Oncology Nursing

2. • Kidney cancer, also known as renal cancer, is a type
of cancer that originates from the cells in
the kidney. kidney cancers first appear in the lining
of tiny tubes (tubules) in the kidney. This type of
kidney cancer is called renal cell carcinoma.
• The two most common types of kidney cancer are
a. renal cell carcinoma (RCC) and
b. transitional cell carcinoma (TCC) or uothelial
cell carcinoma (UCC) (a tissue lining the inner
surface of these hollow organs)
• RCC is responsible for approximately 80% of
primary renal cancers, and UCC accounts the
majority of the remainder

3. Other types of kidney cancer
• Squamous cell carcinoma
• Juxtaglomerular cell
tumor (reninoma)
• Angiomyolipoma (benign)
• Bellini duct carcinoma
(Papillary duct)
• Clear – cell sarcoma of the
kidney(kidney to bone)
• Mesoblastic nephroma
(Congenital:ETV6-NTRK3)
• Wilms' tumor
• Mixed epithelial stromal
tumor
• Clear cell adenocarcinoma
• Inverted papilloma
• Renal lymphoma
• Teratoma (germ layer)
• Carcinosarcoma (Miture of
sarcoma and carcinoma)
• Carcinoid tumor of the renal
pelvis

4. Etiology
• Age 40
• Smoking
• Gender (male)
• Obesity:- changes to hormones that increase
risk.
• Over dose or abuse of medications
• Dialysis
• Genetic factors (Von Hippel-Lindau (VHL)
• Chemicals, such as asbestos, cadmium,
benzene, organic solvents, or certain
herbicides
• High blood pressure or medication used to
treat it is the source of the increased risk.

5. Pathophysiology
• Kidney cancer originates in the
kidney in two principal locations:
the renal tubule and the renal pelvis.
– Renal tubule cancers are renal cell
carcinoma and clear cell
adenocarcinoma.
– Renal pelvis are transitional cell
carcinoma.

6. Signs and symptoms
• Blood in urine
• A lump in side or abdomen
• A loss of appetite
• A pain in side
• Weight loss
• Fever that lasts for weeks
• Extreme fatigue
• Anemia
• Swelling in ankles or legs
• Shortness of breath
• Coughing up blood
• Bone pain

7. Kidney cancer staging
Kidney cancer stages include:
• Stage I. At this stage, the
tumor can be up to 2 3/4
inches (7 centimeters) in
diameter. The tumor is
confined to the kidney.
Stage T N M
I T1 N0 M0
II T2 N0 M0
III T1-2 N1 M0
T3 N0-1 M0
IV T4 N2 M0
Any T Any N M1

8. Stage II.
• cancer is larger than
a stage I tumor, but
it's still confined to
the kidney.

9. Stage III.
• At this stage, the
tumor extends
beyond the kidney to
the surrounding
tissue and may also
have spread to a
nearby lymph node.

10. Stage IV.
• Cancer spreads
outside the kidney,
to multiple lymph
nodes or to distant
parts of the body,
such as the bones,
liver or lungs.

11. TNM classification for renal cell carcinoma
Primary tumors (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Tumor ≤7 cm in greatest dimension, limited to the kidney
T1a Tumor ≤4 cm in greatest dimension, limited to the kidney
T1b Tumor >4 cm but ≤7 cm in greatest dimension, limited to the kidney
T2 Tumor >7 cm in greatest dimension, limited to the kidney
T2a Tumor >7 cm but ≤10 cm in greatest dimension, limited to the kidney
T2b Tumor >10 cm, limited to the kidney
T3 Tumor extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond
the Gerota fascia
T3a Tumor grossly extends into the renal vein or its segmental (muscle-containing) branches, or tumor invades
perirenal and/or renal sinus fat but not beyond the Gerota fascia
T3b Tumor grossly extends into the vena cava below the diaphragm
T3c Tumor grossly extends into the vena cava above the diaphragm or invades the wall of the vena cava
T4 Tumor invades beyond the Gerota fascia (including contiguous extension into the ipsilateral adrenal gland)
Regional lymph node (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in regional lymph node(s)
Distant metastasis (M)
M0 No distant metastasis
M1 Distant metastasis

12. Diagnostic Tests
• Urine tests:- check for blood in urine or other signs of problems.
• Blood tests:-
– Kidney function test
– Complete Blood Count
• Intravenous pyelogram (IVP) involves X-raying of kidneys after
injecting a dye, that travels to urinary tract, highlighting any
tumors.
• Ultrasound:- uses sound waves to create a picture of kidneys. It
help to find a tumor is solid or fluid-filled.
• A CT scan:- uses X-rays and a computer to create a series of
detailed pictures of kidneys.
• Magnetic resonance imaging (MRI):- uses strong magnets and
radio waves to create detailed images of soft tissues in your body.
• Renal arteriogram:- This test is used to evaluate the blood supply
to the tumor.
• Biopsy:- remove a small sample of cells (biopsy) from a suspicious
area of kidney and tests in a lab to look for signs of cancer.
• Tumor Markers
– BTA (Bladder Tumor Antigen)
– CEA (Carcinoembryonic Antigen)

13. Treatment
Surgical Management
• Nephrectomy:-
– Partial Nephrectomy
– Radical Nephrectomy
• Cryoablation:- to freeze cancer cells
• Radiofrequency ablation:- to heat cancer
cells

14. Medical Management
• Biological Therapy (immunotherapy)
– Interferon
– Aldesleukin
• Targeted Therapy
– Bevacizumab, pazopanib, sorafenib and sunitinib etc.
• Chemotherapy:- kidney cancer cells are usually resistant to
chemo, so chemo is not a standard treatment for kidney
cancer. Some chemo drugs, such as vinblastine, floxuridine,
5-fluorouracil (5-FU), capecitabine, and gemcitabine have
been shown to help a small number of patients. Still, chemo
is often only used for kidney cancer after targeted
drugs and/or immunotherapy have already been tried.

15. Treatment Choices by Stage
for Kidney Cancer
Stages I, II, or III
• These cancers are usually removed
with surgery when possible. Either a partial
nephrectomy (removing part of the kidney)
or a radical nephrectomy (removing the
entire kidney) may be done. Partial
nephrectomy is often the treatment of choice
in tumors up to 7 cm (a little less than 3
inches in size) if it can be done.
• The lymph nodes near the kidney may be
removed as well, especially if they are
enlarged.

16. • Stage IV
• Stage IV kidney cancer means that the cancer has
grown outside of the kidney or it has spread to other
parts of the body such as distant lymph nodes or other
organs.
• Treatment of stage IV kidney cancer depends on how
extensive the cancer is and on the person’s general
health. In some cases, surgery may still be a part of
treatment.
• Targeted Therapy, Immunotherapy and palliative
treatments such as embolization or radiation
therapy may be the best option.
• Chemotherapy

17. Nursing Management
• Watch the patient for signs and symptoms of pulmonary,
neurologic, and liver dysfunction.
• Monitor laboratory test results for anemia, polycythemia, and
abnormal blood chemistry.
• Watch for adverse effects of radiation or chemotherapy.
• Monitor the patient’s degree of pain and assess the
effectiveness of analgesics.
• Provide symptomatic treatment for adverse effects of
chemotherapeutic drugs.
• Tell the patient what to expect from surgery and other
treatments.
• Explain the possible effects of radiation and drug therapy.
• Stress the importance of compliance with any prescribed
outpatient treatment.
• Encourage the patient to express his anxieties and fears and
remain with him during periods of severe stress and anxiety
• Administer prescribed analgesics as needed by the patient.
• Prepare for nephrectomy as indicated.

18. THANK YOU