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Skin Radiation therapy > Kidney cancer > Flashcards

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

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2
Q 
the inferior border of the pyloric plane is at :
A.T12
B.L1
c.L2
D.L3
A

D`

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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

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4
Q 
what is NOT a risk factor for kidney cancer?
A.obesity
B.smoking
C.leather tanning worker
D.alcohol use
A

D

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5
Q 
what is a sigh/symptom of kidney cancer?
A/hematuria 
B.nocturia
C.urinary frequency
D.light stream
A

A

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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

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7
Q 
what is not a treatment modality used for kidney cancer?
A. interferon
b.interleukin
C.nephrectomy
D.TURB
A

D

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8
Q

whats the renal cell carcinoma presentation triad

A

pain
gross hematuria
palpable abdomen

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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
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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%

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11
Q

prevention of kidney cancer

A

No smoking

Maintain healthy weight and have healthy blood pressure

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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

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13
Q

diagnostic tests for metastatic kidney cancer

A

Bone scan
Chest x ray
Ct scan
MRI

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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
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15
Q

age at diagnosis for renal cell cancer

A

55-60yo

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16
Q

renal cell carcinoma is more common in men than women

A

men

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17
Q

what countries is renal cell carcinoma more common in

A

more common in developed countries than developing countires

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18
Q

age for renal pelvis and ureter cancer

A

5th to 6th decade

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19
Q

what percent of all kidney cancers is of the ureters and renal pelvis?

A

7%

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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
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21
Q

lifestyle factors that can cause kidney cancer

A

obesity
smoking
high blood pressure

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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
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23
Q

main risk factor in renal pelvis and ureter cancer

A

smoking is most common risk factor in western countirs

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24
Q

what risk factor is associated with near and end stage renal pelvis and ureter cancer

A

Aristolochic acid (from chinese herbal medicine )

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25
Q

what risk factor is associated with upper urinary tract tumours?

A

arsenic contaminated water

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26
Q

what syndromes are associated with renal pelvis and ureter cancer

A

Lynch syndrome and balkan endemic neuropathy

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27
Q

what T levels is the kidney between

A

T11-L3

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28
Q

kidneys length

A

11-12cm

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29
Q

blood supply to the kidny

A

Vasculature branches from the abdominal aorta and returns blood to the ascending vena cava

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30
Q

portions of the kidney

A 
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
Q

LN drainage of the kidney

A

paraaortic and paracaval nodes

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32
Q

LN drainage of the ureters and renal pelvis

A

renal hilar, abdominal, paraortic, paracaval, common iliac internal iliac and external iliacs

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33
Q

% patients with localized, %regional and %mets at diagnosis

A

45% of patients have localized disease, 25% have regional disease, 30% have evidence of metastases at diagnosis

34
Q

sites of distant mets for kidney cancer

A

bone, liver, lung and adrenal gland

35
Q

how common is distant mets

A

about half of patients develop distant mets for RCC

36
Q

LOCAL infiltration of RCC

A

Local infiltraion through the renal capsule involve perinephric fat and gerotas fascia

37
Q

Direct extension of RCC

A

through venous channels to renal vein in 21% of cases

38
Q

LN drainage in RCC

A

Lymph drainage to renal hilar paraortic and paracaval lymph nodes

39
Q

RENAL PELVIS AND URETER SPREAD

A

Can spread by direct extension, hematogenous and lymphatic metastases
Tumor cells can also be implanted into the bladder

40
Q

Tumour related prognostic factors in RCC

A 
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
41
Q

MOST IMPORTANT PROGNOSTIC FACTOR IN rcc

A

stage at presentation

42
Q

Patient related prognostic factor in RCC

A

Weight loss
Paraneoplastic syndrome
An interval of <1 year between diagnosis and the start of systemic therapy

43
Q

Laboratory related prognostic factors in RCC

A

Thrombocytosis
Elevated erythrocyte sedimentation rate
C-reactive protein

44
Q

Prognostic factors in ureters and renal pelvis

A

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
Q

SBRT in RCC

A

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
Q

Neoadjuvant XRT in RCC

A

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
Q

Dose of neoadjuvant XRT in RCC

A

30-40Gy/2Gy/fx or 30/15 -40/20

48
Q

Adjuvant XRT in RCC indications

A

NOT recommended after complete resection

49
Q

Adjuvant XRT in RCC dose

A

50-55Gy/ 20fx

50
Q

treatment of stage 1a RCC

A

Partial or Radical nephrectomy, active surveillance in selected patients or ablative techniques for nonsurgical candidates

51
Q

Treatment of stage 1B RCC

A

partía or radical nephrectomy

52
Q

Treatment of stage 2 and 3 RCC

A

Radical nephrectomy

53
Q

treatment of stage 4 RCC

A

Neprectomy and surgical metasectomy for a solitary metastasis if feasible followed by systemic first-line therapy if surgery is not feasible

54
Q

Nephrectomy procedure

A

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
Q

indications for nephrectomy

A

preferred treatment for involvement of the IVC

56
Q

contraindications for nephrectomy

A

not used for early stage RCC when nephron sparing surgery can be used (T1a-T1b tumours)

57
Q

nephron sparing surgery procedure

A

aka partial nephrectomy only parti of the kidney is removed

58
Q

nephron sparing surgery indications

A

used for early/ small tumours T1a-T1b

preferred in patients with hereditary RCC to preserve renal function

59
Q

radio frequency ablation procedure

A

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
Q

indications for radifrequency ablation procedure

A

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
Q

chemo agents used in RCC

A 
Sunitinib 
Sorafenib 
Pazopanib
Temsirolimus
Everolimus
Axitinib
Bevacizumab
62
Q

RCC is chemo _______.

A

resistant

63
Q

what is RCC chemo used in combination with

A

interferon

64
Q

where do most RCC originate from?

A

most (90%) originate from the epithelium of the renal tubules

65
Q

most common pathology of RCC

A

clear cell tumour (80-90%)

papillary RCC and chromophore are the next most common types

66
Q

papillary RCC type 1 and 2`

A

Type 1- typically lower grade and better prognosis

Type 2- more aggressive, worse prognosis

67
Q

most common tissue of origin of renal pelvis and ureter

A

90% are urpthelial

68
Q

most common pathology of renal pelvis and ureter

A

SCC variant followed by glandular cell variant

69
Q

staging RCC

A

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
Q

RCC is considered to be radio _______.

A

resistant

71
Q

active surveillance in RCC

A

Used when a patient has significant comorbidities leading them to have surgical risk or a short life expectancy +localized disease

72
Q

what histology of RCC has most response to interferon

A

clear cell subtype

73
Q

metastatic RCC treatment

A

cytoreductive nephrectomy followed by immunotherapy (interferon)

74
Q

OARS in RCC

A

spinal cord, liver, spleen, stomach, duodenum, small bowel, any normal contralateral or ipsilateral kidney, and normal adrenal gland(s).

75
Q

DVH constraints for kidney cancer

A

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
Q

XRT in RCC

A

not typically given but in some special cases

77
Q

Side effects RCC

A

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
Q

most common site of distant mets RCC

A

LUNG

79
Q

Where do most ureter cancers occur

A

distal 1/3

80
Q

LN drainage of the kidney

A

RT- pericaval and interarterocaval

LT= PA ln

Skin Radiation therapy (40 decks)

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