Renal/ Kidney cancer

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Introduction:
·         Also known as kidney cancer
·         Arise from the cortex or pelvis ( and calyces) of the kidney
Epidemiology:
·         Relatively rare type  of ca
·         In US over 39000 new cases diagnosed and over 12800 die annually
·         Approx. two third are discovered incidentally in the pelvic or abdominal scanning
Etiology/ risk factors:
·         Unknown
·         Age- old age
·         Occupational exposure asbestos, patroleum, cadmium, herbicides and trichoroethylene.
·         Obesity , fat intake , tobacco use
·         Family history
·         Autosomal dominant polycystic kidney disease and tuberous sclerosis
·         Hypertension and CKD
·         Diuretic medications.

Type:
·         Renal cell carcinoma/ renal cell adenocarcinoma / renal cell cancer(most common)
·         Clear cell renal cell ca
·         Papillary renal cell ca
·         Chromophobe renal cell ca
·         Rare types (mucinous tubular and spindle cell ca, medullary ca etc.)
Staging:

·         Stage I- limitation to renal capsule . size < 7cm.
·         stage II- spreading to perirenal fat but confined to fascia, includes metastasis to adrenal gland . tumor size > 7 cm
·         Stage III- regional lymph nodes involved , renal thrombus in renal vein or vena cava , involvement of renal vein or vena cava
·         Stage IV- presence of distant metastasis

Signs and  symptoms :
·         Asymptomatic
·         Hematuria, flank pain (lower flank pain)
·         Palpable mass on the abdomen or flank
·         Weight loss and anemia
·         Fever
·         Hypertension
·         Generalized fatigue
Dioagnosis:
·         History and physical examination
·         Urine analysis
·         Kidney, ureter, bladder radiography
·         Angiography
·         Reanal USG
·         Pelvic and abdominal CT
·         MRI
·         CT guided Fine needle biopsy
Prevention:
·         Early identification and modification of etiological factors
·         Life style and environmental modification
·         Encourage cessation of tobacco, dietar modifications
·         Minimizing occupational exposure
Management:
Surgery:
·         Radical nephrectomy
·         Nephron sparing surgeries
·         Radiation therapy:
·         RCC is unresponsive to radiation therapy
·         Used as palliationf
Chemotherapy:
·         5FU,floxuridine and gemicitabine
Biologica therapy:
·         Alfa interferon, interleukin-2

Nursing Management:
·         Pre and postop management
·         Health teaching to minimize the complications
·         Pain management
·         Observe the nephrectomy dressing closely for bleeding
·         Maintain I/O chart
·         Auscultation of bowel sounds and repositioning to promote peristalsis
Health Teaching:
·         Avoid any potential nephrotoxic drugs including NSAIDs
·         Care must be taken to avoid trauma on the remaining kidney
·         Early recognization and prompt treatment of urinary tract inferction
·         Consulting the physician before using OTC drugs, any dietary supplementation or complementary therapy

·         Regular follow up examination

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notes.nursium.com: Renal/ Kidney cancer
Renal/ Kidney cancer
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