Renal Mass Flashcards
(29 cards)
When a renal mass is identified, what are other labs and imaging to be obtained?
- CBC, CMP, U/A
- chest imaging (CXR vs CT)
- if alk phos is elevated - should consider bone scan
Describe the Bozniak classification system.
I - simple renal cyst
II - minor sepatations with calcification, non enhancing
IIF - increased number of, possibly thickened septations, possible some minor enhancement
III - thick septa or wall with measurable enhancement
IV - clearly malignant, solid with cystic component
Who are other disciplines that need to be considered for consult?
IR, nephrology, genetic counselor, med Onc
Characteristics to consider in workup?
Male sex, tumor size, complexity
What are risks of partial nephrectomy?
Bleeding, pseudo aneurysm, urine leak
What is disadvantage of tumor ablation?
Lower local recurrence free rate compared to other modalities
What are potential risk factors of renal mass biopsy?
bleeding, hematuria, perinephric hematoma, pseudo aneurysm, infection, pneumothorax, pain
What are the limiters of renal mass biopsy?
Poor NPV
Unclear if truly negative vs non diagnostic
oncocytomas
When should RMB be performed?
metastatic concerns, infectious concerns, blood cancer (lymphoma)
Give me the T staging for RCC
T1a - less than 4 cm
T1b - less than 7 cm
T2a - less than 10 cm
T2b - > 10 cm
T3a - perinephric fat, renal veins
T3b - IVC thrombus below diaphragm
T3c - IVC thrombus above diaphragm
T4 - adjacent tissues - Gerota
nodal mets locally = stage III
Give me risk stratification
LR - T1, G1-2
IR - T2 + any grade, or T1 + G3-4
HR - T3 and above
VHR - T4 or N1, sarcamatoid, rhabdoid
If positive surgical margin, uprisk by one level
When should partial nephrectomy be prioritized?
T1a, bilateral tumors, solitary kidney, pre-existing CKD, familial RCC
When should radical be prioritized?
suggestion of renal malignancy, high tumor complexity that may make partial nx difficult, no pre-existing CKD, normal contralateral kidney
When should LND be performed?
If there is clinical suspicion of nodes - there should be LND. It does not offer survival benefit, but aids in adjuvant treatment.
What are follow up labs?
Cr, UA, and GFR
What is follow up for LR?
Cross sectional yearly for 5 years, with CXR
What is follow up for IR?
Cross sectional q6 months for first year, followed by yearly, with CXR
What is follow up for HR?
Cross sectional q6 months for three years, followed by yearly, with chest CT
What is follow up for VHR?
Cross sectional q3 months for first year, followed by q6 months for next two years, followed by yearly, with chest CT
What is follow up for TA
baseline CT at six months, then follow IR
What are potential complications during a NX surgery?
Bowel injury - close in two layers - NPO + NGT
Liver injury - Pressure - hemostatic agents, oversew if necessary
Pleural injury - close the defect under suction with red rubber cath - reduce the pneumothorax. If PTX still too large, place chest tube. Get CXR post procedure.
Ureteral injury - Debride, close primarily. place stent if rather large defect.
What are prognostic items for renal cancer?
- Local tumor extent and size
- Histological
- Surgical margins
- Local nodes
- Distant mets
- performance status
If patient with pain post nephrectomy, what are things to be concerned about?
Rhabdo - check CK
Pancreatic injury (if left sided, check amylase and lipase)W
What are considerations for cytoreductive NX?
have to be able to resect at least 75% of the tumor, no brain metastases (treat prior), ECOG 0-1, good pulm + cardiac reserve, clear cell primary, no advancement on immunotherapy
