Renal, Renal Pelvis, and Ureter Cancer Flashcards
Renal, Renal Pelvis, and Ureter Cancer
BONUS:
Which kidney is lower in location than the other?
Right
Renal, Renal Pelvis, and Ureter Cancer
BONUS:
The renal axis runs parallel to the lateral margin of which muscle?
psoas
Renal, Renal Pelvis, and Ureter Cancer
What is the most common primary malignancy of the kidney?
RCC
Renal, Renal Pelvis, and Ureter Cancer
Gender predisposition of RCC?
males
Renal, Renal Pelvis, and Ureter Cancer
Median age of RCC diagnosis?
65
Renal, Renal Pelvis, and Ureter Cancer
RCC.
What are the most implicated risk factors?
- 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
Renal, Renal Pelvis, and Ureter Cancer
RCC.
inhertied syndromes related to RCC?
-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
Renal, Renal Pelvis, and Ureter Cancer
What is the most important risk factor for the development of urothelial carcinoma of the urinary tract?
smoking
Renal, Renal Pelvis, and Ureter Cancer
What genetic condition is associated with the development of urothelial carcinoma of the urinary tract?
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
Renal, Renal Pelvis, and Ureter Cancer
Ureteral tumors tend to occur in the ____ third of the ureter.
distal
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?
gross hematuria
palpable flank mass
pain
Renal, Renal Pelvis, and Ureter Cancer
What is the most frequent symptom in both RCC and renal pelvis/ureteral tumors?
hematuria
Renal, Renal Pelvis, and Ureter Cancer
RCC TNM Staging
What is the T-stage?
Tumor ≤7 cm in greatest dimension, limited to the kidney
T1
Renal, Renal Pelvis, and Ureter Cancer
RCC TNM Staging
What is the T-stage?
Tumor >7 cm in greatest dimension, limited to the kidney
T2
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)
T4
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
T3a
Renal, Renal Pelvis, and Ureter Cancer
RCC TNM Staging
What is the T-stage?
Tumor extends into the vena cava above the diaphragm
T3c
Renal, Renal Pelvis, and Ureter Cancer
RCC TNM Staging
What is the T-stage?
Tumor extends invades the wall of the vena cava
T3c
Renal, Renal Pelvis, and Ureter Cancer
RCC TNM Staging
What is the T-stage?
Tumor extends into the vena cava below the diaphragm
T3b
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
T2b
Renal, Renal Pelvis, and Ureter Cancer
RCC TNM Staging
What is the T-stage?
Tumor ≤4 cm in greatest dimension, limited to the kidney
T1a
Renal, Renal Pelvis, and Ureter Cancer
RCC TNM Staging
What is the stage group?
N+
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
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
N1
The rest are N2
Renal, Renal Pelvis, and Ureter Cancer
Renal Pelvis, and Ureter Cancer TNM
What is the stage group?
N+
Stage IV
Renal, Renal Pelvis, and Ureter Cancer
RCC
What subtype is the most common?
Clear cell RCC
Renal, Renal Pelvis, and Ureter Cancer
RCC
What subtype is associated with young black patients with sickle cell trait/disease?
Renal medullary carcinoma (RMC)
Renal, Renal Pelvis, and Ureter Cancer
RCC
What is the most important prognostic factor for RCC survival?
stage at initial presentation
followed by nuclear grade, Furhman system
Renal, Renal Pelvis, and Ureter Cancer
What are the most important prognostic factors for renal pelvis and ureteral cancers in general?
initial stage and grade
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.
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
Renal, Renal Pelvis, and Ureter Cancer
RCC
In what instances can a nephron-sparing nephrectomy be chosen as the surgical procedure?
T1a and T1b
hereditary RCC
bilateral RCC
Renal, Renal Pelvis, and Ureter Cancer
RCC
Is there a role for neoadjuvant RT in patients with resectable RCC?
None.
Renal, Renal Pelvis, and Ureter Cancer
RCC
Is there a role for adjuvant RT in patients with completely resected RCC?
No proven role yet.
Renal, Renal Pelvis, and Ureter Cancer
RCC
Is there a role for adjuvant RT in patients with completely resected RCC? (with + margins)
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.
Renal, Renal Pelvis, and Ureter Cancer
RCC
What is the predominant pattern of failure in RCC?
distant spread/metastases
Renal, Renal Pelvis, and Ureter Cancer
RCC
RT dose preferred for WBRT?
> 30 Gy
2 Gy x 20) (3 Gy x 15
Renal, Renal Pelvis, and Ureter Cancer
RCC
Stereotactic RT dose for primary treatment?
single fraction 25 Gy to the 70% IDL
Renal, Renal Pelvis, and Ureter Cancer
RCC
What is the ideal lesion size criteria for intracranial metastatic SRS?
≤2 cm
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?
Mean dose <15 to 18 Gy
V12 <55%
V20 <32%
V23 <30%
V28 <20%
Renal, Renal Pelvis, and Ureter Cancer
When RT is needed, what should be the dose constraints for the stomach?
<45 Gy
Renal, Renal Pelvis, and Ureter Cancer
When RT is needed, what should be the dose constraints for the small bowel?
V45 <195 cc
Renal, Renal Pelvis, and Ureter Cancer
When RT is needed, what should be the dose constraints for the liver?
<30 to 32 Gy
or sparing 700 cc of the liver
Renal, Renal Pelvis, and Ureter Cancer
When RT is needed, what should be the dose constraints for the spleen?
5 to 10 Gy
Renal, Renal Pelvis, and Ureter Cancer
RCC
What should be the dose when considering preoperative RT to improve resectability?
40 to 50 Gy (1.8-2)
Renal, Renal Pelvis, and Ureter Cancer
RCC
What should be the dose when considering post-operative RT?
45 to 50 (1.8-2) to the tumor and scar
10 to 15 Gy boost to residual + microscopic
Renal, Renal Pelvis, and Ureter Cancer
For renal pelvis and ureter carcinoma, what should be the target volumes for adjuvant RT?
renal fossa,
course of the ureter to the bladder,
entire bladder,
paracaval and para-aortic lymph nodes
Renal, Renal Pelvis, and Ureter Cancer
RCC
Follow-up schedule?
6 months for the 1st 2 years, annually up to 5 years
baseline abdominal imaging within 3 to 12 months of surgery
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
C
