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.

Monitoring

  • The initial monitoring of tumor size by serial abdominal imaging [eg ultrasound (UTZ), computed tomography (CT) or magnetic resonance imaging (MRI) scan] w/ delayed intervention reserved for tumors showing clinical progression during follow-up
  • Patient characteristics that makes an active surveillance a treatment option:
    • Elderly
    • Poor kidney function
    • Hereditary forms of kidney cancer
    • Tumor size is ≤4 cm

Follow Up

Stage I (pT1a)

During Active Surveillance

  • History & physical exam every 6 months for 2 years, then annually up to 5 years after diagnosis
  • Comprehensive metabolic panel & other tests as indicated every 5 months for the first 2 years, then annually up to 5 years after diagnosis:
  • Abdominal computed tomography (CT) or magnetic resonance imaging (MRI) w/in 6 months of surveillance initiation, then CT, MRI, or ultrasound (UTZ) at least annually
  • Chest x-ray or CT annually to assess for pulmonary metastases, if biopsy positive for renal cell carcinoma (RCC)
  • Pelvic imaging, as clinically indicated
  • CT or MRI of the head or MRI of spine, as clinically indicated
  • Bone scan, as clinically indicated

During Ablative Techniques

  • History & physical exam every 6 months for 2 years, then annually up to 5 years after the diagnosis
  • Comprehensive metabolic panel & other tests as indicated every 6 months for the first 2 years, then annually up to 5 years after the diagnosis
  • Abdominal CT or MRI w/ & w/o contrast at 3-6 months following ablative therapy unless otherwise contraindicated then CT, MRI or UTZ, annually for 5 years
  • Chest x-ray or CT annually for 5 years, for patients who have biopsy proven low risk RCC, nondiagnostic biopsies or no prior biopsy
  • Repeat biopsy:
    • New enhancement, a progressive increase in the size of an ablated neoplasm w/ or w/o contrast enhancement, new nodularity in or around the treated zone, failure of the lesion to regress over time, satellite or port site lesions
  • Pelvic imaging, as clinically indicated
  • Bone scan, as clinically indicated

Stage I (pT1a) & (pT1b)

After Partial or Radical Nephrectomy

  • History & physical exam every 6 months for 2 years, then annually up to 5 years after nephrectomy
  • Comprehensive metabolic panel & other tests as indicated every 6 months for 2 years, then annually up to 5 years after nephrectomy

After Partial Nephrectomy

  • Baseline abdominal CT, MRI or UTZ w/in 3-12 months of surgery
  • If the initial postoperative scan is negative, abdominal CT, MRI or UTZ may be considered annually for 3 years based on individual risk factors

After Radical Nephrectomy

  • Patients should undergo abdominal CT, MRI or UTZ w/in 3-12 months of surgery
  • If the initial postoperative imaging is negative, abdominal imaging beyond 12 months may be performed at the discretion of the physician
  • Chest x-ray or CT annually for 3 years, then as clinically indicated
  • CT or MRI of head or MRI of spine, as clinically indicated
  • Bone scan, as clinically indicated

Stage II or III

After Radical Nephrectomy

  • History & physical exam every 3-6 months for 3 years, then annually up to 5 years after radical nephrectomy & then as clinically indicated thereafter
  • Comprehensive metabolic panel & other test as indicated every 6 months for 2 years, then annually up to 5 years after radical nephrectomy, then as clinically indicated thereafter
  • Baseline abdominal CT or MRI w/in 3-6 months, then CT, MRI or UTZ (UTZ is category 2B for Stage III) every 3-6 months for at least 3 years & then annually up to 5 years
  • Tumor size by serial abdominal imaging (UTZ, CT, or MRI) w/ delayed intervention is reserved for tumors showing clinical progression during follow-up
  • Baseline chest CT w/in 3-6 months after radical nephrectomy w/ continued imaging (CT or chest x-ray) every 3-6 months for at least 3 years & then annually up to 5 years
    • Imaging beyond 5 years, as clinically indicated based on individual patient characteristics & tumor risk factors

Relapsed or Stage IV or Surgically Unresectable Disease

  • History & physical exam every 6-16 weeks for patients receiving systemic therapy, or more frequently as clinically indicated & adjusted for the type of systemic therapy the patient is receiving
  • Laboratory requirements as per the requirements for those therapeutic agents being used
  • CT or MRI imaging to assess baseline pretreatment or prior to observation
  • Follow-up imaging every 6-16 weeks as per physician discretion & per patient clinical status
  • Imaging interval may be adjusted according to the rate of disease change & sites of active disease
  • Consider CT or MRI of the head at baseline & as clinically indicated
  • MRI of the spine as clinically indicated
  • Bone scan as clinically indicated
Editor's Recommendations
Most Read Articles
13 Jul 2017

According to the Singapore National Registry of Diseases Office (NRDO), prostate cancer is the third most common cancer and the sixth most common cause of cancer-related deaths affecting men in Singapore. Dr Daniel Tan, radiation oncologist and medical director of Asian American Radiation Oncology at Gleneagles Hospital, Singapore, speaks to Roshini Claire Anthony on the importance of early detection of prostate cancer and the challenges associated with diagnosing and treating this condition. 

15 Oct 2017
Physiotherapy and behaviour therapy appear to be effective interventions in females with overactive bladder syndrome, with those who have had no previous exposure to the treatments benefitting from post-therapy effects, a recent study has shown.
Christina Lau, 20 Jan 2016
New data from the phase III METEOR trial (Metastatic Renal Cell Carcinoma Phase III Study Evaluating Cabozantinib vs Everolimus) provide compelling evidence for the efficacy of cabozantinib in patients with advanced clear-cell renal cell carcinoma (RCC) who progressed after first-line VEGF receptor-tyrosine kinase inhibitor (TKI) therapy.
22 May 2015
A highly selective M3 antagonist developed for treating overactive bladder (OAB).