Table of contents
- 1. Introduction
- 2. Symptoms
- 3. Investigations
- 4. Management
.
Introduction
- Arise from renal cortex - most common kidney tumor.
- Metastatic Sites:
- BONE
- Lung
Symptoms
- Generally asymptomatic until advanced
- Classic Triad (9% of pts)
- Hematuria
- Flank Pain
- Abdominal Mass
- Other Symptoms:
- Unexplained Weight Loss
- Abdominal Pain
- Many paraneoplastic syndromes:
- Erythrocytosis
- AA amyloidosis
- PMR
- Hepatic Dysfunction
Investigations
- Abdo Ultrasound or CT
- Solid mass or complex cyst require further intervention
- Biopsy small lesions if possible.
- Large masses suspicious for cancer can be removed without biopsy. (still do CT to assess local/metastatic disease)
Management
- Large massess suspicious for malignancy on imaging --> remove without biopsy.
- Non-metastatic:
- Radical or partial nephrectomy
- If not candidates for surgery:
- Active Surveillance
- Ablative Treatment (if small tumor)
- Metastatic
- Poor outcomes.
- Often cytoreductive nephrectomy is done for metastatic disease (improves survival!!)
- For spinal compression: if single-level compression can refer to neurosurg followed by radiation (if multi-level, do radiation only) (RCT done showing benefit of neurosx+rads vs. rads alone)
- Often needs to be embolized before any surgery (highly vascular, bleeds a lot)
- NO ADJUVANT Therapy established (poor outcomes) (studies with targeted agents ongoing).
- No cytotoxic therapy available.
- Specific Therapies:
- Interleukin-2: can result in long-term remission in 10% (highly toxic and expensive)
- VEGF Inhibitors
- Bevacizumab
- Sunitinib (tyrosine kinase inh.)
- Sorafenib
- Pazopanib
- Axitinib
- mTOR Inhibitors
- Temsirolimus
- Everolimus
- VEGF inhibitors are often first-line, but poor evidence.
- High Risk Features: LDH, performance status, lactate, calcium, anemia,
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