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SOTS Renal Cancer Fact Sheet Surgical Management General Info Asymptomatic • Laparoscopic, robotic and open techniques exist Excision • Renal cancer is a relatively common condition and its incidence is rising • Management depends on tumour staging techniques • Renal cancer commonly has no presenting symptoms • Partial nephrectomy is the established treatment for T1 • Enucleation disease • Enucleoresection • Incidental diagnoses occur frequently Flank • Between 80 – 90% of tumours are renal cell carcinomas (RCCs) Haematuria pain • T2 disease may also be treated with partial nephrectomy • Wedge excision • Partial nephrectomy and ablation therapy are nephron • Polar resection • Laparoscopic methods are used more often during nephrectomy Symptoms sparing treatments • Targeted molecular therapies are used in metastaticdisease • Chemo is not rarely used to treat RCC • Follow up is based on data driven scoring systems Flank Varicocoele Epidemiology mass • 3 – 5% of all cancer diagnoses th th th • 7 most common cancer overall – 5 in men, 10 in women Basic Investigations • More common in western countries and its incidence is rising • Bloods – U&E, FBC, bone profile, LDH and • Risk factors – male gender, age, smoking, obesity, HTN and ESRF clotting profile • Urine sample for ACR and for cytology Other risk factors for renal Common risk factors for Imaging renal cancer: cancer: • CT with contrast is the standardmethod https://www.eu-focus.europeanurology.com/article/S2405-4569(17)30059-7/fulltext • Smoking • Hypertension • CT-TAP is used for staging • Obesity • End stage renal disease • Alternatives include USS and MR Surgical Management • Positive family history – VHL • Exposure to substances – • MR - useful for investigating IVC thromboses • Larger/complex lesions – radical nephrectomy gene cadmium, asbestos, petroleum by-products • Removes – kidney, para-nephric fat, peri- • Males are twice as likely to be Renal Biopsy nephric fat and Gerota’s fascia affected • Several single gene mutations • Remains an area of debate • The adrenal gland and local lymph nodes are • Biopsy effectively diagnoses malignant and usually kept in situ Prognosis benign disease but fears over seeding exist • Most cases are managed laparoscopically • Modern literaturecasts doubt over this risk • Follow up is based upon risk stratification • Open surgery is less complex and quicker • Heng’s criteria – most widely used prognostic model for metastaticpatients nephrectomy/doctor.solutions/eidikotites/urology/kidney-removal-radical- • The Leibovich score is used to determine follow up post-nephrectomy MetastaticDisease • Tumour stage and size • The status of local lymph nodes • Patientswith metastaticrenal cancer have many surgical and medical options – metastatectomy,cytoreductive surgery, tarted molecular therapy • Particular histological features • Chemotherapyis generally ineffective for RCC and active surveillance and palliative treatments may also be considered