Editing CUA: Surgical Management of RCC (2014) (section)

===== Evaluation: history, physical exam, CBC, creatinine, LFTs, markers of bone disease, CT abdo/pelvis, CXR/CT chest =====

# '''History and Physical Exam'''
#* History
#** Risk factors for renal cell carcinoma
#** Symptoms
#*** Pain (bony and flank) and gross hematuria
#*** New onset coughing or other respiratory issues may suggest pulmonary metastases and new neurologic symptoms may suggest cerebral metastases
#** Performance status should be assessed
#* Physical exam
#** Blood pressure
#** Abdominal examination for masses and assessment for cervical lymphadenopathy and lower extremity edema, which may suggest inferior vena cava (IVC) involvement.
#** Neurologic exam should be performed if there is any suggestion of cerebral or spinal metastases.
# '''Laboratory investigations'''
#* '''Complete blood count (CBC)'''
#* '''Renal function'''
#* '''Liver function (transaminases)'''
#* '''Markers of bone disease (alkaline phosphatase and corrected calcium)'''
#* '''Markers of prognosis in patients with advanced disease''' (Lactic acid dehydrogenase [LDH], platelets, calcium, neutrophils, hemoglobin)
#* '''Urine cytology in central tumours'''
# '''Imaging'''
#* '''Primary tumour'''
#** '''Triphasic CT abdo/pelvis (preferred)'''
#*** The evaluation of CT image includes staging of the primary tumour, determination of lymphadenopathy, abdominal metastatic disease and characterization of the contralateral kidney.
#*** Consider MRI, if patient pregnant, contrast allergy or renal insufficiency or CT suggests caval thrombus and level cannot be determined
#*** Doppler ultrasound is also a valuable tool to determine the extent of tumour involvement of the IVC
#* '''Metastatic evaluation'''
#** '''Chest X-ray, consider CT chest if ≥stage T2'''
#** Bone scan, if clinically indicated (bony pain) or elevated alkaline phosphatase and serum calcium
#** Brain CT or MRI if large volume metastatic disease or suspicion of brain metastases in cases with neurologic symptoms
#* '''Isotope renogram may be useful in patients with compromised renal function, bilateral or multifocal disease for surgical planning and patient counselling.'''
#* '''Positron emission tomography (PET) has no role in the primary assessment of RCC, its role in advanced RCC and assessment of tumour recurrence is evolving'''