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FRCR2 > renal > Flashcards

renal Flashcards

1
Q

What are the commonest histologies of renal cell carcinoma

A

Clear cell

Papillary

Chromophobe

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2
Q

What mutation is typically seen in clear cell renal carcinoma & on what chromosome

A

VHL alterations (chr 3)

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3
Q

What tumour is associated with a VHL mutation

A

Phaeochromocytoma

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4
Q

What is associated with VHL disease
What is the inheritance

A

AD
Haemangioblastoma of brain, spine and retina Pancreatic and renal cysts
Neuroendocrine tumours
Endolympatic sac tumours
Phaeochromocytoma

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5
Q

How are renal cell carcinomas graded and for which histologies

A

Fuhrman grading 1-4
Clear cell and papillary onlywha

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6
Q

What must be excluded in renal cell cancers <40yrs

A

Micro-ophthalmia associated transcription factor (MiT) alterations

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7
Q

How much is the risk of renal cell carcinoma increased by due to dialysis

A

30

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8
Q

What genetic syndromes increase the risk of renal cell carcinoma

A

VHL disease (AD)
Tuberous sclerosis (AD)
Adult PKD (AD)
Hereditary leiomyomatosis and renal cell cancer (HLRCC)
Hereditary papillary renal cell carcinoma (AD)

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9
Q

What paraneoplastic syndromes occur with renal cell carcinoma

A

Secretion of:
PTHrP -> hyper-Ca
Renin -> htn
EPO -> polycythaemia
IL6 -> hepatic dysfunction with raised ALP (cholestasis) -> stauffer syndrome

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10
Q

What scoring system predicts the risk of metastatic disease following nephrectomy
What factors are included

A

Leibovitch scoring system
Includes: stage, nodal involvement, tumour size, grade, histological necrosis (Y/N)

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11
Q

How is a T1 renal tumour defined

A

Tumour confined to the kidney and is <7cm
T1a - <4cm
T1b - 4-7cm

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12
Q

How is a T2 renal tumour defined

A

Tumour confined to the kidney but >7cm
T2a - 7-10cm
T2b - >10cm

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13
Q

How is a T3 renal tumour defined

A

Tumour invades into perinephric tissues or renal vein, but not the adrenal or beyond Gerota’s fascia
T3a - into renal vein or perirenal fat
T3b - tumour extends into vena cava below diaphragm
T3c - tumour extends into vena cava above the diaphragm or invades the wall of the vena cava

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14
Q

How is a T4 renal tumour defined

A

Spread beyond Gerota’s fascia, incl invasion into adrenal gland

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15
Q

How is stage 3 renal cell carcinoma defined

A

T3 disease (invasion into perinephric fat or renal vein) or node positive

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16
Q

How is stage 4 renal cell carcinoma defined

A

T4 disease (invasion into adrenal or beyond Gerota’s fascia) or distant mets

17
Q

How is a stage 1 (T1N0) renal carcinoma treated

A

Partial nephrectomy
Or RFA if not suitable for surgery

18
Q

How is a stage 2 (T2 N0) renal cell carcinoma treated

A

Lap radical nephrectomy

19
Q

How is a stage 3 (T1-3 N1, T3N0) treated

A

Open radical nephrectomy +/- lymphadenectomy +/- adrenalectomy if involved

Radical nephrectomy - Remove kidney, adrenal, peri-renal fat, Gerota’s fascia +/- LN dissection.

20
Q

When is adjuvant treatment indicated for renal cell carcinoma

A

Adjuvant pembrolizumab for 1yr following nephrectomy or nephrectomy and removal of all metastatic disease, for intermediate-high and high-risk clear cell RCC (≥T2 or ≥Gr3, or N+)

21
Q

What is the treatment for metastatic renal cell carcinoma

A

Cytoreductive radical nephrectomy
Indicated if: Good PS, large tumours (esp symptomatic), favourable/intermediate risk, limited metastatic disease

Not if: nephrectomy would delay systemic treatment for symptomatic pts, asymptomatic primary for int/poor risk pts, poor PS

22
Q

When is a secondary cytoreductive radical nephrectomy indicated

A

Pts with local symptoms due to the primary tumour or near-complete responses to systemic therapy

23
Q

When is local metastasis-directed treatment indicated

A

Good PS
Metachronous disease with disease free interval >2yrs
Solitary or oligomet
Absence of progression on systemic treatment
Low or intermediate grade and complete resection of primary tumour

24
Q

What scoring system quantifies prognosis of metastatic renal cell carcinoma

What is included

What are the categories

A

IMDC / Heng criteria

PS >2 / KPS<80%
Hb <12
Diagnosis to development of mets <12mths
Corrected calcium > ULN
Platelets > ULN
Neutrophils > ULN

Categories:
Favourable risk - 0 factors
Intermediate risk 1-2 factors
Poor risk - ≥3 factors

25
Q

How is the first line management of clear cell renal cell carcinoma determined
What are they

A

According to risk

Favourable risk - single agent TKI or axitinib or avelumab

Int / poor risk - lenvatinib / pembro, ipi/nivo

Or clinical trial

26
Q

What is the second line management of ccRCC

A

If first line TKI -> nivolumab, cabozantinib, axitinib, everolimus or lenvastinib/everolimus

If first line ipi/nivo -> TKI, lenvatinib/everolimus

If first line lenvatinib/pembro -> TKI

27
Q

What is the preferred first line treatment for non-clear cell RCC

A

Cabozantinib
Or axitinib or avelumab

28
Q
A

FRCR2 (28 decks)

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