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Ph RadOnc Residency PBRROE2-3 Review 2021 > Renal, Renal Pelvis, and Ureter Cancer > Flashcards

Renal, Renal Pelvis, and Ureter Cancer Flashcards

1
Q

Renal, Renal Pelvis, and Ureter Cancer

BONUS:

Which kidney is lower in location than the other?

A

Right

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2
Q

Renal, Renal Pelvis, and Ureter Cancer

BONUS:

The renal axis runs parallel to the lateral margin of which muscle?

A

psoas

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3
Q

Renal, Renal Pelvis, and Ureter Cancer

What is the most common primary malignancy of the kidney?

A

RCC

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4
Q

Renal, Renal Pelvis, and Ureter Cancer

Gender predisposition of RCC?

A

males

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5
Q

Renal, Renal Pelvis, and Ureter Cancer

Median age of RCC diagnosis?

A

65

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6
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC.

What are the most implicated risk factors?

A
  • occupational (tirchloroethylene and others, asbsetos, cadmium, dry-cleaning solvents, gasoline, petroleum
  • environmental (thorium dioxide)
  • hormonal (DES)
  • dietary (fried meats)
  • cigaretter smoking
  • obesity, diabetes, hepatitis, hypertension
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7
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC.

inhertied syndromes related to RCC?

A

-von Hippel-Lindau
(VHL) disease

-hereditary papillary renal cancer (HPRC)

-hereditary
leiomyomatosis renal cell carcinoma (HLRCC)

-Birt-Hogg-Dubé (BHD)
syndrome

-constitutional chromosome 3 translocation

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8
Q

Renal, Renal Pelvis, and Ureter Cancer

What is the most important risk factor for the development of urothelial carcinoma of the urinary tract?

A

smoking

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9
Q

Renal, Renal Pelvis, and Ureter Cancer

What genetic condition is associated with the development of urothelial carcinoma of the urinary tract?

A

Lynch syndrome
***
Patients with Lynch
syndrome, an autosomal dominant genetic condition because of inherited
mutations that impair DNA mismatch repair, have an increased risk of
developing urinary tract cancer

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10
Q

Renal, Renal Pelvis, and Ureter Cancer

Ureteral tumors tend to occur in the ____ third of the ureter.

A

distal

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11
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC

Classic triad of symptoms is a rare finding in RCC and is often suggestive of advanced disease and poor prognosis.

What is the classic triad?

A

gross hematuria
palpable flank mass
pain

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12
Q

Renal, Renal Pelvis, and Ureter Cancer

What is the most frequent symptom in both RCC and renal pelvis/ureteral tumors?

A

hematuria

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13
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor ≤7 cm in greatest dimension, limited to the kidney

A

T1

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14
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor >7 cm in greatest dimension, limited to the kidney

A

T2

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15
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor invades beyond Gerota fascia (including contiguous extension into the
ipsilateral adrenal gland)

A

T4

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16
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor extends into the renal vein or its segmental branches, or tumor invades the
pelvicalyceal system or invades perirenal and/or renal sinus fat but not beyond
Gerota fascia

A

T3a

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17
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor extends into the vena cava above the diaphragm

A

T3c

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18
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor extends invades the wall of the vena cava

A

T3c

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19
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor extends into the vena cava below the diaphragm

A

T3b

20
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor >7 cm but ≤10 cm in greatest dimension, limited to the kidney

A

T2b

21
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor ≤4 cm in greatest dimension, limited to the kidney

A

T1a

22
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the stage group?

N+

A

Stage III or IV

(all T stages correspond to the stage group T1=stage 1 except in N+ disease, T1 or T2 N+ is stage III

23
Q

Renal, Renal Pelvis, and Ureter Cancer

Renal Pelvis, and Ureter Cancer TNM
Identify the N stage:

Metastasis in a single lymph node, ≤2 cm in greatest dimension

A

N1

The rest are N2

24
Q

Renal, Renal Pelvis, and Ureter Cancer

Renal Pelvis, and Ureter Cancer TNM
What is the stage group?

N+

A

Stage IV

25
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

What subtype is the most common?

A

Clear cell RCC

26
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

What subtype is associated with young black patients with sickle cell trait/disease?

A

Renal medullary carcinoma (RMC)

27
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

What is the most important prognostic factor for RCC survival?

A

stage at initial presentation

followed by nuclear grade, Furhman system

28
Q

Renal, Renal Pelvis, and Ureter Cancer

What are the most important prognostic factors for renal pelvis and ureteral cancers in general?

A

initial stage and grade

29
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

Is nephron sparing comparable to radical nephrectomy in terms of DFS?

Which is inferior if no?
If yes, no need to answer.

A

In a matched-pair
analysis of 164 patients undergoing nephron-sparing surgery at the Mayo Clinic,
the disease-free survival was 79%, which compared favorably to 77% in patients
undergoing radical nephrectomy

30
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

In what instances can a nephron-sparing nephrectomy be chosen as the surgical procedure?

A

T1a and T1b

hereditary RCC

bilateral RCC

31
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

Is there a role for neoadjuvant RT in patients with resectable RCC?

A

None.

32
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

Is there a role for adjuvant RT in patients with completely resected RCC?

A

No proven role yet.

33
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

Is there a role for adjuvant RT in patients with completely resected RCC? (with + margins)

A

No proven role yet.

positive surgical margins are not yet prospectively proven to be associated with an increased risk of local tumor recurrence or metastatic
disease.

34
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

What is the predominant pattern of failure in RCC?

A

distant spread/metastases

35
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

RT dose preferred for WBRT?

A

> 30 Gy

2 Gy x 20) (3 Gy x 15

36
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

Stereotactic RT dose for primary treatment?

A

single fraction 25 Gy to the 70% IDL

37
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

What is the ideal lesion size criteria for intracranial metastatic SRS?

A

≤2 cm

38
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

After nephron-sparing surgery and when RT is needed, what should be the dose constraints for the kidney?

A

Mean dose <15 to 18 Gy

V12 <55%
V20 <32%
V23 <30%
V28 <20%

39
Q

Renal, Renal Pelvis, and Ureter Cancer

When RT is needed, what should be the dose constraints for the stomach?

A

<45 Gy

40
Q

Renal, Renal Pelvis, and Ureter Cancer

When RT is needed, what should be the dose constraints for the small bowel?

A

V45 <195 cc

41
Q

Renal, Renal Pelvis, and Ureter Cancer

When RT is needed, what should be the dose constraints for the liver?

A

<30 to 32 Gy

or sparing 700 cc of the liver

42
Q

Renal, Renal Pelvis, and Ureter Cancer

When RT is needed, what should be the dose constraints for the spleen?

A

5 to 10 Gy

43
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

What should be the dose when considering preoperative RT to improve resectability?

A

40 to 50 Gy (1.8-2)

44
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

What should be the dose when considering post-operative RT?

A

45 to 50 (1.8-2) to the tumor and scar

10 to 15 Gy boost to residual + microscopic

45
Q

Renal, Renal Pelvis, and Ureter Cancer

For renal pelvis and ureter carcinoma, what should be the target volumes for adjuvant RT?

A

renal fossa,
course of the ureter to the bladder,
entire bladder,
paracaval and para-aortic lymph nodes

46
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

Follow-up schedule?

A

6 months for the 1st 2 years, annually up to 5 years

baseline abdominal imaging within 3 to 12 months of surgery

47
Q

Renal, Renal Pelvis, and Ureter Cancer
RCC

(from inservice bank)

Renal cell carcinoma has been known to be radioresistant, however in which clinical situation as radiation been reported to have a distinct advantage?

A. Gross visceral metastases

B. Post-op RT to the tumor bed after complete nephrectomy

C. Radiosurgery for brain mets from renal cell CA

D. Whole brain RT for brain mets from renal cell CA

A

C

Ph RadOnc Residency PBRROE2-3 Review 2021 (57 decks)

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