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
COMMENTS