Topic: Renal mass,cancer Prostate. Haemothorax, stones of Gall bladder, Kidney, Ureter and Urinary Bladder.
Question: A 56 year old male patient presented with history of weight loss, hypertension, hematuria and flank pain. Write the most probable diagnosis. Describe on the management of this disease.
Reference Material-This material is informational alone and is not specifically prepared as an answer for any question. Readers may do their own research before finalising diagnoses according to the characteristics unique to each question. Readers should not proceed without cross-referencing with relevant textbooks as well as standard guidelines available.
Based on the patient’s symptoms, the most probable diagnosis is renal cell carcinoma (RCC), which is the most common type of kidney cancer in adults. RCC can present with symptoms such as weight loss, hypertension, hematuria, and flank pain.
Diagnosis: Imaging modalities like USS, CT, MRI and angiography are used. Biopsy is rarely needed except for suspicious lesions. Blood tests include LDH, calcium and hepatitis profile.
Staging: Stage I: Tumor <7 cm, Stage II: Tumor 7-10 cm, Stage III: Tumor >10 cm or renal vein/inferior vena cava thrombus, Stage IV: Metastatic disease.
Treatment options:
•Partial Nephrectomy: For T1 tumors. Kidney preserving surgery. Improved renal function and cancer control.
•Radical Nephrectomy: Removal of whole kidney, perirenal fat and renal pedicle lymph nodes. Gold standard for T2-T4 tumors. Can be open or laparoscopic.
•Ablative techniques: Percutaneous cryoablation or radiofrequency ablation for small tumors. Using imaging guidance. Kidney preserving.
•Surgical thrombectomy: For stage III tumors with intracaval thrombus. To remove thrombus and resect tumor. Requires cardiopulmonary bypass.
•Targeted drug therapy: Tyrosine kinase inhibitors like Sunitinib, Pazopanib and Bevacizumab for advanced cases. Improves PFS and OS.
•Immunotherapy: Ipilimumab and Nivolumab (anti CTLA-4 and PD-1 antibodies) for advanced disease. Improves OS.
•Surveillance: Periodic imaging (CT/MRI), physical exam and lab tests for residual disease or recurrence. to guide further treatment.
•Interferon alfa: For high risk patients (pT3, grade 4, microvascular invasion or error margin involvement). Improves DFS and OS.
•IL-2: For advanced disease. Rarely used due to toxicity.
•No adjuvant therapy is used for pT1, grade 1-2 tumors. Regular follow up suffices.
Overall, maximally precise surgery followed by adjuvant targeted drug therapy and close surveillance offers the best chance for cure and long term survival in RCC. Newer techniques like partial nephrectomy and ablative therapy aim at kidney preservation while managing the tumor. Strategic use of newer drugs has revolutionized the management of advanced disease.
