Renal Tumors- MJ Flashcards
Which renal carcinoma?
- Most common in men
- Median age of dx= 64y/o (6th-8th decades)
- Strong association w/ smoking
Renal Cell Carcinoma
Which is the MC primary renal malignancy?
Renal Cell Carcinoma
What is the biggest risk factor for Renal Cell Carcinoma?
SMOKING
(will be on exam)
The following are risk factors for which renal tumor?
- Smoking
- HTN
- obesity
- chronic dialysis
- toxic exposure (abestosis)
- Heavy ASA, NSAIDs or Acetaminophen use
- Genetics
Renal Cell Carcinoma
What is the most common type of renal cell carcinoma?
Clear Cell (75-85%)
Which type of renal cell carcinoma?
- Depletion of Chromosome 3p
- Proximal tubule
- usually solid
Clear Cell Renal Cell Carcinoma (the MC)
Which type of Renal Cell Carcinoma?
- Less common (10-15%)
- Proximal Tubule
- Type 1- usually stage I or II at dx, good prognosis
- Type 2- aggressive, usually stage III or IV at dx
Papillary (chromophilic) Renal Cell Carcinoma
What is the classic presentation of Renal Cell Carcinoma (3 things)
- Hematuria (MC)
- Abdominal Mass
- Flank pain
The following are the clinical presentation of what?
- Hematuria
- abdominal mass
- flank pain
- Weight loss
- L-sided scrotal varicocele
(bolded= MC)
Renal Cell Carcinoma
What are the 5 MC site of metastasis for Renal Cell Carcinoma?
- Lungs
- Lymph Nodes
- Bone
- Liver
- Brain
The following paraneoplastic syndromes are associated with which renal cancer?
- Anemia
- Hepatic dysfunction
- Fever
- Hypercalcemia
- Cachexia
- Erythrocytosis
- Secondary amyloidosis
- Thrombocytosis
- Polymyalgia rheumatica
Renal Cell Carcinoma
What is the initial diagnostic test for Renal Cell Carcinoma?
Abdominal CT with/without contras
If you have a patient that you think might have Renal Cell Carcinoma and the initial CT is non-diagnostic (or the patient has a contraindication to contrast), what would be your next choice of test?
MRI
What is the definitive diagnostic test for Renal Cell Carinoma?
Tissue Biopsy (Nephrectomy or partial nephrectomy)
What are the 4 diagnostic tests you should do in order to evaluate for metastasis of Renal Cell Carcinoma?
- Bone scan (if pain or elevated alk phos)
- CT chest
- MRI w/ gad (for IVC and R atrium)
- PET or PET/CT
Other than hematuria, abdominal mass and flank pain, what 4 other sxs might be present in a patient with Renal Cell Carcinoma if there is IVC involvement?
- LE edema
- Ascites
- Hepatic dysfunction
- Pulmonary emboli
What is the treatment for a localized RCC (Stages I, II, III)?
Surgery is curative
What are the treatment options (3) for advanced RCC (Stages IV)?
Options:
- Systemic therapy (Immunotherapy, molecularly targeted agents)
- Surgery
- Radiation
*treatment decisions are dependent on prognosis*
What are the predictors of malignancy for a small renal mass, <4cm (w/ enhancement on contrast imaging, solid or complex cyst)?
Male sex
Increasing tumor size
How do you manage a renal mass that is <2cm?
- 20-40% are _____
- 10% high grade ____
- <1% develop ______
- 20-40% are benign
- 10% are high grade RCC
- <1% develop mets
*
Management of small renal mass:
What are the chances of a renal mass that is >4cm being benign? Being high grade or advanced RCC?
Increased chance of malignancy!
5-10% benign
20-30% high grade or advanced RCC
The following are steps in management of what?
- Urology
- Dedicated Renal CT or MRI, without and then with IV contrast
- CMP and CBC (paraneoplastic syndrome)
- Renal function to eval for CKD
- Chest imaging if malignancy risk high and concern for Mets
- Biopsy decision
Management of small renal mass
What are the 4 management strategies of small renal masses and at what size are each indicated?
- Surgery (partial nephrectomy)
- Thermal ablation (if < 3cm)
- Surveillance (only if <2cm)
- <1cm =surveillance (NO biopsy)
If you find a small renal mass < 2cm, how would you manage this?
Surveillance
Mets eval q3-6mo x2 years then q6-12 month
What is the management for a renal cell mass <1cm?
Surveillance
(NO biopsy)
Which renal tumor?
- MC primary renal cancer in children < 15 y/o
- 2/3 dx before 5y/o, 95% before 10y/o
- Sporadic (NOT genetic)
Wilms Tumor
Pathology of which Renal Tumor?
•Abnormal renal development
- Association with loss of function of tumor suppressor genes
- solitary lesion
- Surrounded by pseudocapsule
Wilms Tumor
What is the most common clinical presentation of a wilms tumor?
Abdominal mass
(usually an incidental finding by a parent)
Other than an abdominal mass, what are 4 other less common presentations for a Wilms tumor?
- Abdominal Pain
- Hematuria
- Fever
- Hypertension
(“Freddy Had A Hamburger”)
What is the definitive diagnosis for a Wilms tumor?
Histologic confirmation (surgical excision or biopsy)
What is the initial diagnostic study for a Wilms Tumor?
What other test(s) do you perform if you don’t find anything on the initial study?
- Initial study= Abdominal ultrasound
- If you dont find anything on u/s, you MUST order: CT or MRI w/ contrast
T/F: In a patient with a Wilms tumor, you do NOT need to evaluate the contralateral kidney
FALSE
It is important to evaluate the contralateral kidney
The Following diagnostic labs would be ordered for which renal tumor?
- renal function
- U/A
- liver function
- calcium
- CBC
- coag studies
Wilms tumor
What is the treatment for a Wilms tumor? (3 steps)
- Refer to pediatric cancer center
- Chest imaging for Mets
- Chemo and surgical excision
What is the prognosis of a Wilms tumor?
- 5-year survival 90%
- Increased risk of premature death in adulthood due to secondary neoplasms and other late complications
What is a patient with history of Wilms tumor at increased risk of?
•Increased risk of premature death in adulthood due to secondary neoplasms and other late complications (i.e. infertility)
Surveillance for Wilms tumor after surgical excision and chemo includes what 3 diagnostic studies performed how often?
- •Includes CXR, abd u/s, chest/abd/pelvic CT
- Q 6-8 weeks during therapy, q 3 months x 2 years, q 6 months x 2 years
