Nursing 4 Lecture 4 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

• -Anemia
• -Erythrocytosis
• -Hypercalcemia
• -Liver dysfunction
• -Increased sedimentation rate
• -Hypertension

• -Adrenal gland
• -Liver
• -Lungs
• -Long bones
• -Other kidney

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

• -Known risk factors (smoking, chemical exposure)
• -Change in urine color
• -Abdominal discomfort
• -Fever
• -Family hx

-Patients describe the flank pain as dull or aching

-Bloody urine is a late common sign

• -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

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

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

• -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