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Renal Cell Carcinoma

RENAL CELL CARCINOMA AKA adenocarcinoma of kidney

Healthy tissue of kidney damaged and replaced by cancer cellsParaneoplastic syndromes (systemic effects occurring w this cancer type)

Anemia

Erythrocytosis

Hypercalcemia

Liver dysfunction

Elevated liver enzymes

Hormonal effects↑sedimentation ratesHTNAnemia and erythrocytosis contradictory; clients either have 1 or the other, not both at the same time**Some blood loss from hematuriaCause of anemia+erythrocytosis is related to kidney cell production of erythropoietinAt times tumor cells produce large amounts of erythropoietin, causing erythrocytosisOther times tumor cells destroy erythropoietin producing kidney cells and anemia resultsHTN may result from ↑blood levels of reninParathyroid hormone produced by tumor cells can cause hypercalcemia*↑HCG human chorionic gonadotropin levels(↓libido+changes 2ndary sex characteristics)

Complications: metastasis and UTobstructionMetastasis usually occurs toAdrenal glandLiverLungsLong bonesOther kidneyRisk ↑ w tobacco use or exposure to lead, phosphate, and cadmium

ASSESSMENT+LABSFlank pain, gross hematuria, palpable renal massPain is dull and aching unless if more intense bleeding which causes intense painCheck flank area for asymmetry or obvious bulgeRenal bruit may be heardRbc in urine↓hemoglobin+hematocritHypercalcemia↑erythrocyte sedimentation rate↑ levels of adenocorticotropic hormone, HCG, cortisol, renin, and parathyroid hormone

INTERVENTIONS

Radiofrequency ablation shown some promise in treating renal cancerMinimal invasive, Carried out during MRIMRI can monitor the results of tumor destruction immediately because MRI is sensitive to temp changesBiologic response modifiers (BRM)such as interleukin,interferon,tumor necrosis factorNephrectomy(kidney removal)Renal cell tumors r highly vascular and blood loss during surgery is a major concernBefore surgery arteries supplying kidneys may b occluded(embolized) by radiation to reduce bleeding during nephrectomyPreop: Give blood and IV fluids to ensure hemodynamic stabilityClient placed on side w kidney to b removed uppermostClients trunk area is flexed to ↑ exposure of kidneyRemoval of the 11th or 12th rib is needed to provide better accessSurgeon removes entire kidney+visible tumor, renal artery+vein, and fascia after tying off the ureterDrain may be placedRadical nephrectomy-periaortic lymph nodes r also removed; radiation therapy may followPostopInspect abdomen for bleeding+distentionCheck bed sheets for bloodHemorrhage or adrenal insufficiency cause hypotension, decreased urine output, and altered level of consciousness
↓ in BP is an early sign of bothWith hypotension, urine output↓Large water+Na loss in urineLarge urine output is followed w hypotension and oliguria (↓400 ml/24 hr or less than 25ml/hr)IV fluids+PACKED rbcsUrine output of 30-50ml/hr is acceptable; output of less that 25-30 suggests↓renal blood flow**Hemoglobin,hematocrit,rbc levels measured every 6-12 hours for 1-2 days postVS q4hDrain placed near incision site removes residual fluidb/c of discomfort of deep breathing , risk for atelectasisopioid analgesics(Diaudid) and morphine sulfate PARENTERALLYincision made through major muscle that r used w breathing and movementoral agents used when client is permitted to eat and drink(book doesn’t say when; maybe first few days)antibiotics during after surgery for infection preventionsteroid replacements may be needed in clients who have adrenal insufficiency