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FRCR CO2A Clinical Oncology > Kidney Cancer FRCR CO2A > Flashcards

Kidney Cancer FRCR CO2A Flashcards

(83 cards)

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1
Q

Radical Nephrectomy

A

Removal of kidney, perinephric fat, adrenal gland along with Gerota fascia

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2
Q

what should be removed with radical nephrectomy

A

the tumor or tumor thrombus from the infra and supradiaphragmatic venacava and rarely right atrium

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3
Q

open operation vs laparoscopic surgery

A

equivalent survival and equal local recurrence rate

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4
Q

when is partial nephrectomy preferred

A

tumor < 4 cm

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5
Q

whats the role of radiotherapy pre and post nephrectomy

A

No beneficial role, not used routinely

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6
Q

Chemotherapy in adjuvant setting

A

no evidence of its use

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7
Q

Immunotherapy in RCC

A

No e/o adjuant IFN or IL 2, post radical nephrectomy

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8
Q

Role of IO In adjuvant setting

A

Adjuvant pembrolizumab is stage II
Adjuvant pembrolizumab in Stage III (clear cell)
Survellance in non clear cell

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9
Q

Treatment of T4N0

A

Nephrectomy and Adjuvant pembrolizumab for clear cell, survellance for non clear cell

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10
Q

M1 treatment

A

Cytoreductive nephrectomy or systemic therapy

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11
Q

stage IV or Relapsed for clear cell

A

Metastasectomy or stereotactic body
radiation therapy (SBRT)h or ablative
techniques for oligometastatic disease
or
Metastasectomy with complete
resection of disease, followed by
adjuvant pembrolizumab within 1 year of
nephrectomy
and
Best supportive care

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12
Q

Non Clear cell M1 disease treament

A

Systemic Therapy
or
Metastasectomy or SBRTh or ablative
techniques for oligometastatic disease
and
Best supportive care

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13
Q

what are systemic therapy options for IO naive clear cell patients in Metastatic setting?

A

Axitinib + pembrolizumabb
* Cabozantinib
* Cabozantinib + nivolumabb
* Everolimus + lenvatinib
* Ipilimumab + nivolumabb
* Lenvatinib + pembrolizumab
* Nivolumab

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14
Q

what are systemic therapy options for prior IO treated clear cell patients in Metastatic setting?

A
  • Axitinib
  • Belzutifane
  • Cabozantinib
  • Everolimus + lenvatinib
  • Tivozanibf
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15
Q

what are SYSTEMIC THERAPY FOR NON-CLEAR CELL HISTOLOGY ?

A

Erlotinib + bevacizumabg + for selected
patients with advanced papillary RCC including
hereditary leiomyomatosis and renal cell cancer
(HLRCC)-associated RCC (HERED-RCC-D)
* Everolimus + lenvatinib
* Nivolumabb
* Pembrolizumabb
* Sunitinib

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16
Q

what is the role of RT in palliative setting of kidney cancer

A

to control bleeding and pain relief, though results are often disappointing

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17
Q

How is RT for palliation given and Dose?

A

Parallel oposed antr and postr fields, 6-10 MV photons, large tumors CT planning can be done
20 Gy in 5 fractions or 6-10 Gy single fraction

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18
Q

what are the good prognositic factors in M1 disease

A

Good PS
absence of weight loss,
presence of only pulmonary metastasis, removal of primary tumor and
a long disese free interval between nephrectomy and appearance of metastases

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19
Q

What is Heng Criteria

A

its a prognostic model based on 6 risk factors:
KPS < 80
Hb < LLN
Time from Dx to Rx < 1 year
Corrected Ca > ULN
Platelets > ULN
Neutrophils > ULN

Number of RFs 0, favorable group, 2 yr survival 75%
Number of RFs 1-2, Intermediate, 2 yr survival 53%
Number of RFs 3-6, Poor, 2 year survival 7%

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20
Q

What are types of kidney cancer

A

RCC 95 %and transitional cell carcinoma of renal pelvis 5%

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21
Q

what are the RFs for Kidney Cancer

A

Smoking (dose response effect)
Radiation,
Trichloroethylene,
obesity,
use of phenacetin analgesic
Arsenic and Cadmium
Acquired cystic kidney disease

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22
Q

what are the occupational RFS for Kidney Cancer

A

leather tanners
shoe workers
printing process workers
asbestos workers

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23
Q

What is the classical triad of Kidney cancer and in what % of pts it is present

A

pain, mass and hematuria, 19%

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23
Q

what are the Genetic RFs for Kidney Cancer

A

VHL on Chromosome 3
Tuberous Sclerosis
PCKD

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24
what are Paraneoplastic syndromes a/w Kidney cancer
Hypercalcemia (PTH r peptide) Polycythemia (EPO like molecule) Hypertension (renin) and Hepatic dysfunction (IL 06)
24
What are staging investigations?
Renal USG CECT Chest Abdomen and Pelvis to look at perirenal extension, renal vein involvment, LN enlargement and pulmonary mets MRI useful in imaging venacava Bone Scan FBC and Ca LDH and ALP DMSA or MAG3 if there is impaired renal function
25
What percentage of all cancers does renal cell carcinoma (RCC) account for?
2–3% ## Footnote RCC is responsible for approximately 6600 new diagnoses and 3600 deaths per year in the UK.
26
What is the peak age at presentation for renal cell carcinoma?
65–75 years ## Footnote Very few cases are found in individuals under 40 years of age.
27
What is the male to female ratio for renal cell carcinoma?
3:2
28
Name a significant risk factor for renal cell carcinoma.
Smoking ## Footnote Smokers have a relative risk of 2.0 for developing RCC, which is dose-dependent.
29
List other risk factors for renal cell carcinoma.
* Occupational exposure to petroleum, hydrocarbon, steel, asbestos, cadmium, or dry cleaning products * Analgesic nephropathy * Obesity * Acquired cystic kidney disease * Genetic factors (e.g., Von Hippel–Lindau disease, Hereditary papillary renal cell carcinoma)
30
What type of carcinoma accounts for 85% of malignant lesions arising from the kidney?
Renal cell carcinoma (RCC)
31
What are the characteristics of transitional cell carcinomas in the kidney?
They account for 5% of malignancies in the kidney and arise in the renal pelvis ## Footnote Often present late and have a history of bladder tumours.
32
What is the classical triad of symptoms for renal cell carcinoma?
Loin pain, haematuria, flank mass ## Footnote This triad occurs in less than 10% of patients.
33
What is the typical site of metastases for renal cell carcinoma?
* Lungs (75%) * Lymph nodes/soft tissue (36%) * Bone (20%) * Liver (18%)
34
What initial investigations are performed for renal cell carcinoma?
* Urinalysis for protein, blood, and cytology * Blood tests (full blood count, urea and electrolytes, liver function, clotting, calcium levels)
35
What is the definitive treatment for renal cancer?
Surgical resection ## Footnote Radical nephrectomy is the standard procedure.
36
What is the purpose of palliative nephrectomy in patients with metastatic disease?
To reduce symptoms such as pain, haematuria, and hypercalcaemia ## Footnote It may also improve the efficacy of subsequent systemic treatment.
37
What is the role of adjuvant therapy with interferon-α following nephrectomy?
It does not appear to confer any survival advantage.
38
Fill in the blank: The staging of renal tumours determines their _______.
[prognosis and treatment]
39
What does T1 N0 M0 indicate in the staging of renal tumours?
Tumour size 7 cm or less, confined to the kidney
40
What is the significance of the T3 stage in renal tumour staging?
Tumour invades adrenal gland or perinephric tissues, or extends into renal vein(s) or vena cava
41
True or False: Transitional cell carcinomas of the renal pelvis typically present early.
False ## Footnote They are usually discovered late.
42
What is Interferon-alpha?
A cytokine with anticancer and antiviral activity. ## Footnote It has reported response rates in metastatic RCC of 10–15%.
43
What is the typical response rate of Interferon-alpha in metastatic RCC?
10–15% with a 2% complete response rate. ## Footnote Occasional reports of spontaneous remissions off treatment exist.
44
What is the stable disease rate associated with Interferon-alpha treatment?
Approximately 25%. ## Footnote A Cochrane review showed a 3-month survival benefit with interferon compared to no interferon.
45
What factors may influence the effectiveness of Interferon-alpha?
Prognosis of metastatic disease, number of disease sites, performance status, and diagnosis to metastases interval. ## Footnote Better outcomes are observed in patients with 'good' prognosis.
46
What is the typical dosage schedule for Interferon-alpha?
9–12 megaunits subcutaneously three times per week. ## Footnote Often starts at a lower dose to assess tolerability.
47
When should Interferon-alpha treatment be discontinued?
At disease progression or after 6–9 months, whichever comes first.
48
What should be monitored during Interferon-alpha treatment?
Blood counts and liver function.
49
What are common side effects of Interferon-alpha?
* Fatigue * Flu-like symptoms * Diarrhoea * Nausea and vomiting * Anorexia * Bone marrow suppression * Rash at injection site ## Footnote These effects are dose-dependent and typically stop quickly after treatment discontinuation.
50
MOA of Interleukin 2 in cancer treatment?
Stimulates cytotoxic T-cells.
51
What are the methods of administering Interleukin 2?
Subcutaneously, high-dose bolus intravenous injection, or continuous infusion. ## Footnote All methods yield similar results.
52
What is the response rate of Interleukin 2 in cancer treatment?
15–20%.
53
How does Interleukin 2 compare to Interferon in terms of toxicity?
Interleukin 2 has significantly worse toxicity than Interferon.
54
What is the response rate of Medroxyprogesterone-acetate?
5–7%.
55
What survival benefit does Interferon provide over progestins?
Approximately 2.5 months.
56
What is the response rate of chemotherapy in kidney cancer treatment?
Less than 10%.
57
Which chemotherapy agents have shown some response in sarcomatoid variants of RCC?
* Doxorubicin * Ifosfamide.
58
What are novel agents in the treatment of metastatic RCC?
Targeted therapies that are generally better tolerated than interferon-α and interleukin-2.
59
What do Sorafenib and Sunitinib target?
VEGF, PDGF, and c-KIT tyrosine kinases.
60
What is the improvement in progression-free survival with Sorafenib compared to placebo?
5.5 months versus 2.8 months.
61
What is the median progression-free survival with Sunitinib compared to Interferon-α?
11 months compared to 5.1 months.
62
What is the recommended treatment for patients with performance status 0–1 in the UK? M1 kidney cancer 2013
Sunitinib.
63
What is the typical dosage of Sunitinib?
50 mg once daily for 4 weeks with a 2-week rest period. ## Footnote This forms a 6-week cycle.
64
What are common adverse events associated with Sunitinib?
* Rash * Diarrhoea * Hand–foot skin reaction * Fatigue * Thrombocytopaenia * Hypertension.
65
What does Temsirolimus inhibit?
Activity of mTOR.
66
In which patient population has Temsirolimus shown particular benefit?
Poor prognosis patients.
67
What is the benefit of Everolimus in kidney cancer treatment?
Proven benefit in the second-line setting after previous tyrosine kinase inhibitor treatment.
68
What is Bevacizumab?
A monoclonal antibody that inhibits VEGF ## Footnote Bevacizumab is used in conjunction with interferon to improve survival outcomes in metastatic RCC.
69
How does Bevacizumab affect progression-free survival in metastatic RCC?
It doubles progression-free survival compared to interferon alone ## Footnote This effect is observed in previously untreated patients.
70
What is the role of radiotherapy in Kidney cancer treatment?
Control bleeding and pain from primary tumor sites and treat symptoms of bone and CNS metastases ## Footnote Radiotherapy can provide palliative care in metastatic settings.
71
When should surgical management of metastases from RCC be considered?
Particularly for pulmonary lesions ## Footnote Surgical resection can yield excellent results.
72
What are the best survival figures seen after complete resection of solitary lesions?
5-year survival rates of up to 50% ## Footnote This is significantly higher compared to complete resection of multiple lesions, which has a 20% survival rate.
73
What correlates with longer disease-specific survival in RCC?
A longer interval between primary tumor and development of metastases ## Footnote This suggests that timing of metastasis plays a crucial role in prognosis.
74
What have studies shown about the resection of cerebral metastases?
Favorable results, especially with a long interval from primary resection ## Footnote This indicates that timing is also critical for brain metastases.
75
What is the general prognosis for patients with RCC?
Survival remains limited, but long-term survival is recognized in selected patients with metastatic disease ## Footnote Prognosis can vary significantly based on specific characteristics.
76
What characteristics are associated with a better prognosis in RCC?
Stage I disease, absence of invasion into collecting system, predominance of clear cell pattern ## Footnote These factors improve overall survival outcomes.
77
What is the Memorial Sloan–Kettering prognostic stratification used for?
To assess prognosis for metastatic disease ## Footnote It categorizes patients based on specific prognostic factors.
78
What are the five major prognostic factors identified in metastatic RCC?
* Poor performance status (KPS <70) * Raised lactate dehydrogenase (>1.5× normal) * Raised serum calcium * Low hemoglobin * No nephrectomy ## Footnote These factors help categorize patients into risk groups.
79
How are patients categorized based on prognostic factors?
0 = favourable risk, 1-2 = intermediate risk, 3-5 = poor risk ## Footnote This classification aids in treatment decision-making.
80
What are the reported 3-year survival rates for the risk groups?
* 31% for favourable risk * 7% for intermediate risk * 0% for poor risk ## Footnote These statistics highlight the importance of prognostic assessment.
81
What is the stage-wise 5-year survival for renal cell carcinoma?
* 66% for stage I * 64% for stage II * 42% for stage III * 11% for stage IV ## Footnote Survival rates significantly decrease with advanced stages of the disease.

FRCR CO2A Clinical Oncology (35 decks)

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