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17th European Urology Residents Education Programme > Renal Cell Carcinoma > Flashcards

Renal Cell Carcinoma Flashcards

1
Q

What limitation does an MRI have when investigating kidney tumours?

A

It can not be used to evaluate the chest. CT is needed for that.

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2
Q

What are the most common types of kidney tumours?

A

Renal cell carcinoma ~90%
Oncocytoma ~5%
Angiomyolipoma ~2-3%

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3
Q

What types of renal cell carcinomas are they and how common are they?

A

Clear cell 85%
Papillary 10%
Chromophobe 5%

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4
Q

Should you perform a biopsy before deciding on active surveillance of a small renal mass?

A

No

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5
Q

How often is an oncocytoma mis-diagnosed when a biopsy is performed?

A

In 35,4% of the cases

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6
Q

How do you differentiate between an onocytoma and RCC?

A

Imaging characteristicts are unreliable
Biopsy only gives the right diagnosis in 64,6% of the cases
= there is no reliable way

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7
Q

At what size can you consider intervention of an angiomyolipoma?

A

> 4 cm though the evidence is weak

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8
Q

Bosniak I

A

Simple cyst

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9
Q

Bosniak II

A

Mildly complex benign cyst

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10
Q

Bosniak IIF

A

Moderately complex cyst

Follow-up som are malignant

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11
Q

Bosniak III

A

Indeterminate complex cyst

Over 50% are malignant
Surgery or active surveillance

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12
Q

Bosniak IV

A

Complex cystic mass

most are malignant

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13
Q

How many partial nefrektomies do you have to perform a year for good results (hospital volume)?

A

35-40 cases

18-20 in robot

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14
Q

When resecting a kidney tumour, which tumours do you have to clamp arteries and veins both?

A

Centrally located tumours

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15
Q

In what ways are Ablative therapies better than partial nephrectomies?

A

Less decline of renal function over 6-months

Less decline of renal function at long term follow up

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16
Q

Why is Ablative therapies not recommended when compared to partial nephrectomies?

A

Higher risk of local recurrence

Worse overall survival

17
Q

What is the benefit of laprascopic radical nephrectomy vs open surgery?

A

Lower morbidity

18
Q

How does renal cell carcinoma most commonly spread?

A

Haematogenous spread

19
Q

What is the role of lymph node dissection (LND) in treating renal cancer?

A

LND is not standard

Can be considered in high risk tumours but evidence is weak

20
Q

When is radical nephrectomy including a thrombectomy indicated?

A

When there is a vena cava thromb and staging is N0M0

21
Q

After a radical nephrectomy, should you offer adjuvant therapy?

A

No

trials are ongoing if you could offer neadjuvant immunetherapy

22
Q

What are the most frequent sites for metastases of RCC?

A

Lung 54%
lymph nodes 22%
bone 20%

23
Q

What is the recurrence of non metastatic RCC?

A

20% inom 5år

24
Q

When is cytoreductive nephrectomy (CR NE) indicated in Clear cell RCC?

A

Good performance status who do not require systemic therapy

Oligometastases when complete local treatment of the metastases can be achieved

25
Q

Metastasectomy for RCC is indicated:

A

If complete and a favourable risk profile

26
Q

What is the result of a complete resection of metastases in mRCC in 5-year cancer specific-survival?

A

74% in pulmonary

33% in extrapulmonary metastases

27
Q

How do you treat brain or bone metastases of RCC?

A

stereotactic radiotherapy

28
Q

Can you treat retroperitoneal recurrence of RCC?

A

Aggressive surgical resection offers potential cure in a substantial number of patients with retroperitoneal recurrence

29
Q

What is a TKI?

A

Tyrosine kinase inhibitor

30
Q

Give a few examples of Tyrosine kinase inhibitors (TIK:s):

A

Axitinib
Panzopanib
Sorafenib
Sunitinib

31
Q

Give a few examples of mTOR inhibitors:

A

Temsirolimus

Everolimus

32
Q

Give an example of a VEGF antibody:

A

Bevacizumab

33
Q

Give a few examples of a PD-1 inhibitor:

A

Nivolumab

Pembrolizumab

34
Q

Give a few examples of a PD-L1 inhibitor:

A

Atezolizumab

Avelumab

35
Q

Give an example of a drug targeting CTLA-4:

A

Ipilimumab

36
Q

What types of immunotherapy are available for the treatment of RCC?

A 
TKI:s
mTOR inhibitors
VEGF-antibodies
PD-1 inhibitors
PD-L1 inhibitors
drugs targeting CTLA-4
37
Q

When is cytoreductive nephrectomy (CR NE) indicated in non Clear cell RCC?

A

Indicated if patient is not a MSKCC poor-risk patient

MSKCC Memorial Sloan-Kettering Cancer center classification

17th European Urology Residents Education Programme (17 decks)

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