Renal cell carcinoma, part 2.

ABSTRACT: Renal cell carcinoma (RCC) accounts for most renal malignancies. This article, the second in a three-part series, addresses how renal masses are classified, signs and symptoms of RCC, medical treatments for RCC, and priority nursing interventions for patients with RCC.

Renal cell carcinoma, part 3.

ABSTRACT: Renal cell carcinoma (RCC) accounts for most renal malignancies. This article, the last in a three-part series, presents treatment options for RCC using the American Joint Committee on Cancer Tumor, Node, and Metastasis staging system as a framework, as well as nursing-care options for patients undergoing partial or radical nephrectomy.

[Using Shared Decision-Making on a Patient With Renal Cell Carcinoma and Subcutaneous Metastasis: A Care Experience].

When a patient aggressively receives treatment and looks forward to returning home, the prolonging of meaningful life is difficult, even with medical treatment. It is typically very challenging at this juncture for the members of the medical team to fully disclose to the patient the true extent of his / her condition and to recommend the withdrawal of life-support medical treatment. This article describes a nursing care experience with a renal cell carcinoma patient with subcutaneous metastasis. Her pain was induced by an edema and subcutaneous tumor in her lower limbs, which diminished the effectiveness of hemodialysis. During hospitalization, the mood of the patient shifted from looking forward to recovery to facing a rapidly worsening health status. Achieving a balance between fighting the disease and sustaining patient quality of life became increasingly difficult, and the patient began experiencing anxiety about dying. We use the belief of shared decision-making to guide the case in a discussion of her expectations during which primary medical care options and her choice to withdraw from hemodial-ysis treatment were explained. Essential oils, selected for appropriateness with her current disease stage, were used to stabilize her mood and relieve pain. In the end, we helped the patient to complete her pre-death preparations and to say goodbye to her children, parents, and siblings. As a result, the patient experienced a good death.

Renal cell cancer: nurses' role in prevention and management.

In both the UK and throughout Europe, more patients are presenting with renal cell cancer (RCC), also known as renal cell carcinoma or kidney cancer. The overall survival rate varies depending on tumour grade, nodal involvement and metastasis. For those with metastasis survival drops to 10%. This article explores the risk factors associated with RCC diagnosis and staging, treatments including drugs and procedures and the role of the nurse in diagnosis and accurate assessment. Nurses are ideally suited to consider the physical, functional, social, and emotional status of their patients In addition, it is essential that the nurse has an understanding of new pharmaceutical therapies, which have been licensed to treat RCC, and a sound knowledge of the possible side effects and nursing management associated with these drugs.

Renal cell carcinoma: a reappraisal.

Surgical treatment of renal cell carcinoma is the gold standard. Nephron-sparing surgery, laparoscopic and robotic surgery and minimally invasive procedures have decreased the morbidity of treatment. Although traditionally resistant to chemotherapy and radiation therapy, advances have been made with immunotherapies. Physicians and nurses caring for patients with renal cell carcinoma should be aware of changes in management and newer therapies for treatment of advanced disease.

Concepts in advanced renal carcinoma.

OBJECTIVES: Treatment options for advanced renal cell carcinoma have increased dramatically over the past 6 years as a result of improved understanding of the biology of renal cancer and the development of therapies to target pathways relevant to tumor progression. DATA SOURCES: Research-based articles. CONCLUSION: New therapies to treat advanced renal cell cancer results in a need for evidence-based decision making when discussing treatment choices. IMPLICATIONS FOR NURSING PRACTICE: Knowledge of therapeutic strategies, their proposed mechanism of action, potential adverse events, and management strategies provides nurses with a foundation to provide appropriate patient education and effective management of treatment-related side effects, assisting patients to maximize clinical outcomes.

Nursing considerations with pazopanib therapy: focus on metastatic renal cell carcinoma.

The rapid evolution of targeted therapies has had a dramatic impact on multiple domains in oncology, particularly metastatic renal cell carcinoma (RCC). Four agents antagonizing vascular endothelial growth factor-mediated signaling have been approved for the treatment of metastatic RCC, including the monoclonal antibody bevacizumab and the small molecular inhibitors sunitinib, sorafenib, and pazopanib. Pazopanib was approved in 2009 for this disease on the basis of a phase III clinical trial demonstrating a superior progression-free survival compared to placebo in 435 patients with either treatment-naive or cytokine-refractory disease. The trial offered insight related to the toxicity profile associated with this agent. The most common clinical adverse events are diarrhea, hypertension, nausea, anorexia, and vomiting. With respect to laboratory adverse events, hepatotoxicity represents a specific concern with pazopanib. Oncology nurses play a critical role in counseling patients regarding the toxicity profile and management of adverse events in pazopanib treatment.

Managing renal cell carcinoma: the nurse's role.

Diagnosing renal cell carcinoma (RCC) can be difficult. Symptoms include a palpable mass in the abdomen, haematuria and hydronephrosis, but diagnosis can be delayed because of symptom similarities with other conditions, and often occurs incidentally during radiographic imaging for other complaints. This aside, more than 6600 people are diagnosed with kidney cancer annually in the UK (Patient UK, 2011). Although numerous improvements and greater use of screening measures have occurred, screening for this disease is limited to those patients identified as having a known genetic lineage linked to RCC (Pirass and Dahlstrom, 2010).

New therapeutic strategies for renal cell carcinoma.

Treatment options for renal cell carcinoma have changed dramatically since 2005 when the U.S. Food and Drug Administration approved six new therapies. These agents inhibit pathways relevant in the pathogenesis of renal cell carcinoma, interfering with tumor angiogenesis, cell progression, and metastasis. Understanding the pharmacology of these agents is necessary for clinicians to provide appropriate patient education, assure adherence with the treatment plan, and facilitate early identification and intervention for side effects. These activities will provide positive clinical outcomes.

Managing adverse events associated with sorafenib in renal cell carcinoma.

Sorafenib, a multi-targeted kinase inhibitor, is approved in Europe for the treatment of patients with advanced renal cell carcinoma whose treatment with an interferon or interleukin-2-based therapy has previously failed, or who are unsuitable for such therapy. Unlike some first-generation anti-cancer therapies, sorafenib is generally associated with moderate and manageable adverse events. Some of the most common adverse events include a hand-foot skin reaction, diarrhoea and rash. As nurses provide an interface between the patient and the clinical team, it is important that they understand how sorafenib-related adverse events impact on patients. It is equally vital that nurses are able to recognize and manage these adverse events. Our experience has shown that with patient education, early reporting, monitoring and treatment, the adverse events of sorafenib therapy can be easily and effectively managed. Optimal adverse event management helps ensure treatment compliance and ensures that patients receive maximum benefit from therapy.

Management of vascular endothelial growth factor and multikinase inhibitor side effects.

The availability of vascular endothelial growth factor and multikinase inhibitors (MKIs) has enhanced treatment strategies for patients with advanced kidney cancer. Side effects associated with the agents include dermatologic toxicities, gastrointestinal toxicities, and hematologic and metabolic abnormalities that may interfere with treatment adherence. Nurses play a key role in managing side effects associated with emerging therapies. This article presents a case study to illustrate side-effect management strategies for patients receiving MKIs for the treatment of advanced renal cell carcinoma.

Management of mTOR inhibitor side effects.

Although surgery remains the primary curative treatment for renal cell carcinoma (RCC), systemic therapy also is indicated in the advanced disease setting. This article reviews the role of mammalian target of rapamycin inhibitors in the treatment of metastatic RCC. A case study is presented to illustrate side-effect management issues commonly encountered by oncology nurses in clinical practice.

Nursing care of patients receiving high-dose, continuous-infusion interleukin-2 with pulse dose and famotidine.

High-dose, continuous-infusion interleukin-2 (IL-2) followed by pulse dose and concurrent administration of famotidine has demonstrated response rates of 64% and 33% in patients with metastatic melanoma and metastatic renal cell carcinoma, respectively. Currently, no information is available concerning the nursing care of patients receiving that IL-2 regimen. Given the high response rates of patients on the treatment, attention by the nursing profession is warranted. Effective nursing care of patients receiving IL-2 is essential to the regimen's success. Recognition and prompt treatment of common side effects lead to better patient outcomes. This article provides nurses with an overview of the treatment regimen, expected side effects, psycho-social considerations, and discharge instructions for patients receiving continuous-infusion plus pulse IL-2 and famotidine.

New weapons to snuff out kidney cancer.

Learn how to assess and care for a patient with this often-hidden cancer. Then get the scoop on two newly approved drugs to treat advanced stages of the disease.

Laparoscopic radical nephrectomy in renal cell carcinoma.

Historically, the only surgical option for removal of a renal mass was through a large incision in the abdomen. Recently, many urologists have adopted new innovations in the removal of renal masses including laparoscopic radical nephrectomy. The laparoscopic approach to radical nephrectomy has been associated with improved patient outcomes including decreased pain, shorter hospital stay, rapid recovery, and improved aesthetic cosmetic appearance. Laparoscopic radical nephrectomy may be performed in three different types of surgical procedures including laparoscopic hand-assisted radical nephrectomy, transperitoneal radical nephrectomy, and retroperitoneal radical nephrectomy. Understanding the procedure, preoperative instructions, and recovery will assist nurses in counseling patients considering laparoscopic radical nephrectomy.