Renal Cell Carcinoma Flashcards
What limitation does an MRI have when investigating kidney tumours?
It can not be used to evaluate the chest. CT is needed for that.
What are the most common types of kidney tumours?
Renal cell carcinoma ~90%
Oncocytoma ~5%
Angiomyolipoma ~2-3%
What types of renal cell carcinomas are they and how common are they?
Clear cell 85%
Papillary 10%
Chromophobe 5%
Should you perform a biopsy before deciding on active surveillance of a small renal mass?
No
How often is an oncocytoma mis-diagnosed when a biopsy is performed?
In 35,4% of the cases
How do you differentiate between an onocytoma and RCC?
Imaging characteristicts are unreliable
Biopsy only gives the right diagnosis in 64,6% of the cases
= there is no reliable way
At what size can you consider intervention of an angiomyolipoma?
> 4 cm though the evidence is weak
Bosniak I
Simple cyst
Bosniak II
Mildly complex benign cyst
Bosniak IIF
Moderately complex cyst
Follow-up som are malignant
Bosniak III
Indeterminate complex cyst
Over 50% are malignant
Surgery or active surveillance
Bosniak IV
Complex cystic mass
most are malignant
How many partial nefrektomies do you have to perform a year for good results (hospital volume)?
35-40 cases
18-20 in robot
When resecting a kidney tumour, which tumours do you have to clamp arteries and veins both?
Centrally located tumours
In what ways are Ablative therapies better than partial nephrectomies?
Less decline of renal function over 6-months
Less decline of renal function at long term follow up
Why is Ablative therapies not recommended when compared to partial nephrectomies?
Higher risk of local recurrence
Worse overall survival
What is the benefit of laprascopic radical nephrectomy vs open surgery?
Lower morbidity
How does renal cell carcinoma most commonly spread?
Haematogenous spread
What is the role of lymph node dissection (LND) in treating renal cancer?
LND is not standard
Can be considered in high risk tumours but evidence is weak
When is radical nephrectomy including a thrombectomy indicated?
When there is a vena cava thromb and staging is N0M0
After a radical nephrectomy, should you offer adjuvant therapy?
No
trials are ongoing if you could offer neadjuvant immunetherapy
What are the most frequent sites for metastases of RCC?
Lung 54%
lymph nodes 22%
bone 20%
What is the recurrence of non metastatic RCC?
20% inom 5år
When is cytoreductive nephrectomy (CR NE) indicated in Clear cell RCC?
Good performance status who do not require systemic therapy
Oligometastases when complete local treatment of the metastases can be achieved
Metastasectomy for RCC is indicated:
If complete and a favourable risk profile
What is the result of a complete resection of metastases in mRCC in 5-year cancer specific-survival?
74% in pulmonary
33% in extrapulmonary metastases
How do you treat brain or bone metastases of RCC?
stereotactic radiotherapy
Can you treat retroperitoneal recurrence of RCC?
Aggressive surgical resection offers potential cure in a substantial number of patients with retroperitoneal recurrence
What is a TKI?
Tyrosine kinase inhibitor
Give a few examples of Tyrosine kinase inhibitors (TIK:s):
Axitinib
Panzopanib
Sorafenib
Sunitinib
Give a few examples of mTOR inhibitors:
Temsirolimus
Everolimus
Give an example of a VEGF antibody:
Bevacizumab
Give a few examples of a PD-1 inhibitor:
Nivolumab
Pembrolizumab
Give a few examples of a PD-L1 inhibitor:
Atezolizumab
Avelumab
Give an example of a drug targeting CTLA-4:
Ipilimumab
What types of immunotherapy are available for the treatment of RCC?
TKI:s mTOR inhibitors VEGF-antibodies PD-1 inhibitors PD-L1 inhibitors drugs targeting CTLA-4
When is cytoreductive nephrectomy (CR NE) indicated in non Clear cell RCC?
Indicated if patient is not a MSKCC poor-risk patient
MSKCC Memorial Sloan-Kettering Cancer center classification
