unclear whether decreasing weight decreases the risk (need more data esp. on benefits of moderate alcohol consumption.)

Question 14

What are the OAR for kidney ca?

Answer 14

• Spleen
• Stomach
• Pancreas
• Liver
• Sp Cord
• Contro kidney
• SI

Question 15

What is the max dose that can be received to the kidney portions (e.g. 1/3)?

What is the mean dose?

Answer 15

1/3 - 50Gy
2/3 - 30Gy
3/3 - 23Gy

mean dose - 17.5Gy

Question 16

What group did nephrectomy have the biggest impact on overall survival?

Answer 16

Patients with solitary mets only, low grade tumour and weight loss of less than 10%.