Workup/Staging Flashcards
How is RCC diagnosed?
RCC requires a tissue Dx. Often, nephrectomy is both diagnostic and therapeutic. Percutaneous Bx can also be employed for surgically unfit pts, those considering active surveillance, or at the time of ablative therapy.
What % of biopsied pts have benign Dz?
∼33% of small renal masses may be characterized as benign according to the specimen obtained. The risk of benign pathology is inversely proportional to the size of the renal mass.
What imaging is important in the initial workup of RCC?
Imaging workup typically includes contrast-enhanced CT or MRI scan of the abdomen and chest imaging. Consider bone scan and MRI brain if clinically indicated.
Summarize the AJCC 8th edition (2017) T staging for RCC.
TX: primary tumor cannot be assessed
T0: no evidence of primary tumor
T1: limited to kidney and ≤7 cm
T1a: ≤4 cm
T1b: >4 and ≤7 cm
T2: limited to kidney and >7 cm
T2a: >7 cm but ≤10 cm
T2b: >10 cm
T3: invades into major veins or perinephric tissues but not into ipsi adrenal gland and not beyond Gerota fascia
T3a: extends into renal vein or its segmental branches, or invades the pelvicalyceal system, or invades perirenal and/or renal sinus fat but not beyond Gerota fascia
T3b: extends into vena cava below diaphragm
T3c: extends into vena cava above diaphragm or invades wall of vena cava
T4: invades beyond Gerota fascia, including contiguous extension into ipsi adrenal gland
Summarize the AJCC 8th edition (2017) stage grouping for RCC.
Stage I: T1N0M0
Stage II: T2N0M0
Stage III: T1–2N1M0 or T3N0–1M0
Stage IV: T4 or M1
What other staging systems are widely used for RCC?
The Flocks and Kadesky system (with or without Robson modification) and Jewett–Strong classification system have been used to stage RCC.
Name 3 prognostic factors for RCC.
Prognostic factors for RCC:
- TNM stage
- PS
- Fuhrman grade