Renal cell carcinoma

1. WELCOME

2. DEFINITION
•Kidney cancer is usually defined as any cancer
that is determined to have arisen from the
kidney.

3. INCIDENCE
•India :0.9%
•Mortality 0.6%
•Age 50 -70 yrs
•Men 1 In 46
•Women 1 in 80

4. PREVALENCE
•Global 13.4%
•In India male 2/100000 -female
1/100000

5. ETIOLOGY/CAUSES
•Mutations in DNA
•Smoking tobacco
•Obesity
•Hereditary
•Family history

6. RISK FACTORS
•Age : above 64yrs
•Gender: men more risk
•Tobacco use
•Occupational exposure
•Obesity
•High blood pressure
•Dialysis

7. •Estrogen therapy
•Polycystic kidney disease
•Genetic : family history
•Hereditary disease

8. LIFESTYLE
Smoking tobacco
Occupational exposure

9. PATHOPHYSIOLOGY

10. CLINICAL MANIFESTATION
•Abdominal mass
•Hematuria
•Pain and mass in the flank
•First painless hematuria then become pain in
the back
•Colicky pain
•Weight loss
•Weakness
•Anemia

11. STAGES
Sta
ge
Stage
groupin
g
Stage description*
I T1
N0
M0
• The tumor is 7 cm across or smaller and is
only in the kidney (T1).
• There is no spread to lymph nodes (N0) or
distant organs (M0).

12. II T2
N0
M0
• The tumor is larger than 7 cm across but is
still only in the kidney (T2).
• There is no spread to lymph nodes (N0) or
distant organs (M0).
T3
N0
M0
The tumor is growing into a major vein
(like the renal vein or the vena cava) or
into tissue around the kidney, but it is not
growing into the adrenal gland or beyond
Gerota’s fascia (T3).
There is no spread to lymph nodes (N0) or
distant organs (M0).

13. T1 to T3
N1
M0
The main tumor can be any
size and may be outside the
kidney, but it has not spread
beyond Gerota’s fascia. The
cancer has spread to nearby
lymph nodes (N1) but has not
spread to distant lymph nodes
or other organs (M0).
IV T4
Any N
M0
The main tumor is growing
beyond Gerota’s fascia and
may be growing into the
adrenal gland on top of the
kidney (T4). It may or may not
have spread to nearby lymph
nodes (any N). It has not
spread to distant lymph nodes

14. o Any
T
o Any
N
o M1
o The main tumor can be any size and
may have grown outside the kidney
(any T).
o It may or may not have spread to
nearby lymph nodes (any N).
o It has spread to distant lymph nodes
and/or other organs (M1).

15. DIAGNOSTIC FINDINGS
• KUB/Kidney ureters bladder
• Intravenous pyelogram(IVP)
• Renal arteriogram
• Retrograde pyelogram
• Renal ultrasound
• CT scan
• MRI
• Endoscopy /cystoscopy

16. INTRAVENOUS PYELOGRAM(IVP)
• Intravenous pyelogram (IVP) is an x-ray exam that uses an injection
of contrast material to evaluate kidneys, ureters and bladder and help
diagnose blood in the urine or pain in lower back

18. RENAL ARTERIOGRAM

19. MEDICAL MANAGEMENT
• Pharmacologic management
• Chemotherapy
• Chemotherapy (chemo) uses anti-cancer drugs that are given
into a vein (IV) or taken by mouth (as pills). which makes this
treatment potentially useful for cancer that has spread
(metastasized) to organs beyond the kidney.
• Some chemo drugs, such as cisplatin, 5-fluorouracil (5-FU)

20. •Possible side effects can include:
•Hair loss
•Mouth sores
•Loss of appetite
•Nausea and vomiting
•Diarrhea or constipation
•Increased chance of infections

21. HORMONE THERAPY
• Hormone therapy is a cancer treatment that slows or stops the
growth of cancer that uses hormones to grow. Hormone therapy is
also called hormonal therapy, hormone treatment, or endocrine
therapy.

22. RADIATION THERAPY
• Radiation therapy (also called radiotherapy) is a cancer treatment
that uses high doses of radiation to kill cancer cells and shrink
tumors.

24. BIOLOGICAL THERAPY
• Biological therapy for cancer is a type of treatment that uses the
body's immune system to kill cancer cells. Biological therapy for
cancer is used in the treatment of many types of cancer to prevent or
slow tumor growth and to prevent the spread of cancer.

25. SURGICAL MANAGEMENT
•Nephrectomy
•A nephrectomy is the surgical removal of a kidney,
performed to treat a number of kidney diseases
including kidney cancer. It is also done to remove a
normal healthy kidney from a living or deceased donor,
which is part of a kidney transplant procedure.

26. LAPAROSCOPIC NEPHRECTOMY
• A laparoscopic nephrectomy uses a small tool with a camera
(laparoscope) and a few tiny incisions.

27. •Partial nephrectomy, where a surgeon removes
only the diseased portion of the kidney.
•Radical nephrectomy, where a surgeon removes
the entire kidney. Surgeons may also remove a
section of the ureter (tube leading to the
bladder), in a procedure called
nephroureterectomy. They may also remove the
adrenal glands (hormone glands that sit above
the kidneys). This may also be performed as an
open or laparoscopic/robotic procedure.

28. RENAL ARTERY EMBOLIZATION

29. •In patient with metastatic renal carcinoma
•A catheter is introduce into the renal artery and
embolizing material are injected into the artery
and carried with the arterial blood flow to
occlude the tumor vessels mechanically

30. •Renal artery embolization (RAE) refers to
the occlusion of the renal artery, or some
of its branches, by injection of an embolic
agent through an endovascular catheter.

31. NURSING MANAGEMENT
•Nursing assessment
•History
•Nutritional history
•Elimination

32. PRE OPERATIVE NURSING MANAGEMENT
• Nursing assessment
• Preparation of patient
• Protection of area from infection
• Maintain iv fluids
• Informed consent
• Skin preparation
• GI prepareation

33. POST OPERATIVE MANAGEMENT
• Close monitoring
• Drainage care
• Health teaching
• Follow-up care
• Prevention of infection and complications
• Maintain urine output 30 to 50 ml/hr

34. • Maintain IO chart
• Ensure adequate ventilation
• Pain management
• Deep breathing exercises
• Maintain iv fluids

35. NURSING DIAGNOSIS
PREOPERATIVE
1.Fluid volume deficit/over load related to dehydration and
hypothermia
2.Impaired urinary elimination related to urinary drainage
3.Altered nutritional status related to anorexia, nausea
4.Comfort and activity alteration related to pain and fatigue

36. FLUID VOLUME DEFICIT/OVER LOAD RELATED TO
DEHYDRATION AND HYPOTHERMIA
• Monitor and document vital signs, especially BP and HR.
• A decrease in circulating blood volume can cause hypotension and tachycardia. Alteration in HR is a
compensatory mechanism to maintain cardiac output. Usually, the pulse is weak and irregular if electrolyte
imbalance also occurs. Hypotension is evident in hypovolemia.
• Assess skin turgor and oral mucous membranes for signs of dehydration.
• Oral fluid replacement is indicated for mild fluid deficit and is a cost-effective method for replacement
treatment.
• A fluid deficit can cause a dry, sticky mouth. Attention to mouth care promotes interest in drinking and
reduces the discomfort of dry mucous membranes.
• Provide a comfortable environment by covering the patient with light sheets.
• Insert an IV catheter to have IV access. Consider the need for an IV fluid challenge with an immediate
infusion of fluids for patients ,Administer blood products as prescribed.

37. ALTERED NUTRITIONAL STATUS RELATED TO ANOREXIA, NAUSEA
• Assess the nutritional status of the patient.
• Provide a pleasant environment.
• Elevating the head of bed 30 degrees aids in swallowing and reduces risk for
aspiration with eating.
• Provided Oral hygiene it has a positive effect on appetite and on the taste of food.
Dentures need to be clean, fit comfortably, and be in the patient’s mouth to
encourage eating.
• Nursing assistance with activities of daily living (ADLs) will conserve the patient’s
energy for activities the patient values.
• For patients with physical impairments, refer to an occupational therapist for
adaptive devices.
• offer high protein supplements based on individual needs and capabilities.

38. COMFORT AND ACTIVITY ALTERATION
RELATED TO PAIN AND FATIGUE
• Assess the activity level of the client
• Implement the use of assistive devices
• Promote sufficient nutritional intake. The patient will need properly balanced intake
of fats, carbohydrates, proteins, vitamins, and minerals to provide energy resources.
• Encourage an exercise conditioning program as appropriate.
• Offer diversional activities that are soothing
• Educate the patient and family about task organization methods and time
organization methods.

39. POST OPERATIVE SURGERY
•Acute Pain related to Surgery
•Anxiety related to Surgery
•Deficient Knowledge related to disease condition
•Risk for Injury
•Risk for Infection

40. ACUTE PAIN RELATED TO SURGERY
• Provide measures to relieve pain before it becomes severe.
• It is preferable to provide an analgesic before the onset of pain or before
it becomes severe when a larger dose may be required.
• Pain management using pharmacologic methods involves using opioids
(narcotics), nonopioids (NSAIDs), and coanalgesic drugs.
• Provide nonpharmacologic pain management.
• Nonpharmacologic methods in pain management may include physical,
cognitive-behavioral strategies, and lifestyle pain management.

41. ANXIETY RELATED TO SURGERY
•Assess the anxiety level of the client
•Provide health education to the client
•Provide psychological support to the client
•Maintain good IPR with client

42. DEFICIENT KNOWLEDGE RELATED TO DISEASE
CONDITION
• Assess the knowledge of the client
•Provide education to the client
•Provide full details about the procedures
•Explain the all procedure to the client

43. RISK FOR INFECTION
•Assess the site of infection
•Provide antibiotics to the client
•Handwashing
•Follow Aseptic technique