Question

You admit a 68 year old woman who was diagnosed with renal cell carcinoma after experiencing a recurrent UTI with hematuria. When her UTI did not resolve with a second course of antibiotics, the cancer was discovered with a pelvic CT. She is on the surgical unit for exploratory surgery and possible nephrectomy. She asks, "Is it possible that the lump that was found on my CT is not cancer? Why not just do a biopsy? That is what happened when they found a lump in my breast, and it turned out not to be cancer. If it is cancer, could i walk out of here cured? '

1. What is the rationale for not using a biopsy to evaluate a kidney mass?

2. What are the characteristics of abnormal tissue that is cancer, distinctive from tissue that is not cancer?

3. Is nephrectomy a cure for renal cell cancer? Why or why not?

4. Following a nephrectomy, what are the concerns for this patient that require follow up monitoring?

Answer 1

1.Removal of a sample of tissue by excision or needle aspiration for examination.Contraindications to kidney biopsy include bleeding tendencies,uncontrolled hypertension,a solitary kidney,and morbid obesity.

2 Normal cells

• have normal,predictable cell division.
• perform specific,differentiated functions.Each cell has a purpose.
• are contact inhibited and adhere tightly together.Once cells are in direct contact on all surfaces with othercells it no longer undergo mitosis.
• They are euploid.

Cancer cells.

• have rapid and continous cell division.
• have no specific function,they serve no useful purpose.
• have loss of contact inhibition and adhere loosely together.They do not respect other cell boundaries and have persistent cell division.They do not care if there is no room for more cells or that they are causing pain.
• aneuploid.

3 Radical nephrectomy is the removal of ipsilateral kidney with perinephretic tissues,including Gerotas fascia and the ipsilateral adrenal gland.Removal of adrenal gland is not required for RCC involving the middle/lower poles.Preoperative CT scan help decide whether this is feasible;there is a high sensitivity and specificity for adrenal gland involvement.Laparoscopic nephrectomy can be performed for removal of the kidney with a small tumor.Nephron-sparing surgery is increasingly being used to treat patients with solid renal lesions.The technical success rate of nephron-sparing surgery is excellent,and operative morbidity and mortality are low.

4

• Perform incisional site care and dressing changes as ordered.
• Assist with ambulation as indicated.
• Assess renal function closely.
• Encourage coughing and deep breathing and frequent position changes.