Where are the Right and Left kidneys located (level)?
Left - T12-L3
Right - 2-4cm lower than the left, in contact with the liver.
What are the 3 regions of the kidney?
- Medulla
- Cortex
- Renal Pelvis
What are the 3 main functions of the kidney?
- Maintains the body composition (regulates fluid volumes)
- Excretion/production of enzymes and hormones
- Escretion of metabolic byproducts and foreign wastes
Epidemiology/ Aetiology
what is?
- Most common in adults
- Most common in children
- Rare
- Adults = renal tumour (renal cell carcinoma) aka. hypernephroma
- Children = nephroblastoma (Wilm’s tumour)
- Rare to get tumours of the renal pelvis.
Risk Factors for kidney ca? (6)
- Being male
- 65 years of age
- obesity
- family history
- VOL (Von-Hippel) Syndrome
- Smoking
What system is used for staging and what does it rely on?
TNM relies on surgical resection
For renal cell adenocarcinoma, what is the most common type of tumour and what is the least common type?
- Most = clear cell carcinoma
- Least = chromophilic (papillary) carcinoma
What is the diagnostic work-up for kidney Ca (3 stages)
- Complete history and physical examination
- Serum chemistries
- Blood Count
- Lactate Dehydrogenase
- urinalysis - Radiological studies
- chest radiography and CT
- Brian MRI
- Chest MRI
- Abdo/pelvis CT or MRI (with intravenous gallium)
- Bone scrintography - Additional Studies
- Ultrasonography
- MR angiography.
What is the staging for kidney cancer (T1, T2, T3 and T4)?
T1 - Tumour <7cm, limited to kidney
T2 - Tumour >7cm, limited to kidney
T3 - Tumour invades adrenal glands, major vessels and perinephric tissue but not beyond Gerotas Fossa
T4 - Tumour invades beyond Gerotas Fossa.
What are the signs and symptoms of Kidney Cancer (5)
- Haematuria
- Palpable flank mass/ abdo pain
- Hypertension and increased ca
- fatigue and weight loss
- pyrexia (fever)
What are the patterns of spread for kidney ca?
- Direct invasion into the renal vein is common
- 25% evidence of distant mets
- local lymphatic and Heamatogenous spread common
- sometimes get direct invasion into the peri-renal tissue and LN mets.
Is RT used in the primary management of Renal Cell Carcinoma?
No, no longer used as the primary management option. Used in a palliative setting for mets. (e.g. to relive bone pain).
Surgery is the primary management.
What is the most effective way of reducing risk of getting RCC?
Cessation of smoking. (from the time you stop the risk decreases, after 15 years returns to that of a non-smoker).
- Unclear whether decreasing weight decreases the risk (need more data esp. on benefits of moderate alcohol consumption.)
What are the OAR for kidney ca?
- Spleen
- Stomach
- Pancreas
- Liver
- Sp Cord
- Contro kidney
- SI
What is the max dose that can be received to the kidney portions (e.g. 1/3)?
What is the mean dose?
1/3 - 50Gy
2/3 - 30Gy
3/3 - 23Gy
mean dose - 17.5Gy
What group did nephrectomy have the biggest impact on overall survival?
Patients with solitary mets only, low grade tumour and weight loss of less than 10%.
