You Got to be Kidneying Me!

Question 1

What is the age related pathology?

Answer 1

• adults (renal cell carcinoma)

- children (nephroblastoma)

Question 2

What is the Aeitology?

Answer 2

• cigarette smoking & obesity the most common
• family history
• Von Hippell Lindau syndrome
• men higher incidence
• Occupational exposure to asbestos, lead

Question 3

What is the pathology of Renal Cell Adenocarcinoma?

Answer 3

• clear cell carcinoma

- chromophilic carcinoma (no redness in red cells)

Question 4

What are the signs and symptoms?

Answer 4

• abdominal pain
• palpable flank mass
• haematuria
• fatigue
• weight loss
• pyrexia (fever)
• hypertension
• hypercalcaemia

Question 5

What are the patterns of spread?

Answer 5

• distant mets to liver, lung, bone, brain, ovaries and testes
• local lymphatics (hilar, para-arotic, retro-peritoneal
• direct invasion to perirenal tissue
• common to the renal vein –> IVC –> right atrium

Question 6

What is the clinical managmenet?

Answer 6

• surgical resection

- RT is no longer primary management

Question 7

What is the common surgical procedure?

Answer 7

• full resection
• LN disection
• parts of bladder if it has spread

Question 8

What is the prevention?

Answer 8

• quite smoking

- reduction in weight loss

Question 9

How to do early detect RCC?

Answer 9

• 40% asymptomatic at time of diagnosis

- diagnostic scanning for other issues usually detects RCC

Question 10

What is the RT dose fractionation?

Answer 10

• 45-50.4Gy (1.8Gy -2Gy per day)

- small volume can be boosted to 60Gy

Question 11

What is the most common RT treatment technique?

Answer 11

• IMRT/VMAT

- surgery prior to treatment can remove small bowel and stomach from feidl

Question 12

What are the OAR?

Answer 12

• contra-lateral kidney (max of 18Gy)
• liver
• stomach
• spleen
• small bowel