TAILIEUCHUNG - Chapter 090. Bladder and Renal Cell Carcinomas (Part 7)

Renal Cell Carcinoma: Treatment Localized Tumors The standard management for stage I or II tumors and selected cases of stage III disease is radical nephrectomy. This procedure involves en bloc removal of Gerota's fascia and its contents, including the kidney, the ipsilateral adrenal gland, and adjacent hilar lymph nodes. The role of a regional lymphadenectomy is controversial. Extension into the renal vein or inferior vena cava (stage III disease) does not preclude resection even if cardiopulmonary bypass is required. If the tumor is resected, half of these patients have prolonged survival. Nephron-sparing approaches via open or laparoscopic surgery may be appropriate. | Chapter 090. Bladder and Renal Cell Carcinomas Part 7 Renal Cell Carcinoma Treatment Localized Tumors The standard management for stage I or II tumors and selected cases of stage III disease is radical nephrectomy. This procedure involves en bloc removal of Gerota s fascia and its contents including the kidney the ipsilateral adrenal gland and adjacent hilar lymph nodes. The role of a regional lymphadenectomy is controversial. Extension into the renal vein or inferior vena cava stage III disease does not preclude resection even if cardiopulmonary bypass is required. If the tumor is resected half of these patients have prolonged survival. Nephron-sparing approaches via open or laparoscopic surgery may be appropriate for patients who have only one kidney depending on the size and location of the lesion. A nephron-sparing approach can also be used for patients with bilateral tumors accompanied by a radical nephrectomy on the opposite side. Partial nephrectomy techniques are being applied electively to resect small masses for patients with a normal contralateral kidney. Adjuvant therapy following this surgery does not improve outcome even in cases with a poor prognosis. Advanced Disease Surgery has a limited role for patients with metastatic disease. However long-term survival may occur in patients who relapse after nephrectomy in a solitary site that can be removed. One indication for nephrectomy with metastases at initial presentation is to alleviate pain or hemorrhage of a primary tumor. Also a cytoreductive nephrectomy before systemic treatment improves survival for carefully selected patients with stage IV tumors. Metastatic renal cell carcinoma is highly refractory to chemotherapy and only infrequently responsive to cytokine therapy with IL-2 or IFN-a. IFN-a and IL-2 produce regressions in 10-20 of patients but on occasion these responses are durable. IL-2 was approved on the observation of durable complete remission in a small proportion of cases. The situation

• Y học thường thức
• Bladder and Renal Cell Carcinomas
• bệnh học và điều trị
• bài giảng bệnh học
• tài liệu y khoa
• Harrisons Internal Medicine
• medical books
• pharmacology
• epidemiologic
• Obstetrics
• anatomy
• Preventing Morbidity
• Multidisciplinary Care
• Harrisons principles of internal medicine
• Internal medicine
• Quality of health care
• Developed countries
• Health care systems
• Chest discomfort
• Clinical medicine
• The cardiovascular system
• Critical care medicine
• The kidney and urinary tract
• The gastrointestinal system
• The joints and adjacent tissues
• Neoplasms of the Lung
• bệnhbệnh học và điều trị
• tài liệu học ngành y
• Sodium and Water học và điều trị
• General considerations in clinical medicine
• Cardinal manifestations
• Presentation of diseases
• The environment and disease
• Regenerative medicine
• Introduction to clinical medicine
• The environment
• Disorders of the cardiovascular system
• Disorders of the respiratory system
• Disorders of the gastrointestinal system
• Infectious diseases
• The respiratory system
• Neurologic Disorders
• Moraxella Infections
• Haemophilus Infections
• Bệnh truyền nhiễm
• Tim mạch
• Tiết niệu
• Tiêu hóa
• Cơ xương khớp
• Acute rheumatic fever
• Antiphospholipid syndrome
• Inflammatory myopathies
• Relapsing polychondritis
• Pituitary tumor syndromes