Renal -Cancer

These flashcards cover key concepts and terms related to the urinary system, including infections, incontinence, retention, and chronic kidney disease.

Which of the following are recognized risk factors for the development of renal cell carcinoma? (Select all that apply)

A) Tobacco use
B) Obesity
C) Hypertension
D) Exposure to cadmium
E) Female gender

Answer: A, B, C, D

Rationale: Tobacco use is the single most significant risk factor. Obesity, hypertension, and exposure to industrial chemicals like asbestos and cadmium are also established risks. Males are affected 2 times more often than females.

Which modifiable risk factor is considered the most significant contributor to renal cancer incidence?

A) High-protein diet
B) Use of acetaminophen
C) Cigarette smoking
D) Occupational exposure to lead

Answer: C

Rationale: Cigarette smoking is the most significant modifiable factor, estimated to double the risk of developing renal cell carcinoma (RCC).

Renal cell carcinoma most commonly arises from the epithelium of which structure?

A) Distal convoluted tubule
B) Proximal convoluted tubule
C) Loop of Henle
D) Collecting duct

Answer: B

Rationale: Roughly 85\% of renal cell carcinomas arise from the epithelium of the proximal convoluted tubules.

What is the most common histological subtype of renal cell carcinoma?

A) Papillary
B) Chromophobe
C) Clear cell
D) Collecting duct

Answer: C

Rationale: Clear cell carcinoma is the most common subtype, accounting for approximately 70\% to 80\% of all renal cell cancers.

Which genetic condition is most strongly associated with an increased risk of inherited renal cell carcinoma?

A) Polycystic Kidney Disease
B) Von Hippel-Lindau (VHL) syndrome
C) Huntington’s Disease
D) Down Syndrome

Answer: B

Rationale: Individuals with VHL syndrome have a significantly high risk of developing multiple, bilateral renal cell tumors.

A patient with renal cancer presents with hypercalcemia (11.8\text{ mg/dL}). What is the most likely pathophysiological mechanism?

A) Direct bone destruction by tumor cells
B) Tumor secretion of parathyroid hormone-related protein (PTHrP)
C) Excessive Vitamin D intake
D) Acute kidney injury causing calcium retention

Answer: B

Rationale: Hypercalcemia in renal cancer is frequently a paraneoplastic syndrome caused by the tumor's production of PTHrP, which mimics the action of parathyroid hormone.

A patient with renal cancer presents with an abnormally high hemoglobin level (20\text{ g/dL}). This is likely due to the overproduction of which substance?

A) Renin
B) Adrenocorticotropic hormone (ACTH)
C) Erythropoietin (EPO)
D) Thrombopoietin

Answer: C

Rationale: Renal tumors can produce excess EPO, stimulating the bone marrow to produce more red blood cells, leading to polycythemia (erythrocytosis).

Why does hypertension often occur as a complication or clinical manifestation of renal cell carcinoma?

A) Excess secretion of renin by tumor cells
B) Decreased sodium excretion by the healthy kidney
C) Overproduction of aldosterone
D) Systemic vasodilation

Answer: A

Rationale: Renal tumors can produce and release excess renin, which activates the renin-angiotensin-aldosterone system, leading to systemic hypertension.

Which clinical signs comprise the 'Classic Triad' of renal cell carcinoma? (Select all that apply)

A) Dull flank pain
B) Fever of unknown origin
C) Gross hematuria
D) Palpable abdominal mass
E) Pedal edema

Answer: A, C, D

Rationale: The classic triad consists of flank pain, hematuria, and a palpable mass. However, these symptoms often only appear simultaneously in advanced disease (10\% of cases).

What is often the first clinical sign of renal cell carcinoma?

A) Palpable abdominal mass
B) Intractable flank pain
C) Sudden weight gain
D) Asymptomatic hematuria

Answer: D

Rationale: Hematuria is often the first sign, though it is frequently intermittent or microscopic, leading to delayed diagnosis.

In males, the sudden appearance of which physical finding on the left side can indicate a renal tumor obstructing the spermatic vein?

A) Inguinal hernia
B) Hydrocele
C) Varicocele
D) Testicular torsion

Answer: C

Rationale: A left-sided varicocele occurs in approximately 2-3\% of males with RCC due to the tumor obstructing the left renal vein into which the spermatic vein drains.

Which diagnostic imaging modality is the 'Gold Standard' for identifying and staging a renal mass?

A) Ultrasound
B) Magnetic Resonance Imaging (MRI)
C) Computed Tomography (CT) scan with contrast
D) Intravenous Pyelogram (IVP)

Answer: C

Rationale: CT with contrast provides the most accurate information regarding tumor size, location, vascular involvement, and nodal metastasis.

Before a patient undergoes a CT scan with intravenous contrast for renal cancer, what is the priority assessment?

A) Liver enzyme levels
B) Serum Creatinine and allergy to shellfish/iodine
C) Last bowel movement
D) Blood glucose level

Answer: B

Rationale: Contrast media is nephrotoxic; therefore, baseline renal function must be assessed. Allergies to iodine or shellfish are contraindications for ionic contrast.

A tumor that is found to be 5\text{ cm} in diameter and is confined strictly within the kidney is staged as:

A) Stage I
B) Stage II
C) Stage III
D) Stage IV

Answer: A

Rationale: Stage I tumors are defined as being \le 7\text{ cm} in diameter and limited to the kidney.

Which staging classification is used if a renal tumor has grown into the renal vein or invaded the adrenal gland but not beyond Gerota's fascia?

A) Stage I
B) Stage II
C) Stage III
D) Stage IV

Answer: C

Rationale: Stage III involves extension into major veins or the adrenal gland, or localized lymph node involvement, but stays within Gerota's fascia.

Percutaneous renal biopsy is not routinely performed for suspected renal cancer primarily because:

A) It is too painful for the patient
B) It has a high risk of spreading cancer cells (seeding)
C) Imaging alone is usually diagnostic enough for surgery
D) It causes permanent kidney failure

Answer: C

Rationale: Imaging is usually sufficient. Biopsy is avoided when possible to prevent potential seeding of tumor cells and because a negative biopsy does not always rule out malignancy.

Which structures are removed during a radical nephrectomy? (Select all that apply)

A) Kidney
B) Adrenal gland
C) Perirenal fat
D) Gerota’s fascia
E) Entire bladder

Answer: A, B, C, D

Rationale: A radical nephrectomy removes the kidney, adrenal gland, perirenal fat, Gerota's fascia, and the proximal ureter. The bladder is not part of this procedure.

What is the treatment of choice for a small renal tumor (<4\text{ cm}) located at the pole of the kidney to preserve renal function?

A) Radical nephrectomy
B) Partial nephrectomy (Nephron-sparing surgery)
C) Radiation therapy
D) Systemic chemotherapy

Answer: B

Rationale: Partial nephrectomy is the standard of care for small, localized tumors to preserve as much functioning renal tissue as possible.

Following a nephrectomy, what is the minimum acceptable hourly urine output the nurse should monitor for?

A) 10\text{ mL/hr}
B) 30\text{ mL/hr}
C) 60\text{ mL/hr}
D) 100\text{ mL/hr}

Answer: B

Rationale: A urine output of at least 30\text{ mL/hr} (or 0.5\text{ mL/kg/hr}) is generally required to ensure the remaining kidney is maintaining adequate perfusion and function.

Which nursing intervention is most important post-operatively to prevent respiratory complications after a flank-incision nephrectomy?

A) Maintaining strict bedrest for 48 hours
B) Restricting fluid intake
C) Encouraging frequent use of incentive spirometry and splinting the incision
D) Administering prophylactic antibiotics

Answer: C

Rationale: The incision is close to the diaphragm, making breathing painful. Splinting and incentive spirometry are vital to prevent atelectasis and pneumonia.

Renal cell carcinoma is notoriously resistant to which traditional treatment modality?

A) Surgery
B) Targeted Therapy
C) Immunotherapy
D) Conventional Chemotherapy

Answer: D

Rationale: Renal cancer cells often express high levels of the multidrug resistance (MDR1) gene, making traditional chemotherapy largely ineffective.

How do targeted therapies like Sunitinib (Sutent) treat metastatic renal cancer?

A) They kill all rapidly dividing cells in the body
B) They inhibit angiogenesis (blood vessel growth) and cell proliferation
C) They replace defective renal genes
D) They directly dissolve tumor masses

Answer: B

Rationale: These drugs are multi-kinase inhibitors that block vascular endothelial growth factor (VEGF) receptors, starving the tumor of the blood supply needed for growth.

Which of the following is a potential side effect of immunotherapy with Interleukin-2 (IL-2) for renal cancer? (Select all that apply)

A) Capillary leak syndrome
B) Hypotension
C) Flu-like symptoms (chills, fever)
D) Weight gain due to fluid retention
E) Hyperactivity

Answer: A, B, C, D

Rationale: Immunotherapy with cytokines causes systemic inflammation, often leading to capillary leak syndrome, which results in significant fluid shifts, hypotension, and edema.

The drug Nivolumab (Opdivo) is used in advanced renal cancer and works as a:

A) Chemotherapeutic alkylating agent
B) Immune checkpoint inhibitor (PD-1 inhibitor)
C) Hormone replacement
D) Antibiotic

Answer: B

Rationale: Nivolumab helps the immune system recognize and attack cancer cells by blocking the PD-1 protein that prevents T-cells from attacking the tumor.

What is the goal of renal artery embolization in a patient with an inoperable renal tumor?

A) To cure the cancer permanently
B) To restore normal renal function
C) To decrease the tumor's blood supply and reduce symptoms like pain/bleeding
D) To prevent the need for a biopsy

Answer: C

Rationale: Embolization is a palliative procedure used to infarct the tumor, which reduces its size and helps control symptoms like gross hematuria and pain.

A patient develops 'Post-infarction syndrome' after renal artery embolization. What symptoms should the nurse expect?

A) Bradycardia and hypotension
) Flank pain, fever, and GI symptoms (nausea/vomiting)
C) Excessive thirst and polyuria
D) Skin rash and joint pain

Answer: B

Rationale: Post-infarction syndrome is a common reaction to the localized cell death caused by embolization, characterized by pain, fever, and nausea.

In thermal ablation of renal tumors, 'cryoablation' refers to destroying cancer cells by:

A) High-frequency electrical currents
B) Intense heat
C) Extreme cold via a probe
D) Laser light

Answer: C

Rationale: Cryoablation involves inserting a probe into the tumor and using gases to freeze and kill the malignant tissue.

Which laboratory result is frequently elevated in renal cancer and may indicate liver involvement (Stauffer's Syndrome)?

A) Serum Glucose
B) Alkaline Phosphatase and Bilirubin
C) Serum Potassium
D) White Blood Cell count

Answer: B

Rationale: Stauffer's Syndrome is a paraneoplastic condition where renal cancer causes liver dysfunction (elevated LFTs) without direct liver metastasis.

Education for a patient with a solitary kidney following a nephrectomy must include which of the following? (Select all that apply)

A) Avoidance of contact sports
B) Avoidance of nephrotoxic medications like NSAIDs
C) Monitoring for signs of UTI and treating promptly
D) Restricting all fluid intake
E) Monitoring blood pressure regularly

Answer: A, B, C, E

Rationale: Protecting the remaining kidney is crucial; physical trauma (sports) and nephrotoxic drugs (NSAIDs) should be avoided. Infection and high blood pressure can damage the remaining nephrons.

Which of the following should a patient be taught to report immediately following discharge after renal surgery?

A) Urine output of 2,000\text{ mL} in 24 hours
B) Incisional redness, warmth, or purulent drainage
C) Mild fatigue
D) Appetite returning to normal

Answer: B

Rationale: These are classic signs of a surgical site infection (SSI) and require immediate medical evaluation.

What is the primary site of distant metastasis for renal cell carcinoma?

A) Brain
B) Lungs
C) Spleen
D) Pancreas

Answer: B

Rationale: The lungs are the most common site of metastasis for renal cell carcinoma, followed by the bones, liver, and brain.

Why is it important to monitor the patient's heart rate and blood pressure closely in the first 24 hours after a radical nephrectomy?

A) To monitor for fluid volume excess
B) To detect internal hemorrhage (the kidney is highly vascular)
C) To assess for drug addiction
D) To evaluate the effectiveness of deep breathing

Answer: B

Rationale: The kidneys receive about 20\% of cardiac output. Post-operative hemorrhage is a major risk, manifested by tachycardia and hypotension.

Which finding on a urinalysis is most consistent with a diagnosis of renal cell carcinoma?

A) Glucosuria
B) Presence of Nitrites
C) Gross or microscopic hematuria
D) Low specific gravity

Answer: C

Rationale: Hematuria is found in the majority of $RCC$ cases due to the tumor eroding into the urinary collecting system.

A patient experiencing dull flank pain and a palpable mass in the right upper quadrant is likely in which stage of renal cancer pathophysiological progression?

A) Very early (localized to tubules)
B) Advanced (tumor is large enough to stretch the renal capsule)
C) Pre-malignant
D) Recovering

Answer: B

Rationale: Because the kidneys are retroperitoneal and well-protected, symptoms like pain and a palpable mass usually indicate the tumor has grown significantly and distorted the renal architecture.

Which of the following assessments is a priority just prior to a radical nephrectomy surgery?

A) Checking bowel sounds
B) Evaluating the function of the other (contralateral) kidney
C) Assessing the patient's pupillary response
D) Measuring height and weight

Answer: B

Rationale: It is essential to ensure the kidney being left behind is functional enough to support the patient's life after the affected kidney is removed.

A patient with renal cancer and bone metastasis is at high risk for which complication?

A) Hypovolemic shock
B) Pathological fractures
C) Muscle hypertrophy
D) Hypotension

Answer: B

Rationale: Bone metastasis from $RCC$ is usually osteolytic (breaks down bone), making the bones fragile and prone to fractures from minimal trauma.

A rise in Erythrocyte Sedimentation Rate (ESR) in a patient with renal cancer is usually indicative of:

A) Effective treatment and cure
B) Systemic inflammation or advanced disease
C) Improved renal perfusion
D) Successful smoking cessation

Answer: B

Rationale: A high ESR is a non-specific marker but is often elevated in patients with systemic symptoms of renal malignancy.

What effect does renal cell carcinoma have on the serum creatinine level early in the disease?

A) It causes a marked increase immediately
B) It usually remains normal if the other kidney is healthy
C) It drops to near zero
D) It only rises if the patient drinks water

Answer: B

Rationale: Serum creatinine often remains normal early on because the unaffected kidney compensates for the loss of function in the diseased one.

Targeted therapies like Sorafenib (Nexavar) primarily work by inhibiting which of the following enzymes?

A) Amylase
B) Tyrosine kinase
C) Acetylcholinesterase
D) DNA polymerase

Answer: B

Rationale: Many targeted therapies for renal cancer are tyrosine kinase inhibitors (TKIs), which interfere with cell signaling pathways that promote tumor growth and survival.

Thermal ablation is most appropriate for which type of patient?

A) Those with large, metastatic tumors
B) Those with small, localized tumors who are poor surgical candidates
C) Younger patients with perfect health
D) Patients with bladder cancer only

Answer: B

Rationale: Ablation is an alternative for patients who cannot tolerate a major surgery like a nephrectomy but have small, accessible tumors.

What is the significance of removing Gerota's fascia during a radical nephrectomy?

A) It is the source of all urine production
B) It contains the lymph nodes and fat where the cancer is most likely to spread locally
C) It is removed to make the surgery faster
D) It allows the patient to breathe better post-operatively

Answer: B

Rationale: Gerota's fascia is the fibrous envelope surrounding the kidney and adrenal gland. Removing it ensures that localized extension of the cancer is fully Excised.

During the post-operative period, the nurse notes the patient’s urine is dark red. The nurse understands this is:

A) A sign of immediate kidney failure
B) Normal for the first 24-48 hours after renal surgery
C) A sign that the patient is dehydrated
D) Not possible after a nephrectomy

Answer: B

Rationale: Some hematuria is expected in the immediate post-operative period following renal procedures due to trauma and surgical manipulation.

If a patient with renal cancer displays sudden confusion and muscle weakness, the nurse should immediately check the level of:

A) Glucose
B) Sodium
C) Calcium
D) Hemoglobin

Answer: C

Rationale: These are common symptoms of hypercalcemia, a frequent paraneoplastic complication of $RCC$.

A laparoscopic nephrectomy is often preferred over an open radical nephrectomy because it results in: (Select all that apply)

A) Less pain
B) Shorter hospital stay
C) Faster recovery
D) Increased risk of cancer recurrence
E) Smaller incisions

Answer: A, B, C, E

Rationale: Minimally invasive techniques provide similar oncological outcomes to open surgery but with significantly reduced morbidity for the patient.

Which instruction should be given to a patient taking Sunitinib for metastatic renal cancer?

A) Stop the medication if you get a skin rash
B) Avoid grapefruit and grapefruit juice
C) Double the dose if you miss one
D) Take only when you feel a tumor mass

Answer: B

Rationale: Grapefruit can increase the blood levels of many targeted therapies, including TKIs, potentially leading to toxic effects.

What is a common sign that renal cell carcinoma has metastasized to the brain?

A) Increased appetite
B) New-onset seizures or headache
C) Improved vision
D) Leg swelling

Answer: B

Rationale: Brain metastasis in $RCC$ presents with neurological deficits, increased intracranial pressure, or seizure activity.

Following a nephrectomy, why is a high-fiber diet and stool softeners often prescribed?

A) To prevent straining, which increases intra-abdominal pressure at the surgical site
B) To treat the cancer directly
C) To prevent the need for more fluids
D) Because the patient cannot eat protein

Answer: A

Rationale: Straining during bowel movements can put stress on the flank or abdominal incision and increase pain post-operatively.

Patients with renal cell carcinoma often present with 'fever of unknown origin.' This is thought to be caused by:

A) A secondary bacterial infection
B) The release of endogenous pyrogens (cytokines) by the tumor cells
C) Dehydration
D) Allergy to medications

Answer: B

Rationale: Malignant cells can release cytokines like $Interleukin-6$, which act on the hypothalamus to cause a systemic fever.

Radiation therapy in renal cell carcinoma is primarily used for:

A) Curing the primary tumor
B) Preventive screening
C) Palliation of symptoms from bone or brain metastasis
D) Diagnosing the stage of the cancer

Answer: C

Rationale: While $RCC$ is relatively radioresistant, radiation can be very effective at shrinking metastatic lesions to reduce pain or neurological symptoms.

The nurse teaches a patient that 'angiogenesis' refers to:

A) The death of cells
B) The formation of new blood vessels by the tumor to support its growth
C) The movement of the kidney into the pelvis
D) The filtering of blood by the nephron

Answer: B

Rationale: Renal tumors are highly vascular because they stimulate angiogenesis