Kidney cancer Flashcards
1
Q
the area where the ureters and blood vessels enter and exit the kidneys is: A.Nephron B.Hilum C.minor calyx D.renal sinus
A
B
2
Q
the inferior border of the pyloric plane is at : A.T12 B.L1 c.L2 D.L3
A
D`
3
Q
what id the average age of diagnosis for kidney cancer? a.45-50y.o. b.50-55y.o. c.55-60y.o. D.60-65y.o.
A
B
4
Q
what is NOT a risk factor for kidney cancer? A.obesity B.smoking C.leather tanning worker D.alcohol use
A
D
5
Q
what is a sigh/symptom of kidney cancer? A/hematuria B.nocturia C.urinary frequency D.light stream
A
A
6
Q
which of the following is not a typical site for distant metastatic disease of the kidney? A.Brain B.Liver C.lung D.bone
A
A
7
Q
what is not a treatment modality used for kidney cancer? A. interferon b.interleukin C.nephrectomy D.TURB
A
D
8
Q
whats the renal cell carcinoma presentation triad
A
pain
gross hematuria
palpable abdomen
9
Q
renal cell carcinoma presentation
A
Blood in urine Pain in abdomen or back Lump in abdomen Swelling legs Swollen vein Paraneoplastic syndrome Renal cell carcinoma triad Pain Gross hematuria Palpable abdomen Anemia Hepatic dysfunction Fever Hypercalcemia Cahexia Erythrocytosis Thrombocytosis
10
Q
renal pelvis and ureter presentation
A
Gross and microscopic hematuria occurs in 70-95% of cases
Pain up to 40% of cases
Bladder irritation in 5-10%
Flank mass secondary to tumor or hydronephorosis in 10-20%
11
Q
prevention of kidney cancer
A
No smoking
Maintain healthy weight and have healthy blood pressure
12
Q
diagnostic test for kidney cancer
A
IV Pyelogram- can detect the tumor, location and function of contalateral kidney but not sensitive or specific enough for small to medium sized tumors
13
Q
diagnostic tests for metastatic kidney cancer
A
Bone scan
Chest x ray
Ct scan
MRI
14
Q
diagnostic tests for renal pelvis and ureter
A
Complete history and physical examination CBC Liver and kidney function tests CT urography CT and MRI of the abdomen and pelvis Cytoscopy
15
Q
age at diagnosis for renal cell cancer
A
55-60yo
16
Q
renal cell carcinoma is more common in men than women
A
men
17
Q
what countries is renal cell carcinoma more common in
A
more common in developed countries than developing countires
18
Q
age for renal pelvis and ureter cancer
A
5th to 6th decade
19
Q
what percent of all kidney cancers is of the ureters and renal pelvis?
A
7%
20
Q
occupational exposures that can cause kidney cancer?
A
Occupational Exposures Blast furnace Coke oven Iron or steel industry Asbestos exposure Cadmium Dry cleaning solvents Gasoline and petroleum
21
Q
lifestyle factors that can cause kidney cancer
A
obesity
smoking
high blood pressure
22
Q
disease that can cause kidney cancer
A
Inherited genetic conditions Von Hippel-Lindau syndrome (VHL) Hereditary papillary renal cancer Hereditary leiomyomatosis Brit-Hogg-Dube End stage kidney disease and dialysis Family history of kidney cancers Hepatitis C Exposure to tricholorythene Aquired Cystic Kidney Disease (ACKD)- which occurs in patients who have been on dialysis for 3 plus years have a 50x more likeliness of developing RCC Children who recieved cytoxic chemotherapy in treatment of childhood malignancies may get translocation RCC
23
Q
main risk factor in renal pelvis and ureter cancer
A
smoking is most common risk factor in western countirs
24
Q
what risk factor is associated with near and end stage renal pelvis and ureter cancer
A
Aristolochic acid (from chinese herbal medicine )
25
what risk factor is associated with upper urinary tract tumours?
arsenic contaminated water
26
what syndromes are associated with renal pelvis and ureter cancer
Lynch syndrome and balkan endemic neuropathy
27
what T levels is the kidney between
T11-L3
28
kidneys length
11-12cm
29
blood supply to the kidny
Vasculature branches from the abdominal aorta and returns blood to the ascending vena cava
30
portions of the kidney
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Cortex (glomeruli, convoltuted tubules)
Proximal convuluted tubule
Descending loop of henle
Thick ascending limb
Distal convuluted tubule
Collecting duct
Medulla (Henle loops,collecting ducts and pyramids of converging tubules
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31
LN drainage of the kidney
paraaortic and paracaval nodes
32
LN drainage of the ureters and renal pelvis
renal hilar, abdominal, paraortic, paracaval, common iliac internal iliac and external iliacs
33
% patients with localized, %regional and %mets at diagnosis
45% of patients have localized disease, 25% have regional disease, 30% have evidence of metastases at diagnosis
34
sites of distant mets for kidney cancer
bone, liver, lung and adrenal gland
35
how common is distant mets
about half of patients develop distant mets for RCC
36
LOCAL infiltration of RCC
Local infiltraion through the renal capsule involve perinephric fat and gerotas fascia
37
Direct extension of RCC
through venous channels to renal vein in 21% of cases
38
LN drainage in RCC
Lymph drainage to renal hilar paraortic and paracaval lymph nodes
39
RENAL PELVIS AND URETER SPREAD
Can spread by direct extension, hematogenous and lymphatic metastases
Tumor cells can also be implanted into the bladder
40
Tumour related prognostic factors in RCC
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Stage at presentation is the most important prognostic factor
Stage and grade
Tumor size
Histologic type
Tumor necrosis
Sarcomatoid transformation
More than 2 sites of organ metastases
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41
MOST IMPORTANT PROGNOSTIC FACTOR IN rcc
stage at presentation
42
Patient related prognostic factor in RCC
Weight loss
Paraneoplastic syndrome
An interval of <1 year between diagnosis and the start of systemic therapy
43
Laboratory related prognostic factors in RCC
Thrombocytosis
Elevated erythrocyte sedimentation rate
C-reactive protein
44
Prognostic factors in ureters and renal pelvis
Most important are initial stage and grade of the tumor
Prior history of bladder cancer
Type papillary and RCC better prognosis and are usually low grade collecting duct and renal cell carcinoma and renal cell sarcoma have poor prognosis
45
SBRT in RCC
8Gy electrons in 5 fractions or 10 Gy in 3-4 fractions fractionation schemes are dependant on size of the tumor
Tumor size can be 1.5-10cm
Side effects are generally mild
46
Neoadjuvant XRT in RCC
Not recommended in patients with resectable RCC, shows no improvement in overall survival or disease free from metastases
However increases the rate of resectability in patients with locally advanced tumors
47
Dose of neoadjuvant XRT in RCC
30-40Gy/2Gy/fx or 30/15 -40/20
48
Adjuvant XRT in RCC indications
NOT recommended after complete resection
49
Adjuvant XRT in RCC dose
50-55Gy/ 20fx
50
treatment of stage 1a RCC
Partial or Radical nephrectomy, active surveillance in selected patients or ablative techniques for nonsurgical candidates
51
Treatment of stage 1B RCC
partía or radical nephrectomy
52
Treatment of stage 2 and 3 RCC
Radical nephrectomy
53
treatment of stage 4 RCC
Neprectomy and surgical metasectomy for a solitary metastasis if feasible followed by systemic first-line therapy if surgery is not feasible
54
Nephrectomy procedure
Remove part or all of the kidney
Removes the perirenal fat,regional lymph nodes, and ipsilateral adrenal gland
Thoracoabdominal or transabdominal approach
76% of cases the adrenal gland can be spared
Remove part or all of the kidney
55
indications for nephrectomy
preferred treatment for involvement of the IVC
56
contraindications for nephrectomy
not used for early stage RCC when nephron sparing surgery can be used (T1a-T1b tumours)
57
nephron sparing surgery procedure
aka partial nephrectomy only parti of the kidney is removed
58
nephron sparing surgery indications
used for early/ small tumours T1a-T1b
| preferred in patients with hereditary RCC to preserve renal function
59
radio frequency ablation procedure
are treatments that use image guidance to place a needle through the skin into a kidney tumor. In RFA, high-frequency electrical currents are passed through an electrode in the needle, creating a small region of heat.
60
indications for radifrequency ablation procedure
Used for clinically localized RCC , especially in elderly pts and patients with only one kidney or comorbidities impending surgery
Preferable lesions to be treated with this method are <4cm and located in the periphery of the kidney
61
chemo agents used in RCC
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Sunitinib
Sorafenib
Pazopanib
Temsirolimus
Everolimus
Axitinib
Bevacizumab
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62
RCC is chemo _______.
resistant
63
what is RCC chemo used in combination with
interferon
64
where do most RCC originate from?
most (90%) originate from the epithelium of the renal tubules
65
most common pathology of RCC
clear cell tumour (80-90%)
| papillary RCC and chromophore are the next most common types
66
papillary RCC type 1 and 2`
Type 1- typically lower grade and better prognosis
| Type 2- more aggressive, worse prognosis
67
most common tissue of origin of renal pelvis and ureter
90% are urpthelial
68
most common pathology of renal pelvis and ureter
SCC variant followed by glandular cell variant
69
staging RCC
T1a-<4cm and confined to the kidney
T1b-4-7cm and confined to the kidney
T2a>7cm <10cm and confined to the kidney
T2b->10cm and confined to the kidney
T3a- extends into renal vein or invades perineal or renal sinus fat and not beyond the Gerona's fascia
T3b-extends to vena cava below diaphragm
T3c-invades wall of vena cava and extends to vena cava above diaphragm
T4-tumour invades Gerotas fascia and including adrenal gland
70
RCC is considered to be radio _______.
resistant
71
active surveillance in RCC
Used when a patient has significant comorbidities leading them to have surgical risk or a short life expectancy +localized disease
72
what histology of RCC has most response to interferon
clear cell subtype
73
metastatic RCC treatment
cytoreductive nephrectomy followed by immunotherapy (interferon)
74
OARS in RCC
spinal cord, liver, spleen, stomach, duodenum, small bowel, any normal contralateral or ipsilateral kidney, and normal adrenal gland(s).
75
DVH constraints for kidney cancer
Kidney<15 to 18 Gy and a bilateral kidney dose-volume histogram (DVH) with a V12 <55%, V20 <32%, V23 <30%, and V28 <20%.149 The dose to the stomach should be kept at <45 Gy, and the small bowel V45 <195 cc mean liver dose should be kept at <30 to 32 Gy, excluding patients with pre-existing liver disease or hepatocellular carcinoma who have a lower tolerance.
76
XRT in RCC
not typically given but in some special cases
77
Side effects RCC
include nausea, vomiting, diarrhea, and abdominal cramping. Patients with right-sided tumors may have significant portions of the liver irradiated, and radiation-induced liver damage is possible.
78
most common site of distant mets RCC
LUNG
79
Where do most ureter cancers occur
distal 1/3
80
LN drainage of the kidney
RT- pericaval and interarterocaval
| LT= PA ln
