RENAL CANCER

GOPIKA U.B
3RD YEAR BSC NURSING
NIMS COLLEGE OF NURSING
NEYYATTINKARA
 INTRODUCTION
• Kidney cancer, also known as renal cancer is a type of cancer that
originates from the cells in kidney. Kidney cancer first appear in
the lining of tiny tubes (tubules)in the kidney. This type of kidney
cancer is called renal cell carcinoma.
• 2 most common types of kidney cancers are;
a. Renal cell carcinoma
b. Transitional cell or urothelial cell carcinoma
 CONTINUATION
Other types of kidney cancers;
Squamous cell carcinoma
Juxtaglomerular cell tumour
Mesoblastic nephroma
Wilms tumour(common in children)
Renal lymphoma
Angiomyolipoma(benign)
 CONTINUATION
• Kidney cancer originate from cortex or pelvis. Tumour from
these area may be benign or malignant. However malignant
tumour are more common.
• Incidence of kidney cancer in India is 0.9% and mortality being
0.6%.
• Renal cell carcinoma (adenocarcinoma) is the most common
type of kidney cancer.
 DEFINITION

Renal cell cancer (also called kidney cancer or

renal cell adenocarcinoma) is a disease in which malignant
(cancer) cells are found in the lining of tubules in the kidney.
 CAUSES AND RISK
FACTORS
The exact cause of renal cancer is unknown
Other causes are;
• Age: The risk of kidney cancer increases with age and is
typically discovered when person is 50-70 years of age.
• Sex: Tumour occur twice as often in men as in women.
• Smoking: cigarette smoking is the most significant risk factor
for the development of renal cell carcinoma.
• Being black: Risk is slightly higher in black people than whites.
 CONTINUATION
• Obesity: People who are obese have higher risk of renal cell
carcinoma.
• Hypertension: High blood pressure increases the risk of renal
cancer.
• Family history: An increased risk has been found in first degree
relatives of people who have or had renal cell carcinoma.
• Chemicals: Exposure to chemical such as cadmium, asbestos,
benzene, organic solvents, herbicides and gasoline increase the risk.
 PATHOPHYSIOLOGY
• Tumour growth begins in the renal cortex and usually
continues for some time before it produces manifestations. The
tumour can grow very large and tend to compress the adjacent
renal parenchyma rather than infiltrate it. The tumour, usually
avascular tend to surround blood vessels and constrict them.
• The lung and mediastinum are the most frequent metastatic
sites of occurrence. Liver, bone, skin, spleen, renal vein and
brain are other common sites of metastases.
 CLINICAL MANIFESTATIONS
Early stage kidney cancer usually has no symptoms. The common
triad of manifestation are;
Hematuria
Flank pain
Palpable mass in flank or abdomen
Weight loss and Cachexia
Fever
Hypertension
 CONTINUATION
Fatigue
Anemia
Erythrocytosis
Amyloidosis
Thrombophlebitis
Hypercalcemia
Elevated ESR
Edema
 STAGING
STAGE I - The tumour can be up to 7cm in diameter but is
confined to the kidney.
STAGE II - The tumour is larger than stage I tumour but is still
confined to the kidney.
STAGE III - The tumour extend beyond the kidney to the
surrounding tissue and may also be spread to nearby lymph node.
STAGE IV – Cancer spread outside the kidney to multiple lymph
nodes or to distant parts of body such as lung, liver, bone or brain.
 DIAGNOSTIC EVALUATION
 History Collection
 Physical Examination
 Urine analysis: Check for blood in urine or other signs of problem.
 Blood test: Kidney Function Test
Complete Blood Count
 Ultra sound: Non invasive procedure for visualizing soft tissues.
 Intravenous pyelogram: visualization of kidney, ureter and bladder
after injecting dye into the vascular system.
 CONTINUATION
• X-Ray: Kidney, Ureter, Bladder (KUB) x-ray is taken to find out
abnormalities.
• CT urogram: A computerized tomography (CT) urogram is an
imaging exam used to evaluate the urinary tract.
• CT scan: A CT scan of the kidney may be performed to assess the
kidneys for tumors and other lesions, obstructions such as kidney
stones etc..
• Renal arteriogram: Test is used to evaluate blood supply of the
tumour.
 CONTINUATION
• Renal biopsy: remove a small sample of kidney cells and test
for signs of cancer growth.
• Tumour markers;
- BTA(Bladder Tumour Antigen)
- CEA(Carcinoembryonic Antigen)
• Radionucleotide isotope: used to detect metastases.
 MANAGEMENT
Surgical management: Surgery is the standard of care for majority of
kidney cancers. Surgical procedures include;
1. RADICAL NEPHRECTOMY:
It removes kidney, adrenal gland and surrounding tissues
and part of ureter. It also removes surrounding lymph nodes and is
usually done for large tumours.it can now be done with a small incision
with a laparoscope.
 CONTINUATION
2. SIMPLE TOTAL NEPHRECTOMY:
In this procedure only kidney is removed. It is
mainly done for large tumours.
3. PARTIAL NEPHRECTOMY:
Remove the cancer in the kidney along with some
tissues around it. This procedure is used for patients with large
tumours.
 CONTINUATION
Other treatment options are ;
a. Cryotherapy - It uses extreme cold to kill tumour.
b. Radio frequency ablation - It uses high frequency radio
waves to kill tumour cells.
c. Arterial embolization - It involves inserting a material into
an artery that leads to kidney. This block blood flow to
tumour and it help in shrinkage of tumour before the surgery.
ARTERIAL EMBOLIZATION RADIO FREQUENCY ABLATION
 CHEMOTHERAPY
 Chemotherapy uses drug to kill cancer cells or stop them from
multiplying. It is used as a treatment in metastatic disease.
 Drugs used in chemotherapy are;
5-flurouracil
Floxuridine
Gemcitabine
 RADIATION THERAPY
• Radiation therapy is used as an adjunct with chemotherapy
• It is used palliatively in inoperable cases and when there is
metastasis to bone or lungs.
• It is sometimes also used post operatively to destroy residual or
recurrent tumour cells and treat lymphatic involvement.
 IMMUNOTHERAPY
• Stimulants of the immune system have led to some positive results as
long as the tumour is not too large and the immunosuppression is not
too severe.
• α- interferon and interleukin-2 is another treatment in metastaic disease.
• Another type of drug used is Nivolumab. This drug target PD-1 a
protein on t cells that normally help to keep these cells from attacking
other cells in the body, by blocking PD-1 this drug boost the immune
response against cancer cells. This can shrunk some tumour or slow
their growth.
 TARGETED THERAPY
• Kinase inhibitor is one class of targeted therapies that block
certain proteins(kinase) that play a role in tumour growth and
cancer progression .
• Kinase inhibitor include Sunitinib, Sorafenib, Cabozantinib and
Axitinib.
• Bevacizumab and Pazopanib inhibit the formation of new
blood vessel growth to the tumour.
 PREVENTION
Quit smoking
Maintain a healthy weight
Control high blood pressure
Reducing or avoiding exposure to toxins and chemicals.
 NURSING MANAGEMENT
• Administer analgesic as needed by the patient
• Provide symptomatic treatment for adverse effect of
chemotherapeutic drug.
• watch the patient for signs and symptoms of pulmonary,
neurologic and liver dysfunction.
• Monitor laboratory test result for anemia, polycythemia and
abnormal blood chemistry.
• Monitor degree of pain.
 CONTINUATION
• Prepare the patient for nephrectomy as indicated.
• Encourage the patient to express his anxieties and fear and
remain with him during periods of severe stress and anxiety.
• Postoperatively monitor the vital signs of the patient Nd watch
for signs of bleeding.
• Encourage client to take more nutritious food.
• Help the client to perform deep breathing and coughing
exercises.
 NURSING DIAGNOSIS
• Acute pain related to infiltration of nerve or vascular supply as
evidenced by expressive behaviours.
• Imbalanced nutrition related to taste distortions as evidenced
by weight loss.
• Fatigue related to anemia as evidenced by disinterest in
surroundings.
• Fear or anxiety related to situational crisis as evidenced by
reports concern due to changes in life events.
 CONTINUATION
• Grieving related to anticipated loss of significant body part as
evidenced by psychological distress.
• Risk for infection
• Risk for situational low Self-Esteem.
• Risk for impaired skin integrity.
• Risk for impaired oral mucous membrane.
• Risk for interrupted family process
• Risk for diarrhea or constipation.