TNM Staging
Patient has a tumor >7 cm with lymph node involvement and renal vein involvement... what is their 5 year survival prognosis?
What is the inheritance pattern of a disease which is associated with RCC and hemangioblastomas of the cerebellum?
Autosomal Dominant Disorder Von- Hipple Lindau
What are the two mTOR inhibitor that can be given as a 1st line therapy for non-clear cell renal cell carcinoma.
temsirolimus
everolimus
What percentage of patients present with a fever due to RCC?
20%
Which comorbidies are common amongst RCC?
Hypertension
Hyperglycemia
Obesity
Metabolic Syndromes
When is a RCC tumor considered stage 3?
*Hint 2 ways*
If there is involvement of regional lymph nodes with a T1/2 tumor OR if there is involvement of the renal vein, inferior vena cava, perirenal fat tissue (without crossing into Gerotas Fascia).
What are the 4 hormones that can possibly be secreted by RCC?
P - PTHrP
E- EPO
A- ACTH
R- Renin
If first line therapy does not work, which other small molecule can be used?
Axitinib or Sorafinib (along with everolimus)
Will you get anemia or polycythemia with RCC?
BOTH can occur!
Polycythemia via paraneoplastic EPO
Aneima due to lack of EPO produced
What are the two second common types of renal cell carcinoma?
Papillary RCC
Chromaphobe RCC
Where has a T3c RCC tumor spread?
Into the IVC and gone above the diaphragm.
A loss of the VHL gene leads to an increase in which signaling proteins?
VEGF and PDGF through the transcription factor HIF
What is first line small molecule therapy used in the treatment of Clear Cell Renal Cell Carcinoma?
Sunitnib (50mg daily)
(along with pazopanib and inf-alpha +bevacizumab)
Why did our patient have lower leg edema?
Increased venous pressure due to invasion of the inferior vena cava.
How frequently must a person who has undergone surgical resection of RCC have imaging conducted post surgery?
CT scan once a year for 5 years.
What stage is a tumor with a growth of <7 cm and no metastasis?
Stage 1
Which gender and races have the highest incidence of RCC?
Males; African Americans and Hispanics
Is it better to resect or treat RCC with chemotherapy?
Surgical resection and removal has the best outcomes. (can also have nephrectomy)
What stage was the Patients Tumor?
5 cm Mass
Invasion of IVC above the diaphragm and into the right atrium.
No invasion of Gerota's Fascia
No mets
No lymph node involvement
T3c - involves IVC above diaphragm.
Who is going to do great on this exam?
All of you! Congrats on Finishing the first year of Med School... Wish you all good luck :)
A tumor that has metastasized to the lungs will be what stage?
Stage 4
What are the two pathways that can lead to a loss of the VHL gene to cause RCC?
1. Sporadic
2. Hereditary
Both lead to inactivation of the VHL gene on chromsome 3p
What is the recombinant IL-2 drug used in RCC therapy?
Aldesleukin
What may have caused the multiple emboli found in the patient?
Hypercoaguable state induced by cancer. (rare presentation)
What are the 4 characteristic features of WAGR syndrome?
1. Wilms Tumor
2. Aniridia
3. Genital abnormalities
4. Motor or mental retardation