Renal Cell Cancer Flashcards
Management of small renal cortical tumours <3cm?
RFA
Which imaging should be included for staging of RCC?
CT head, CT TAP
What are the indications for adjuvant SACT in RCC?
High risk i.e. T2 (at least 7cm) G4 or sarcomatoid features, T3 or T4 or node positive or M1 following metastatectomy with no residual disease
Most common sites of metastatic disease in RCC?
LN, lung, bone, brain, liver
Which features are associated with good outcomes in management of oligometastatic disease?
Long DFI, pulmonary mets, Age <60yrs and good PS
What is the Heng score (MDC score)? Name the features (6)
<1 yr since diagnosis to systemic treatment
KPS <80
Hypercalcaemia
Hb <ULN>ULN
Neuts >ULN</ULN>
How many points on Heng score for favourable, intermediate and poor
0= favourable, 1-2= intermediate, >2 = poor
When is ipi/nivo licensed in the first line?
In intermediate and poor risk group
When would you be more likely to use immunotherapy plus TKI in the first line (i.e. pem/len or nivo/cabo?
In high volume and high risk disease where a rapid response is needed
Do sarcomatoid type RCC have a better or worse response to immunotherapy?
Better response
Second line treatment when combination IO or IO/TKI used in first line?
Lenvatinib and Everolimus (can use if only 1 TKI used previously)
Third line options?
Cabozantinib, sunitinib or axitinib
Who is the typical patient to develop medullary renal cancer?
Young patients with sickle cell traits, typically presents with early visceral involvement
Management of metastatic papillary renal cancer?
Cabozantanib, poor response to IO.
What is most likely pathogenesis in the development of clear cell renal cancer?
Up regulated expression of HIF- controlled genes
