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Surgery II - OSCE > L8: Renal Tumors > Flashcards

L8: Renal Tumors Flashcards

1
Q
A
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2
Q

Renal Tumors

  • Outlines
A
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3
Q

Incidence of RCC

A
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4
Q

Incidence of RCC

  • Percentage & Numbers
A
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5
Q

Incidence of RCC

  • Age
A

5th to 6th decades of life.

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6
Q

Incidence of RCC

  • Sex
A

Males (2) : Females (1)

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7
Q

Incidence of RCC

  • Race
A

Hispanics

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8
Q

Etiology of RCC

A
  • Hereditary
  • Acquired Cystic Kidney Diseases
  • Cigarettes
  • Analgesic Abuse
  • Occupational
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9
Q

Etiology of RCC

  • Hereditary
A
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10
Q

Etiology of RCC

  • VHL Syndrome
A
  1. Cerebellar hemangioblastora.
  2. Retinal angioma.
  3. Bilateral RCC.
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11
Q

Etiology of RCC

  • Sporadic Vs Familial
A
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12
Q

Etiology of RCC

  • Acquired Renal Cysteic Disease of the kidney
A
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13
Q

Etiology of RCC

  • Cigarettes
A

At least 2-fold increase in risk.

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14
Q

Etiology of RCC

  • Analgesic Abuse
A

Phenacitin-containing product → analgesic nephropathy → RCC.

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15
Q

Etiology of RCC

  • Occupational
A
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16
Q

Pathology of RCC

  • Histopathology
A
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17
Q

Spread of RCC

A
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18
Q

Spread of RCC

  • Direct
A
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19
Q

Spread of RCC

  • Lymphatic
A

…

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20
Q

Spread of RCC

  • Heamtogenous
A
  • 1/3 cf patients have metastasis at time of presentations.
  • The most common site is the lung.
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21
Q

Staging of RCC

A
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22
Q

Staging of RCC

  • Primary Tumor
A
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23
Q

Staging of RCC

  • LN
A
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24
Q

Staging of RCC

  • Distant Mets
A
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25
Q

Stage Grouping of RCC

A
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26
Q

Prognosis of RCC

A
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27
Q

CP of RCC

A

Symptoms & Signs

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28
Q

CP of RCC

  • Incidental
A
  • Incidental (50%)
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29
Q

CP of RCC

  • Symptomatic
A
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30
Q

CP of RCC

  • Main Symptoms
A

Hematuria (50%) - Loin pain (40%) - Mass 30%.

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31
Q

CP of RCC

  • Old CLassic Triad
A
  • Old classic triad (pain, hematuria, and mass) in 10%.
32
Q

CP of RCC

  • Varicocele & Edema
A

Non-reducing varicocele or bilateral lower limb edema.

33
Q

CP of RCC

  • Mets
A

Metastatic symptoms (25%):
A. Lungs (75%).
B. Bones (20%).
C. Liver.
D. Brain.

34
Q

CP of RCC

  • Paraneoplatsic Syndrome
35
Q

CP of RCC

  • Internist or Radiologist?
A
  • RCC used to be the internist’s tumor.
  • May now be the radiologist’s tumor, as >60% are incidental.
36
Q

Signs of RCC

  • Abdominal Mass
37
Q

Signs of RCC

38
Q

INVx for RCC

39
Q

INVx for RCC

  • US & CT Scan
40
Q

INVx for RCC

  • MRI
41
Q

INVx for RCC

  • SRA
A
  • Diagnostic.
  • Therapeutic: Preoperative or Symptomatic embolization.
42
Q

INVx for RCC

  • Bone Scan, Brain CT or MRI
A

In symptomatic and advanced cases.

43
Q

INVx for RCC

  • Bx
A
  • Metastatic, Lymphoma, survillence or ablative ttt, indeterminate lesion.
44
Q

INVx for RCC

  • 1st Step
45
Q

INVx for RCC

  • Gold Standard
46
Q

INVx of RCC

  • Exclusion or Mets
47
Q

Surgical Management of RCC

  • TTT (Not Palliation)
48
Q

TTT of RCC

  • Palliation
49
Q

TTT of RCC

  • Localized Renal Cancer
A
  1. Radical nephrectomy.
  2. Nephron-sparing surgery.
  3. Tumour ablation.
50
Q

TTT of RCC

  • Locally Advanced Renal Cancer
A

Radical nephrectomy + ….

51
Q

TTT of RCC

  • Metastatic Renal Cancer
A
  • Role of nephrectomy
  • metastatectomy
  • targeted therapy.
52
Q

TTT of Localized Renal Cancer

53
Q

TTT of Localized Renal Cancer

  • Radical Nephrectomy
54
Q

TTT of Localized Renal Cancer

  • NSS
55
Q

NSS

  • Absolute Indications
56
Q

NSS

  • Relative Indications
57
Q

NSS

  • Elective Indications
58
Q

TTT of Locally Advanced RCC

  • Indications of oprn surgery
59
Q

Incidence of RCC with Venous Thrombus

A
  • 4-10%
  • More common on right side.
60
Q

CP of RCC with Venous Thrombus

A
  • 10- 25% extension above the hepatic veins.
  • One third are metastatic.
61
Q

TTT of RCC with Venous Thrombus

A
  • Surgery can provide long tenn survival in suitable candidates with no metastas:
  1. Not difficult.
  2. Pull back the thrombus into RV and side clamp the IVC.
  3. Laparoscopically possible.
62
Q

TTT of Metastatic RCC

  • Chemo & Radio
A

NOOO

  • RCC is chemo-refractory and radio-resistant!
63
Q

TTT of Metastatic RCC

  • Immunotherapy
64
Q

TTT of Metastatic RCC

  • Allogeneic stem cell transplantation
A

Has significant morbidity

65
Q

“The standard of care for advanced RCC is the best available clinical trial”.

66
Q

Targeted therapy for RCC

A
  • Antiangiogenic Drugs
  • mTOR Inhibitors
67
Q

Antiangiogenic Drugs in RCC

A

Tyrosine kinase inhibitors (TKIs):
- block the intracellular domain of the VEGFR (e.g., Sunitinib, Sorafenib, Axitinib).

Monoclonal antibody:
- bind circulating VEGF and prevent it from activating the VEGFR (e.g., Bevacizurab).

68
Q

mTOR Inhibitors in RCC

A

Temsirolimus

69
Q

Etiology of Renal Pelvis Tumors

70
Q

Occupational RF for Renal Pelvis Tumors

A
  • Chemical.
  • Leather.
  • Printing.
  • Gasworks.
  • Rubber.
  • Sewage works.
  • Plastic
71
Q

Pathology of Renal Pelvis Tumors

  • Malignant
A
  • Transitional Cell Carcinoma (TCC) (The most common).
  • Squamous Cell Carcinoma (SCC)-
  • Adenocarcinoma.
72
Q

Staging of Renal Pelvis Tumors

73
Q

INVx for Renal Pelvis Tumors

74
Q

TTT of Renal Pelvis Tumors

75
Q

TTT of Renal Pelvis Tumors

  • Surgical
A
  • Kidney-sparing management.
  • Radical rephroureterctomy and bladder cuff excision.
  • Palliative nephrectomy and chemotherapy for metastatic dis.
76
Q

TTT of Renal Pelvis Tumors

  • Radiation
A

Postoperative or adjuvant

77
Q

TTT of Renal Pelvis Tumors

  • Systemic Chemo
A

MVAC:
M: Methotrexate
V: Vinblastine
A: doxorubicin (Adriamycin)
C: Cisplatin.

Surgery II - OSCE (20 decks)

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