Renal cell carcinoma

Functions of the kidney

Main job is to remove excess water, salt, and waste from blood coming in from renal arteries (filters blood)

Help control blood pressure

Help make sure the body has enough red blood cells

Right kidney lymphatic drainage

Paracaval and interaortocoval lymph nodes

Left kidney lymphatic drainage

Paraaortic lymph nodes

Average age range is ___

55-74

Uncommon in people younger than ___

45

Male to female ratio

2:1

Most common in which racial groups?

African American, American Indian, and Alaskan Natives

Etiology

Cigarette and tobacco use

Weight

Analgesic use

Leather tanners

Shoe workers

Asbestos workers

Sickle cell trait disease

Advanced kidney disease

Exposure to cadmium, petroleum products, thorium dioxide

Clinical presentation

May appear as an occult primary tumor or with signs and symptoms

Blood in urine

Low back pain on one side (not caused by injury)

Fatigue

Loss of appetite

Weight loss

Fever (not caused by infection)

Anemia

Two main prognostic indicators

Stage and Histologic Grade

Routes of spread

Direct extension through renal capsule

Distant mets to lung, soft tissue, bone, liver, skin or central nervous system

Two main treatment techniques

Surgery and Radiation Therapy

Surgery treatment technique

Standard treatment for patients with localized renal cell carcinoma (T1 and T2) is radical nephrectomy

• Regional lymphadenectomy often performed at time of radical nephrectomy

Radiation therapy treatment technique

Most commonly post-op

• AP/PA, wedge pair techniques, shrinking field technique, high energy photons (10 MV or higher)

EBRT dose

4500-5500 cGy post-op

5580 cGy upper abdomen total tumor dose

Contralateral kidney dose constraint

1800 cGy

Spinal cord dose constraint

4500 cGy