Renal Flashcards
What is Von hippel lindau?
Mutation in chromosome 3, tumor suppressor gene
Autosomal dominant inheritance
Predisposes to both benign and malignant cancers including clear cell renal cancer, phaeochromocytoma, neuroendocrine pancreatic cancer etc
What is the age of onset of renal cell
60-80 years
What is the clinical presentation of renal cell
Asymptomatic
Flank pain, haematuria, abdo mass
Anaemia, erythrocytosis, thrombocytosis, high calcium
Scrotal varicoele - usually left sided
Inferior venecava involvement - peripheral odema etc.
What are poor prognostic factors in renal cell?
High calcium Anaemia High LDH Poor performance status Short time from diagnosis to treatment
What is the staging of renal cancer?
T1- less then 7 cm, confined to kidney
T2 - greater then 7cm, confined to kidney
T3 - invasion of perinephric tissue but not through garotas fascia
T4 - invasion through fascia
N1 nodes, m1 mets
Advanced stage = T4 or M1
What is used to diagnose and stage renal cell?
USS, CT (more sensitive then USS)
Bone scan if symptoms or high Alp
Tissue - via nephrectomy or partial nephrectomy (biopsy not often performed due to potential seeding and low specificity)
What s the treatment of local renal cell carcinoma?
Surgical removal
What is bp the treatment of metastatic clear cell renal carcinoma?
1st line - blockage of VEGF pathway with either tyrosine kinase inhibitor (sunitinib, sorafenib, pazopinib) or monoclonal antibody against VEGF (bevicuzumab)
2nd line - MTOR inhibitor (everoliumus)
Older drugs used were interferon and IL2
What are some risk factors for renal cancer?
Smoking
Hypertension
Obesity
Acquired polycystic disease (occurs in people on chronic dialysis)
Chemical exposure - cadmium, asbestos etc.
Von hippel lindau
What are some side effects from sunitinib and pazopinib?
Yellowing of skin Hypertension Thromboembolic (esp pazopinib) Bleeding Impaired wound healing PPE (Palmer plantar erythrodysthesia)
