L8: Renal Tumors Flashcards
(77 cards)
1
Q
A
2
Q
Renal Tumors
- Outlines
A
3
Q
Incidence of RCC
A
4
Q
Incidence of RCC
- Percentage & Numbers
A
5
Q
Incidence of RCC
- Age
A
5th to 6th decades of life.
6
Q
Incidence of RCC
- Sex
A
Males (2) : Females (1)
7
Q
Incidence of RCC
- Race
A
Hispanics
8
Q
Etiology of RCC
A
- Hereditary
- Acquired Cystic Kidney Diseases
- Cigarettes
- Analgesic Abuse
- Occupational
9
Q
Etiology of RCC
- Hereditary
A
10
Q
Etiology of RCC
- VHL Syndrome
A
- Cerebellar hemangioblastora.
- Retinal angioma.
- Bilateral RCC.
11
Q
Etiology of RCC
- Sporadic Vs Familial
A
12
Q
Etiology of RCC
- Acquired Renal Cysteic Disease of the kidney
A
13
Q
Etiology of RCC
- Cigarettes
A
At least 2-fold increase in risk.
14
Q
Etiology of RCC
- Analgesic Abuse
A
Phenacitin-containing product → analgesic nephropathy → RCC.
15
Q
Etiology of RCC
- Occupational
A
16
Q
Pathology of RCC
- Histopathology
A
17
Q
Spread of RCC
A
18
Q
Spread of RCC
- Direct
A
19
Q
Spread of RCC
- Lymphatic
A
…
20
Q
Spread of RCC
- Heamtogenous
A
- 1/3 cf patients have metastasis at time of presentations.
- The most common site is the lung.
21
Q
Staging of RCC
A
22
Q
Staging of RCC
- Primary Tumor
A
23
Q
Staging of RCC
- LN
A
24
Q
Staging of RCC
- Distant Mets
A
25
Stage Grouping of **RCC**
26
Prognosis of **RCC**
27
CP of **RCC**
Symptoms & Signs
28
CP of **RCC**
- Incidental
- Incidental (50%)
29
CP of **RCC**
- Symptomatic
30
CP of **RCC**
- Main Symptoms
Hematuria (50%) - Loin pain (40%) - Mass 30%.
31
CP of **RCC**
- Old CLassic Triad
- Old classic triad (pain, hematuria, and mass) in 10%.
32
CP of **RCC**
- Varicocele & Edema
Non-reducing varicocele or bilateral lower limb edema.
33
CP of **RCC**
- Mets
Metastatic symptoms (25%):
A. Lungs (75%).
B. Bones (20%).
C. Liver.
D. Brain.
34
CP of **RCC**
- Paraneoplatsic Syndrome
35
CP of **RCC**
- Internist or Radiologist?
- RCC used to be the internist's tumor.
- May now be the radiologist's tumor, as >60% are incidental.
36
Signs of **RCC**
- Abdominal Mass
37
Signs of **RCC**
38
INVx for **RCC**
39
INVx for **RCC**
- US & CT Scan
40
INVx for **RCC**
- MRI
41
INVx for **RCC**
- SRA
- Diagnostic.
- Therapeutic: Preoperative or Symptomatic embolization.
42
INVx for **RCC**
- Bone Scan, Brain CT or MRI
In symptomatic and advanced cases.
43
INVx for **RCC**
- Bx
- Metastatic, Lymphoma, survillence or ablative ttt, indeterminate lesion.
44
INVx for **RCC**
- 1st Step
US
45
INVx for **RCC**
- Gold Standard
CT Scan
46
INVx of **RCC**
- Exclusion or Mets
47
Surgical Management of **RCC**
- TTT (Not Palliation)
48
TTT of **RCC**
- Palliation
49
TTT of **RCC**
- Localized Renal Cancer
1. Radical nephrectomy.
2. Nephron-sparing surgery.
3. Tumour ablation.
50
TTT of **RCC**
- Locally Advanced Renal Cancer
Radical nephrectomy + ....
51
TTT of **RCC**
- Metastatic Renal Cancer
- Role of nephrectomy
- metastatectomy
- targeted therapy.
52
TTT of **Localized Renal Cancer**
53
TTT of **Localized Renal Cancer**
- Radical Nephrectomy
54
TTT of **Localized Renal Cancer**
- NSS
55
NSS
- Absolute Indications
56
NSS
- Relative Indications
57
NSS
- Elective Indications
58
TTT of **Locally Advanced RCC**
- Indications of oprn surgery
59
Incidence of **RCC with Venous Thrombus**
- 4-10%
- More common on right side.
60
CP of **RCC with Venous Thrombus**
- 10- 25% extension above the hepatic veins.
- One third are metastatic.
61
TTT of **RCC with Venous Thrombus**
- Surgery can provide long tenn survival in suitable candidates with no metastas:
1. Not difficult.
2. Pull back the thrombus into RV and side clamp the IVC.
3. Laparoscopically possible.
62
TTT of **Metastatic RCC**
- Chemo & Radio
NOOO
- RCC is chemo-refractory and radio-resistant!
63
TTT of **Metastatic RCC**
- Immunotherapy
64
TTT of **Metastatic RCC**
- Allogeneic stem cell transplantation
Has significant morbidity
65
"The standard of care for advanced RCC is the best available clinical trial".
Ok Sir
66
**Targeted therapy** for RCC
- Antiangiogenic Drugs
- mTOR Inhibitors
67
Antiangiogenic Drugs in RCC
**Tyrosine kinase inhibitors (TKIs):**
- block the intracellular domain of the VEGFR (e.g., Sunitinib, Sorafenib, Axitinib).
**Monoclonal antibody:**
- bind circulating VEGF and prevent it from activating the VEGFR (e.g., Bevacizurab).
68
mTOR Inhibitors in RCC
Temsirolimus
69
Etiology of **Renal Pelvis Tumors**
70
Occupational RF for **Renal Pelvis Tumors**
* Chemical.
* Leather.
* Printing.
* Gasworks.
* Rubber.
* Sewage works.
* Plastic
71
Pathology of **Renal Pelvis Tumors**
- Malignant
* Transitional Cell Carcinoma (TCC) (The most common).
* Squamous Cell Carcinoma (SCC)-
* Adenocarcinoma.
72
Staging of **Renal Pelvis Tumors**
73
INVx for **Renal Pelvis Tumors**
74
TTT of **Renal Pelvis Tumors**
75
TTT of **Renal Pelvis Tumors**
- Surgical
- Kidney-sparing management.
- Radical rephroureterctomy and bladder cuff excision.
- Palliative nephrectomy and chemotherapy for metastatic dis.
76
TTT of **Renal Pelvis Tumors**
- Radiation
Postoperative or adjuvant
77
TTT of **Renal Pelvis Tumors**
- Systemic Chemo
MVAC:
M: Methotrexate
V: Vinblastine
A: doxorubicin (Adriamycin)
C: Cisplatin.
