Urology>>>>>Renal Cancer
Question 5#

Which one of the following statements regarding locally advanced renal cell cancer is CORRECT?

A. T3b (TNM classification 2017) RCC have tumour thrombus in the IVC above the diaphragm
B. The 5-year cancer-specific survival rates for T3b renal cell cancers treated by surgery (TNM classification 2017) is 40%
C. The ipsilateral adrenal gland should be excised with the kidney when there is an upper pole renal tumour
D. 5-year cancer-specific survival rates are the same for tumour thrombus within the IVC below the diaphragm compared with invasion of the IVC wall by tumour thrombus
E. Extended regional lymph node dissection at the time of nephrectomy significantly increases cancer-specific survival

Correct Answer is B

Comment:

Answer B

The TNM 2017 staging classifies T3b as tumour grossly extending into the inferior vena cava below the diaphragm. The 5-year cancer-specific survival rates for T3b renal cell cancer is 40%. The ipsilateral adrenal gland should be removed when there is evidence on CT imaging of direct invasion of the adrenal gland by the renal cell cancer or a metastasis is present in the adrenal gland that appears solitary. Tumour thrombus invading the IVC wall portends a worse prognosis (T3c staging in 2017 classification) than tumour thrombus in the IVC lumen below the diaphragm (T3b staging in 2010 classification). Radical Excision of regional para-aortic lymph nodes has not been shown to significantly improve cancer specific survival.