ABSTRACT
Each year, more than 1500 new cases of renal cell carcinoma are diagnosed in the Netherlands, and approximately 850 patients die due to this disease. The guideline 'Renal cell carcinoma' contains clinical practice recommendations on the diagnosis (imaging, pathological assessment, histopathological classification) and treatment (surgery, chemo-, immuno-, and radiotherapy) of renal cell carcinoma. For diagnostic imaging, chest and abdominal CT is recommended. Scintigraphy is not recommended. The term 'Grawitz tumour' is obsolete and should be replaced by 'renal cell carcinoma' with histological subtype specification according to the 2004 WHO classification. Laparoscopic radical nephrectomy is as effective as open surgery for localised tumours (T1 and T2) and possibly also for T3 tumours. The laparoscopic approach is associated with less morbidity due to the less invasive nature of this technique. This operation requires experience. In partial nephrectomy, a small margin of healthy tissue is sufficient. Frozen section examination of the resection edges does not appear to be required. In patients with metastatic renal cell carcinoma who are eligible for immunotherapy, removal of the tumour prolongs survival. Metastasectomy prolongs survival in patients with a solitary metastasis. Most currently available cytotoxic agents are ineffective against renal cell carcinoma. Interferon-alpha may have a role in the treatment of patients with renal cell carcinoma and favourable prognostic factors, given the survival advantage demonstrated with this agent in clinical trials. The guideline is available in English at www.oncoline.nl.
Subject(s)
Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/therapy , Kidney Neoplasms/diagnosis , Kidney Neoplasms/therapy , Practice Guidelines as Topic , Practice Patterns, Physicians' , Carcinoma, Renal Cell/mortality , Combined Modality Therapy , Diagnosis, Differential , Humans , Kidney Neoplasms/mortality , Lymphatic Metastasis , Nephrectomy , Netherlands , Prognosis , Survival Rate , Treatment OutcomeABSTRACT
BACKGROUND: The presented study has investigated a possible improvement of imaging prostate cancer: three-dimensional contrast-enhanced power Doppler ultrasonography (3D-CE-PDU). METHODS: Seventy patients with biopsy proven prostate cancer and scheduled for radical retropubic prostatectomy received a 3D-CE-PDU investigation before surgery. Two experts analyzed the ultrasound images. The ultrasound images were correlated to the whole-mount sections of the prostate specimen. The correlation protocol consisted of three evaluation steps. RESULTS: In total, 153 prostate tumors were found in the 70 prostate specimens: 61 tumors <5 mm, 93 tumors >or=5 mm. The diagnosis of clinical significant and insignificant prostate cancer was made in 85 and 88% of the patients for expert I and II, respectively. Diagnosis by imaging improved from 61% (43 of 70 of the prostate cancers) for standard detection tools to an average 86% (60 of 70 prostate cancers) for 3D-CE-PDU. CONCLUSION: 3D-CE-PDU improves the detection of prostate cancer in this group of prostate cancer patients. The use of 3D-CE-PDU in the clinic is questionable as indications are still unclear.
