Flashcards in Kidney Deck (15):
What are the types of Kidney cancer? Incidence?
Clear cell (80%),
Other (3%): oncocytic, collecting duct, medullary and unclassified.
Histologic and molecular features of Clear Cell, Papillary and Chromophobe?
Clear cell: compact nests of cells with clear cytoplasm, del 3p, VHL hypermethylation, 5q+, 8p-, 9p-, 14q-
Papillary: variable portions of papillae, tubulopapillae and tubules, trisomy 7 & 17. y-, 12+, 16+, 20+, rare MET mutations
Chromophobe: large polygonal cells with reticulated cytoplasm, atypical nuclear with perinuclear halo, eosinophilic cytoplasm, loss of chromosome Y, 1, 2, 6, 10, 13, 17 & 21
Common risk factors?
cadmium, asbestos and petroleum products,
CKD and cystic renal disease
Three factors in prognosis (measured by) for UCLA Integrated Staging System: UISS ?
-extent of disease (TNM)
-nuclear differentiation (Furhman grade)
-performance status (ECOG)
Staging workup for RCC?
CT C/A/P w contrast;
optional: bone scan & MRI brain
What dose radical nephrectomy in RCC include?
What is staging system summary?
III: 1 node or invasion into veins or perinephric tissue
IV: >1 node or invasion into adrenal, beyond Gerota's fascia, distal met
Majority of recurrences for RCC occur within? Surveillance?
3 years, scans q 6 for 3 years, then annually
Important negative factors in risk stratification, original + new? Catergories?
-no nephrectomy or recurrence in
Tx for limited or locally advanced RCC?
Nephrectomy followed by surviellance
Tx for metastatic RCC first line?
-Select: IL-2 (only if lung limited, good PFS & clear cell histology)
-Good or Int (OS): Pazopanib (22.9), Sunitinib (26.4) or Bev + IFN (23.3)
-Poor:(OS): Temsirolimus (10.9) or Sunitinib
Tx for metastatic RCC second line?
-Good or Int (OS): Nivolumab (25), Cabozantinib (PFS: 7.4), Axitinib (20.1), Sorafenib, Sunitinib or Pazopanib
Is there a role for debulking nephrectomy?
What do you give for metastatic non-clear cell RCC?
Temsirolimus, Sunitinib or Sorafenib