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REGUB Surgery - Renal Tumours (ii) (Investigations (specialist imaging for…
REGUB Surgery - Renal Tumours (ii)
Investigations
FBC
ESR
U+E
LFTs
Ca
erythropoietin
renin
initial imaging
US
triphasic CT
specialist imaging for local disease
CT
non-contrast to see stones 1st
then IV contrast (immediate/eary/arterial phase to see renal parenchyma, within 1 min), delayed for TCC (10-15 mins, when contrast being excreted)
MRI
angiogram (vasc tumours)
imaging for mets
CXR
bone scan
CT brain
RCC Tx
surgery = mainstay
radical nephrectomy (open/laparoscopic/robotic)
nephron-sparing surgery: if <4cm
vasc extension: if renal vein thrombus, IVC thrombus below or above diaphragm (incl atrium)
radiotherapy is given post-op in cases of spread into perinephric fat, paralytic nodes or IVC
thermal ablation techniques
when <3cm
renal cryosurgery
radio frequency ablation
active surveillance
natural hx of small renal lesions better defined
30% show no growth over 3 yrs, risk of mets low (1%)
good for elderly, co-morbidities
if advanced...
cryoreductive nephrectomy (debulking tumour mass - nephrectomy +/- metastasectomy )
isolated pul/cerebral mets occasionally excised
radiotherapy for bony mets
immunotherapy
IFNa: overall response rates = 12%, 1.8% complete response, median survival = 5-15 months
IL2: overall response rates = 15%, complete response = 6/8%, median survival = 12-18 months
combo tx
Poor response to chemo (2-6%)
RCC prognosis
confined to kidney: 79% 5 yr survival
nodes/IVC involved: 40% 5yr survival
distant mets 8% 5yr survival