Renal Ca Flashcards
Risk factors of rcc
Tobacco Obesity Hypertension Esrd with acquired cystic ds Hereditary
Mc type of RCC
CLEAR CELL%75- prox tubule Papillary 15 prox tub Chrome phobe Oncocytoma 5 each from distal Collecting duct less than 1 %
How many pt undergoing dialysis develop acquired cystic disease kidney
40-50%
5.8% of those cysts dvelop rcc mc papillary
Which familial rcc aw clear cell histology
Vhl-3p ✅ Hereditary papillary rcc 7q Hereditary leiomyomatosis rcc 1q Birt hogg dube 17p11 Sdh ✅ TSC9q 16p
C met gene asso with
Hprc
Which rcc affects m=f with excellent prognosis
Chromophobe
Rcc mc in women
Mucinous tubular
Sundrome with uterine fibroids early pmset
Adtenal hyperplasia
Kidney cancer
Hlrcc
.Immuno PET using antibody against carbonic
anhydrase IX is useful in which subtype of RCC
Clear cell and papillary
Esrd which yr sceening start
3 yr
Bap1 tumor aw
Clear cell
Melanoma and hif1
MiTF
Screening-Rcc
Vhl and hlrcc
From 16 yr
HGF aw
Papillary type
Xp RCC
Papillary
Rcc in cowden
Papillary
Pten
Killin mutations
How many ct enhancing lesions are benign-rcc
20%
Plant cells seen in
Chromophobe
Positive hales colloid iron stain
CK7 esinophilic subtype
Plant cell
Chromophobe
Positive hales colloid iron stain
Hyper vascular tumors
Clear cell
Multicentric rcc
Papillry
Best prognosis
Papilary 1
Mc paraneoplastic
Elevated esr
Stauffers syndrome whats elevated
ALP
Absolute ci for cytoreductive nephrectomy
Brain mets
Poor performanxe status
Relative- non clear cell
Mskcc prognostic system
Low karnofsky High ldh Low hb High ca Time from dx to tt less than 1 yr
Imdc
Low karnofsky Low hb High ca Time les than 1 yr High neutro High platelet
Radical mephrectomy
Robson
Partial nephrectomy normal percentage left behind in solitary
20-30%
Prevalence of ln mets on rcc
6%
Partial nephrectomy indication
Indication • Small unilateral tumors (Tia, selected Tib) • Tumor in • Uninephric state • Renal insufficiency • Familial tumor • Bilateral tumor Note- Tra-*tumor 4cm or less limited to kidney Tib > tumor >4cm but not >7cm limited to kidney Stage I > T1 NO MO Renal vein thrombus not a ci
Local recurrence after prtial nephrectomy
3-5%
Surveilance after thermal ablation rcc
Annual cxr
6 m mri
3 m ct
• In Small incidentally diagnosed renal tumours what
percentage of tumours will have zero radiographic
growth in 36 months
30%
Linear volumetric growth of radiologically localised small rcc
0.3cm per yr
Surveillance size cut of
Solid tumors 2 cm
Cystic 4 cm
Familial 3 cm
Highest response chemo in mets rcc
Lenvatenib
Pref drug for clear cell
Axitinib + pembrolizumab
• Cabozantinib + nivolumab
• lenvatinib + pembrolizumab®
Pref regime for nonclear cell
Cabozantinib
Sunitinib
Maligannt features in ivu
Calcification within the mass
•increased tissue densit
• Irregular margins
• Distortion of collecting system
Hu less than 20 solid mass negative attenuation
Aml
Rcc if contrast more than hu?
15
Sestamini pet used in which rcc
Chromophobe
Radical nephrect criteria
, RN is preferred if all of the following criteria are met:
(1) high tumor complexity and PN would be
challenging even in experienced hands;
(2) no preexisting chronic kidney disease (CKD) or
proteinuria; and
(3) normal contralateral kidney and new baseline
estimated glomerular filtration rate (eGFR) will likely
de >45 mL/min/1.73 m2
Ariser trial
Everest trial
Prosper trial
Immotion trial
Girentuximab
Everolimus
Nivolumab
Atezolilumab
Carmena
Surtime trial
Targeted therapy sunitinib and cytoreductive nephrectomy
Uiss
Tnm
Performance
Tr grade
Mc tumor mets to kidney is from
Lung
Chemo indicated in rcc
Chromophobe and medullary
Carbo gemcit
Paclicarbo
Genetic screening indication in rcc
Dx les than or eq 46 yrs Bil or multifocal tr One or more first or second degree relative with rcc Histology - multifocal papillary Hlrcc Bhd Aml tsc Sdh
Everolimus prophylaxis
Aml tsc more than 3 cm
Tumor ablation highest for
Posterior lesions
Tumor venous thrombus levels in rcc
0- renal vein 1- ivc less than 2 cm above rv 2- more than 2 cm but below hep vein 3- to or above hep v but below diaphragm 4- above diaphragm
Ln d done in rcc ?
Children or young adults
Markers of rcc
Cc rcc- ca 9
Aquaporin1 and perilipin 2
