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Renal Cell Carcinoma PowerPoint Presentation

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Description : This medical presentation on cancer titled "Renal Cell Carcinoma" talks about renal cell cancer, a disease in which malignant cells (cancer cells) form in tubules of the kidney.

Tags : Cancer, Renal Cell Carcinoma, malignant cells, cancer cells, tubules, kidney, Papillary, chromophilic, Risk factors, Syndromes, Paraneoplastic syndromes

Published on : Apr 28, 2021 | Views : 3075 | Downloads : 12

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Slide 1-

Renal Cell Carcinoma Dr.Amit Gupta Associate Professor Dept. of Surgery
Slide 2-

Epidemiology Male predominance (M:F 1.5:1). Most common in sixth to eighth decades; peak incidence in sixth decade Metastatic disease in 30% at diagnosis, and eventually in 50% (lung, liver, bone, distant LN, adrenal, brain, opposite kidney, soft tissue) Most sporadic RCCs are unilateral and unifocal
Slide 3-

Stage at diagnosis is the most important prognostic factor Predominant histologic type: adenocarcinoma arising from tubular epithelium Adenocarcinoma subtypes: clear cell (75–85%) chromophilic/ papillary (10–15%) chromophobe (5–10%) oncocytic (rare) Sarcomatoid (1–6%; poor prognosis)
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Papillary (chromophilic) renal cell carcinoma extending into the collecting system
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Risk factors Tobacco , urban environmental toxins (cadmium/ asbestos/ petrols), obesity, high dietary fat intake, acquired cystic renal disease from renal failure Association with von Hippel-Lindau disease: autosomal dominant loss of 3p >70% chance developing RCC (almost all clear cell histology) risk of developing multiple other benign and malignant tumors (retinal angiomas, CNS hemangioblastomas, pheochromocytoma , pancreatic cancer)
Slide 6-

Familial Renal Cell Carcinoma Syndromes
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Pathology Round to ovoid Circumscribed by a pseudo capsule of compressed parenchyma and fibrous tissue Nuclear features can be highly variable
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Fuhrman's Classification System for Nuclear Grade
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Diagnosis Common signs and symptoms: hematuria (80%) flank pain (45%) flank mass (15%) classic triad of prior three only present in 10% normocytic/normochromic anemia, fever, weight loss Less common signs and symptoms: hepatic dysfunction without mets Polycythemia hypercalcemia (occurs in 25% of patients with RCC mets)
Slide 10-

Paraneoplastic syndromes in 20% of patients with RCC
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Diagnosis Labs: CBC, LFT, BUN/Cr, LDH, urinalysis Imaging: CT abdomen MRI abdomen if CT suggests IVC involvement Metastatic evaluation: Chest X ray Bone scan or MRI brain only if clinically indicated
Slide 12-

CT scan shows right renal tumor with perinephric stranding suggesting invasion of the perinephric fat
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Contrast inferior venacavogram in patient with a right renal tumor shows involvement of the subdiaphragmatic vena cava
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PET: equivocal findings on conventional imaging Percutaneous renal biopsy or aspiration: limited role
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Staging AJCC 7th Edition
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Prognostic Factors For RCC
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Management Stage I-III Nephrectomy Open radical nephrectomy, but laparoscopic gaining popularity Nephron sparing surgery via partial nephrectomy, if possible (open or laparoscopic) Possible to spare adrenal gland in ~75% cases No role for adjuvant chemo/immunotherapy
Slide 20-

No widely accepted role for neoadjuvant or adjuvant radiotherapy. Retrospective data suggest possible utility in select cases: Positive surgical margins Locally advanced disease with perinephric fat invasion and adrenal invasion (IVC/renal vein extension alone does not increase local recurrence significantly) LN+ Unresectable (pre-op RT)
Slide 21-

Stage IV Cytoreductive nephrectomy: improved survival with nephrectomy followed by interferon alpha vs. interferon alpha alone
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Systemic therapy Immunotherapy (IL-2, interferon alpha, or combination) High dose IL-2 only FDA approved treatment for Biologic agents show promise in recent trials Bevacizumab Sorafenib or sunitinib Temsirolimus Consider chemo (gemcitabine ± 5-FU or capecitabine) Focal palliation of metastases RT alone Metastasectomy Combination of both