Renal Cell Carcinoma for USMLE
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- Опубликовано: 6 сен 2024
- Renal Cell Carcinoma Anatomy, Epidemiology, Etiology, Clinical Signs and Symptoms, Treatment and Management. Handwritten, full lecture for medical students taking USMLE.
Renal Cell Carcinomas make up 90-95% of kidney neoplasms.
ETIOLOGY of Renal Cell Carcinoma
Smoking is the largest risk factor. Obesity and Hyppertension is a known risk factor for Renal Cell Carcinoma in Women. Occupational Exposure such as Trichloroethylene, Benzine, Herbicides, Vinyl Chloride. Drugs associated with Renal Cell Carcinoma (phenacitin). Long term dialysis increases the risk of cystic Diseases which increase risk of renal cell carcinoma.
Von Hipel Lindau - Loss of 3p increases HIF which increases angiogenesis. Also increase risk of pheochromocytoma, pancreatic cysts/islet cell tumors, retinal angiomas, CNS hemangioblastomas.
Hereditary Papillary Renal Carcinoma - MET Gene mutation of tyrosine kinase domain and will have bilateral multifocal papillary renal cell carcinoma.
Burt-Hogg-Dube Syndrome - Bilateral Multifocal oncocytoma which has a better prognosis. Also may cause pulmonary and colonic tumors.
CLINICAL SIGNS AND SYMPTOMS of Renal Cell Carcinoma.
The three most common presenting signs and symptoms is flank pain, hematuria, flank mass. A large percentage of patients may be asymptomatic. Patients with renal cell carcinoma may also have wieght loss, varicocele, malaise, fever.
Paraneoplastic syndromes are very common in renal cell carcinoma. Increase EPO may lead to polycythemia, Renin production may lead to hypetension. Finally may also have hypercalcemia, polyneuropathy.
Shauffer Syndrome - Non-metastatic Hepatic Dysfunction and therefore it is important to monitor liver function, even if no metastasis has occurred.
Metastasis to Lungs (45%), Soft tissue and Liver.
Work Up for Renal Cell carcinoma
Labs - Urinalysis, CBC, Electrolytes, Renal Profile, LFT (AST/ALT) and Serum Calcium.
Imaging - CT scan is the imaging of choice and can identify the tumor and rule out cystic mass. Also allows visualtion of Lymph nodes, Renal Vein, IVC and helps rule out angiolipoma.
For staging abdominal ;pelvic CT with or without contrast. Chest X-ray and Brain MRI.
Histology
Clear Cell Carcinoma - 75%, lipid/glycogen
Chromphilic - Bilateral mulftifocal
Chromophobic - Large polygonal Cells
Oncocytoma - Rarely metastasize
Collecting Tubules
STAGING OF Renal Cell Carcinoma
Stage 1 - Within the kidney and less than 7cm.
Stage 2 - Within the kidney and greater than 7cm.
Stage 3 - Invasion Renal Vein and Inferior Vena Cava or Adrenal Gland, but does not invade Gerota's Fascia
Stage 4 - Extends below Gerota's Fascia, invade nearby lymph nodes and metastasis to organs.
MANAGEMENT of Renal Cell Carcinoma
Surgical
Partial nephrectomy for stage 1 and sometimes stage 2
Radical Nephrectomy - remove complete removal of Gerota's fascia, Removal of kidney with adrenal gland, dissect enlarge lymph nodes.
Palliative Nephrectomy - remove kidney to alleviate pain, polycythemia and hypertension.
Adjuvant Treatment for Renal Cell Carcinoma
Biologic Response Mediators - IL2 (activates T Cell and NK), IFN
Molecular Targeting - Suritinib, Bevacizumab, Dazopomib, Temsirolimu, Sorafenib.
Chemotherapy - 5 floururacil, Vinblastine, Paclitaxel, Caboplatin, Ifosfamide, Gemcitabine.
Radiation - Renal Cell Carcinoma is not sensitive to radiation but the brain metastasize are sensitive.
Renal Artery Embolization inject ethanol or gelatin sponge pledgets in artery feeding tumor to help kill off the tumor. Also done palliative for non-surgical patient.
You are a life savior people don’t understand how imp, this is
Right from Robbins !! Though saved the time ♥️
Slight correction - Stauffer syndrome otherwise great video. Very helpful.
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Hello, a future urologist here, and believe it or not but my exam is tomorrow and right now i am going through this video and thinking, oh man how easy have you summarized this topic. I was wondering if you could tell me what gadget do you use for this note taking and what app. Also, if you could share this file so that i could add my notes on top of that. Thanks
Great video. How do you differentiate whether it is a solid tumour mass or a cystic mass on abdo CT?
Extremely helpful thank you so much
Very good video but there should be 3 to 5 scenario bcqs in last after covering the topic...this will help alot ...
correction Please.. RCC is More common in Men men to women Ratio 2:1
Thank you so much, please update more
thank you so much! how do you tell the difference between renal cell carcinoma and renal transitional cell carcinoma?
Really Excellent and helpful
It was such a nice video, covering all aspects of the topic. Thanks, helped alot.
video is simply outstanding. thanks.
+chetanchetan23 Thank you, glad you found it hlepful
Good one.... thanks a lot.
Thank you you make it easy for me
thank you so much! 27/5/2018 :D
Learned so much thank you!
im thanking him from 26 march 2020 :D
Hi sir! what application are you using in making the video? thanks
thanks a lot for the great video!
Thank you 2021❤🤟
Well done... thanks so much for this! :)
Excellent and very informative. I really enjoy your presentation style. Do you mind sharing what software you used to create this? Do you know if a presentation like this can be given live vs. pre-recorded? Thank you.
+Dominic Lai I use Microsoft OneNote. I do sometimes give the presentations pre-recorded to medical students in the hospital. I just turn the sound off and start talking. Live would be possible, but you would have to write quickly and neatly so it may be a little impractical.
+the study spot Thank you!!
this was really helpful!!thanks :)
anemia is the most common paraneoplastic syndrome seen in RCC; is it true or not?
Epo is much more imp
Is that for step 2?
Thankx much
hello
I wounder if you can help me please I had a kidney pain 15 years ago I was given pain an unknown killer in that time since then blood shows a urine in strip test CT scan and Cystoscopy was negative I t's now over 14 years because I have pain related to IBS lower left abdominal pain dry lips fatigue and it's impossible to sleep on my right side because of the pain it causes I appreciate any advice or help given I start to doubt Doctors are not telling the truth about my CT scan I don't smoke or drink
regards
+roma isa My advice to you is to find a doctor you can trust. It would be literally impossible for me to try and figure out what is medically wrong with you without the ability to do physical examination and run some tests. Healthy skepticism about your doctor is helpful because there are many out there that are either sometimes too dismissive of patients or make mistakes. But thank god there are many great doctors out there who do the best they can do for all of their patients. That is why I think continue looking for a doctor that you feel comfortable with and takes your medical issues seriously. I am sure you will find one.
+the study spot Also, having blood in your urine is very serious and if you are still having that, you need to figure out why.
thanx verrrryyyyyyyyyyyyyy much ))
thank you so much! 14/11/2018 😁