Editing Kidney Cancer: Diagnosis and Evaluation (section)

== UrologySchool.com Summary ==

* '''<span style="color:#ff0000">Diagnosis and Evaluation in a patients with suspected renal cell carcinoma</span>'''
**'''<span style="color:#ff0000">History and physical exam</span>'''
** '''<span style="color:#ff0000">Labs:</span>'''
*** '''<span style="color:#ff0000">AUA (5):</span>'''
***# '''<span style="color:#ff0000">CBC</span>'''
***# '''<span style="color:#ff0000">Urinalysis (including assessment of proteinuria)</span>'''
***# '''<span style="color:#ff0000">Serum electrolytes</span>'''
***#'''<span style="color:#ff0000">Liver function tests</span>'''
***#'''<span style="color:#ff0000">Assessment of GFR</span>'''
***'''<span style="color:#ff0000">CUA: CBC, Cr, AST/ALT (markers of liver dysfunction), ALP, corrected calcium (markers of bone dysfunction)</span>'''
**** '''<span style="color:#ff0000">Urine cytology in central tumours</span>'''
**** '''Markers of prognosis in advanced disease (Motzer/Heng criteria, see [[Metastatic Kidney Cancer|Advanced Kidney Cancer Chapter Notes]])'''
** '''<span style="color:#ff0000">Imaging:</span>'''
*** '''<span style="color:#ff0000">Primary tumour</span>'''
**** '''<span style="color:#ff0000">AUA:</span>'''
***** '''<span style="color:#ff0000">Multiphase CT or MRI</span>'''
****'''<span style="color:#ff0000">CUA:</span>'''
***** '''<span style="color:#ff0000">Triphasic CT abdomen/pelvis</span>'''
****** '''MRI if CT contraindicated''' (pregnant/allergy/CKD)
****** '''If thrombus present, consider doppler US/MRI to stage IVC involvement'''
*** '''<span style="color:#ff0000">Metastasis:</span>'''
**** '''<span style="color:#ff0000">AUA:</span>'''
***** '''<span style="color:#ff0000">CXR</span>'''
****** '''<span style="color:#ff0000">Indications for CT chest (3):</span>'''
******#'''<span style="color:#ff0000">Pulmonary symptoms</span>'''
******#'''<span style="color:#ff0000">Abnormal CXR</span>'''
******#'''<span style="color:#ff0000">High-risk disease, defined by (5):</span>'''
******##'''<span style="color:#ff0000">Presence of thrombi</span>'''
******##'''<span style="color:#ff0000">Presumed adenopathy</span>'''
******##'''<span style="color:#ff0000">Larger tumor size</span>'''
******##'''<span style="color:#ff0000">Infiltrative appearance</span>'''
******##'''<span style="color:#ff0000">Extensive tumor necrosis</span>'''
****'''<span style="color:#ff0000">CUA:</span>'''
***** '''<span style="color:#ff0000">CXR, consider CT chest if ≥stage T2</span>'''
***** '''Bone scan, if clinically indicated or elevated alkaline phosphatase and serum calcium'''
***** '''Brain CT or MRI if large volume metastatic disease'''
** '''<span style="color:#ff0000">Other:</span>'''
*** '''<span style="color:#ff0000">Renal mass biopsy</span>'''
*** '''<span style="color:#ff0000">Genetic counseling, if indicated</span>'''
***'''<span style="color:#ff0000">Referral to nephrology, if indicated</span>'''