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Renal Cell Carcinoma
- -Adenocarcinoma of the kidney
- -Systemic affects occuring with this cancer type are called paraneoplastic syndromes
- -Benign tumors are rare
- -Risk factors: link to smoking, HTN, and obesity
- -Tumor can advance significantly before detection
- -Triad of manifestations: hematuria, flank pain, and palpable mass
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Paraneoplastic Syndrome:
- -Anemia
- -Erythrocytosis
- -Hypercalcemia
- -Liver dysfunction
- -Increased sedimentation rate
- -Hypertension
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The Cancer Usually Spreads To:
- -Adrenal gland
- -Liver
- -Lungs
- -Long bones
- -Other kidney
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Staging for Renal Cell Carcinoma:
Stage 1: Tumor within capsule
Stage 2: Tumor invades perirenal fat
Stage 3: Tumor extends into renal vein or regional lymphatics
Stage 4: Common areas of mestasis- lungs, liver, other kidney, adrenal gland, long bones
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Assessment: History
- -Known risk factors (smoking, chemical exposure)
- -Change in urine color
- -Abdominal discomfort
- -Fever
- -Family hx
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Assessment: Physical/Clinical Manifestations
-Patients describe the flank pain as dull or aching
-Bloody urine is a late common sign
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Assessment: Diagnostic
- -Urinalysis may show RBC
- -Decreased Hgb and Hct
- -Hypercalcemia
- -Increased ESR
- -Increased levels of adrenocorticotropic hormone, hCG, cortisol, renin, and parathyroid hormone
-Diagnosis requires a biopsy of the tumor
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Surgical Management
NEPHRECTOMY!
-Blood loss during the surgery is a MAJOR concern because renal cell tumors are highly vascular
- Pre-op:
- -Teaching
- -Site of incision
- -Drains
- -Pain relief
- -may give blood and fluids preoperatively to prevent shock
- Operative:
- -Patient placed on his or her side w/ the kidney to be removed uppermost
- -Usually the opposite trunk area is flexed to incrase exposure of the kidney area
- -Removal of the 11th or 12th rib is needed
- Post-op Care:
- -Assess for hemorrhage and adrenal insufficiency,abdominal distension, low urine output, hypotension, and altered LOC
- -Low BP is sign of hemorrhage and adrenal insufficiency
- -The second kidney is expected to provide adequate renal function, but it may take days to weeks
- -Monitor urine output, weigh the patient, temp, pulse, respirations, and pain management
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Adrenal Insufficiency:
Commonly associated with the following symptoms which can vary from mild to extreme
- -Fatigue
- -Decreased tolerance to cold
- -Poor circulation
- -Hypoglycemia
- -Low blood pressure
- -Allergies
- -Depression
- -Joint aches and pains
- -Tendancy to constipation
- -Muscle weakness
- -Need for excessive amounts of sleep
- -Subnormal body temperature
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Renal Trauma:
- -Minor injuries such as contusions, small lacerations
- -Maor injuries such as lacerations to the cortex, medulla, or branches of the renal artery
- -Collaborative management
- -Non surgical management: drug and fluid therapy
- -Surgical management: nephrectomy or partial nephrectomy
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