renal%20cancer
RENAL CANCER

Renal cancer is the disease in which certain tissues of the kidney starts to grow uncontrollably and form a tumor.

It is also called as renal adenocarcinoma or hypernephroma.

Classic triad of symptoms are flank pain, palpable abdominal mass and gross hematuria.

Renal%20cancer Management

Monitoring

  • Management option for patients with stage T1 kidney tumor 
    • Patients with tumors <2 cm, T1a masses ≤4 cm with predominantly cystic component, or clinical stage T1 masses at risk for death or morbidity if managed aggressively
  • May also be considered in select asymptomatic patients with favorable-risk ccRCC 
  • The initial monitoring of tumor size by serial abdominal imaging [eg ultrasound (UTZ), computed tomography (CT) or magnetic resonance imaging (MRI) scan] with timely intervention reserved for tumors showing clinical progression during follow-up
  • Alternative strategy for elderly patients, patients with short life expectancy, and significant comorbidities
  • May utilize renal biopsy for surveillance and should include periodic metastatic survey including hematologic exams and chest imaging if with tumor growth

Follow Up

Stage I (pT1a)

During Active Surveillance

  • Annual history and physical exam
  • Annual laboratory tests as clinically indicated
  • Abdominal computed tomography (CT) or magnetic resonance imaging (MRI) within 6 months of surveillance initiation, then CT, MRI, or ultrasound (UTZ) at least annually
    • MRI with contrast if not contraindicated
  • Annual and baseline chest X-ray or CT to assess for pulmonary metastases
  • Biopsy of renal mass may be considered at start of surveillance or during follow-up as clinically indicated

After Ablative Techniques

  • Annual history and physical exam
  • Annual laboratory tests as clinically indicated
  • Abdominal CT or MRI at 3-6 months after ablative therapy unless otherwise contraindicated then CT, MRI or UTZ annually for 5 years or longer as clinically indicated
  • Annual chest X-ray or CT to assess for patients with biopsy-positive low-risk RCC, nondiagnostic biopsies, or even without prior biopsy

Stage I (pT1a) and (pT1b)

After Partial or Radical Nephrectomy

  • Annual history and physical exam
  • Annual laboratory tests as clinically indicated
  • Baseline abdominal CT or MRI (preferred) or UTZ within 3-12 months post-surgery then annually for 3 years or longer as clinically indicated
  • Chest X-ray or CT annually for at least 5 years, then as clinically indicated
    • May decrease follow-up interval or may choose a more rigorous technique modality if with positive margins or adverse pathologic features

Stage II or III

After Radical Nephrectomy

  • History and physical exam every 3-6 months for 3 years, then annually up to 5 years and then as clinically indicated thereafter
  • Comprehensive metabolic panel and other test as indicated every 6 months for 2 years, then annually up to 5 years then as clinically indicated thereafter
  • Baseline abdominal CT or MRI within 3-6 months, then CT, MRI or UTZ every 3-6 months for at least 3 years then annually up to 5 years; as clinically indicated thereafter
  • Baseline chest CT within 3-6 months after radical nephrectomy with continued imaging (CT or chest x-ray) every 3-6 months for at least 3 years and then annually up to 5 years
    • May consider imaging beyond 5 years depending on patient characteristics and tumor risk factors
  • Pelvic imaging, CT or MRI of the head or MRI of spine, and bone scan, as clinically indicated

Relapsed or Stage IV and Surgically Unresectable Disease

  • History and physical exam every 6-16 weeks for patients receiving systemic therapy, or more frequently as clinically indicated and adjusted for the type of systemic therapy the patient is receiving
  • Required laboratory examinations based therapeutic agents being used
  • CT or MRI imaging to assess baseline pretreatment or prior to observation
  • May consider follow-up imaging every 6-16 weeks or as deemed appropriate based on patient's clinical status, rate of disease change and sites of active disease
  • Consider CT or MRI of the head, MRI of spine, and bone scan, as clinically indicated

After Adjuvant Therapy

  • Same follow-up instructions as stage II or III

Long-term Follow-up

  • Should be based on assessment of patient factors eg mortality, risk factors for RCC, performance status, patient preference
  • Annual history and physical exam for evaluation of metastasis risk or treatment sequelae
  • Annual laboratory test after surgery to evaluate renal function and glomerular filtration rate
  • May consider abdominal imaging with increasing intervals if with low but significant risk for metachronous tumors or late recurrences
  • May consider chest imaging in patients with high-stage RCC and to increase intervals if with low but significant recurrence risk
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