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Ph RadOnc Residency PBRROE2-3 Review 2021 > Renal, Renal Pelvis, and Ureter Cancer > Flashcards

Renal, Renal Pelvis, and Ureter Cancer Flashcards

(47 cards)

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1
Q

Renal, Renal Pelvis, and Ureter Cancer

BONUS:

Which kidney is lower in location than the other?

A

Right

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2
Q

Renal, Renal Pelvis, and Ureter Cancer

BONUS:

The renal axis runs parallel to the lateral margin of which muscle?

A

psoas

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3
Q

Renal, Renal Pelvis, and Ureter Cancer

What is the most common primary malignancy of the kidney?

A

RCC

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4
Q

Renal, Renal Pelvis, and Ureter Cancer

Gender predisposition of RCC?

A

males

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5
Q

Renal, Renal Pelvis, and Ureter Cancer

Median age of RCC diagnosis?

A

65

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6
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC.

What are the most implicated risk factors?

A
  • occupational (tirchloroethylene and others, asbsetos, cadmium, dry-cleaning solvents, gasoline, petroleum
  • environmental (thorium dioxide)
  • hormonal (DES)
  • dietary (fried meats)
  • cigaretter smoking
  • obesity, diabetes, hepatitis, hypertension
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7
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC.

inhertied syndromes related to RCC?

A

-von Hippel-Lindau
(VHL) disease

-hereditary papillary renal cancer (HPRC)

-hereditary
leiomyomatosis renal cell carcinoma (HLRCC)

-Birt-Hogg-Dubé (BHD)
syndrome

-constitutional chromosome 3 translocation

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8
Q

Renal, Renal Pelvis, and Ureter Cancer

What is the most important risk factor for the development of urothelial carcinoma of the urinary tract?

A

smoking

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9
Q

Renal, Renal Pelvis, and Ureter Cancer

What genetic condition is associated with the development of urothelial carcinoma of the urinary tract?

A

Lynch syndrome
***
Patients with Lynch
syndrome, an autosomal dominant genetic condition because of inherited
mutations that impair DNA mismatch repair, have an increased risk of
developing urinary tract cancer

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10
Q

Renal, Renal Pelvis, and Ureter Cancer

Ureteral tumors tend to occur in the ____ third of the ureter.

A

distal

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11
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC

Classic triad of symptoms is a rare finding in RCC and is often suggestive of advanced disease and poor prognosis.

What is the classic triad?

A

gross hematuria
palpable flank mass
pain

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12
Q

Renal, Renal Pelvis, and Ureter Cancer

What is the most frequent symptom in both RCC and renal pelvis/ureteral tumors?

A

hematuria

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13
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor ≤7 cm in greatest dimension, limited to the kidney

A

T1

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14
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor >7 cm in greatest dimension, limited to the kidney

A

T2

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15
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor invades beyond Gerota fascia (including contiguous extension into the
ipsilateral adrenal gland)

A

T4

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16
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor extends into the renal vein or its segmental branches, or tumor invades the
pelvicalyceal system or invades perirenal and/or renal sinus fat but not beyond
Gerota fascia

A

T3a

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17
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor extends into the vena cava above the diaphragm

A

T3c

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18
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor extends invades the wall of the vena cava

A

T3c

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19
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor extends into the vena cava below the diaphragm

20
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor >7 cm but ≤10 cm in greatest dimension, limited to the kidney

21
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the T-stage?

Tumor ≤4 cm in greatest dimension, limited to the kidney

22
Q

Renal, Renal Pelvis, and Ureter Cancer

RCC TNM Staging
What is the stage group?

N+

Study These Flashcards
A

Stage III or IV

(all T stages correspond to the stage group T1=stage 1 except in N+ disease, T1 or T2 N+ is stage III

23
Q

Renal, Renal Pelvis, and Ureter Cancer

Renal Pelvis, and Ureter Cancer TNM
Identify the N stage:

Metastasis in a single lymph node, ≤2 cm in greatest dimension

Study These Flashcards
A

N1

The rest are N2

24
Q

Renal, Renal Pelvis, and Ureter Cancer

Renal Pelvis, and Ureter Cancer TNM
What is the stage group?

N+

25
Renal, Renal Pelvis, and Ureter Cancer RCC What subtype is the most common?
Clear cell RCC
26
Renal, Renal Pelvis, and Ureter Cancer RCC What subtype is associated with young black patients with sickle cell trait/disease?
Renal medullary carcinoma (RMC)
27
Renal, Renal Pelvis, and Ureter Cancer RCC What is the most important prognostic factor for RCC survival?
stage at initial presentation | followed by nuclear grade, Furhman system
28
Renal, Renal Pelvis, and Ureter Cancer What are the most important prognostic factors for renal pelvis and ureteral cancers in general?
initial stage and grade
29
Renal, Renal Pelvis, and Ureter Cancer RCC Is nephron sparing comparable to radical nephrectomy in terms of DFS? Which is inferior if no? If yes, no need to answer.
In a matched-pair analysis of 164 patients undergoing nephron-sparing surgery at the Mayo Clinic, the disease-free survival was 79%, which compared favorably to 77% in patients undergoing radical nephrectomy
30
Renal, Renal Pelvis, and Ureter Cancer RCC In what instances can a nephron-sparing nephrectomy be chosen as the surgical procedure?
T1a and T1b hereditary RCC bilateral RCC
31
Renal, Renal Pelvis, and Ureter Cancer RCC Is there a role for neoadjuvant RT in patients with resectable RCC?
None.
32
Renal, Renal Pelvis, and Ureter Cancer RCC Is there a role for adjuvant RT in patients with completely resected RCC?
No proven role yet.
33
Renal, Renal Pelvis, and Ureter Cancer RCC Is there a role for adjuvant RT in patients with completely resected RCC? (with + margins)
No proven role yet. positive surgical margins are not yet prospectively proven to be associated with an increased risk of local tumor recurrence or metastatic disease.
34
Renal, Renal Pelvis, and Ureter Cancer RCC What is the predominant pattern of failure in RCC?
distant spread/metastases
35
Renal, Renal Pelvis, and Ureter Cancer RCC RT dose preferred for WBRT?
>30 Gy | 2 Gy x 20) (3 Gy x 15
36
Renal, Renal Pelvis, and Ureter Cancer RCC Stereotactic RT dose for primary treatment?
single fraction 25 Gy to the 70% IDL
37
Renal, Renal Pelvis, and Ureter Cancer RCC What is the ideal lesion size criteria for intracranial metastatic SRS?
≤2 cm
38
Renal, Renal Pelvis, and Ureter Cancer RCC After nephron-sparing surgery and when RT is needed, what should be the dose constraints for the kidney?
Mean dose <15 to 18 Gy V12 <55% V20 <32% V23 <30% V28 <20%
39
Renal, Renal Pelvis, and Ureter Cancer When RT is needed, what should be the dose constraints for the stomach?
<45 Gy
40
Renal, Renal Pelvis, and Ureter Cancer When RT is needed, what should be the dose constraints for the small bowel?
V45 <195 cc
41
Renal, Renal Pelvis, and Ureter Cancer When RT is needed, what should be the dose constraints for the liver?
<30 to 32 Gy or sparing 700 cc of the liver
42
Renal, Renal Pelvis, and Ureter Cancer When RT is needed, what should be the dose constraints for the spleen?
5 to 10 Gy
43
Renal, Renal Pelvis, and Ureter Cancer RCC What should be the dose when considering preoperative RT to improve resectability?
40 to 50 Gy (1.8-2)
44
Renal, Renal Pelvis, and Ureter Cancer RCC What should be the dose when considering post-operative RT?
45 to 50 (1.8-2) to the tumor and scar 10 to 15 Gy boost to residual + microscopic
45
Renal, Renal Pelvis, and Ureter Cancer For renal pelvis and ureter carcinoma, what should be the target volumes for adjuvant RT?
renal fossa, course of the ureter to the bladder, entire bladder, paracaval and para-aortic lymph nodes
46
Renal, Renal Pelvis, and Ureter Cancer RCC Follow-up schedule?
6 months for the 1st 2 years, annually up to 5 years baseline abdominal imaging within 3 to 12 months of surgery
47
Renal, Renal Pelvis, and Ureter Cancer RCC (from inservice bank) Renal cell carcinoma has been known to be radioresistant, however in which clinical situation as radiation been reported to have a distinct advantage? A. Gross visceral metastases B. Post-op RT to the tumor bed after complete nephrectomy C. Radiosurgery for brain mets from renal cell CA D. Whole brain RT for brain mets from renal cell CA
C

Ph RadOnc Residency PBRROE2-3 Review 2021 (57 decks)

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