Failure to Diagnose & Delay in Treatment of Kidney Cancer

Evaluate breaches in the standard of care evaluating a Failure to Diagnose & Delay in Treatment of Kidney Cancer

Answer the following questions to find out if the standard of care was followed for your case.

  • With which of the following symptoms did the patient present? (Choose all that apply)
    Blood in the urine (Hematuria)
    Pain in the sides of the mid back
    A lump in the abdomen or side of the back
    Loss of appetite
    Weight loss
    Pain in the back, side, or stomach
    None elicited
    Answer unknown
    Why is this important?
    The most common presenting symptoms are hematuria, abdominal mass, pain, and weight loss. Recently, fewer patients have the typical symptoms and there is an increased frequency of incidental diagnosis due to radiologic procedures performed for other reasons.
    (2004) 172 JNLURO 6P1 2167-2171

  • With which of the following risk factors did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Cigarette smoking and obesity are the most consistently established causal risk factors, accounting for about 20% and 30% of renal cell cancers, respectively.
    (2006) 176 JNLURO 6P1 2353-2358

  • With which of the following pre-existing renal conditions did the patient present? (Choose all that apply) Why is this important?
    Answer this question
    Patient’s with pre-existing renal disorders are more prone to develop kidney cancer than those without renal disorders.
    (2006) 176 JNLURO 6P1 2353-2358

  • Was periodic screening performed for patients prone to kidney cancer? Why is this important?
    Answer this question
    Since kidney cancer is more prone to occur in people with predisposing medical histories, it is necessary to perform periodic screenings for evaluation.
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  • Was a physical examination performed? Why is this important?
    Answer this question
    The classic triad of kidney cancer (flank pain, hematuria, and a palpable abdominal renal mass) occurs in only 9% of patients, when present, it strongly suggests locally advanced disease.
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  • Which of the following laboratory investigations were performed? (Choose all that apply) Why is this important?
    Answer this question
    Laboratory testing may be significant in suggesting the presence of disseminated disease. Equally important, it serves to establish the patient’s baseline renal function.
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  • Which of the following imaging studies were performed? (Choose all that apply) Why is this important?
    Answer this question
    An abdominal/pelvic CT is the optimal imaging modality to evaluate the kidneys and must be performed using multi-phase imaging, with and without intravenous contrast.
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  • Were imaging studies performed to rule out metastasis? Why is this important?
    Answer this question
    Besides abdominal imaging, additional studies to assess for metastases or to quantitatively measure renal split function are of benefit.
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  • Which of the following types was the tumor diagnosed as? Why is this important?
    Answer this question
    Although a solid, well-circumscribed enhancing renal mass is the most common appearance suggestive of kidney cancer, other renal abnormalities may be found.
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  • Did the clinician classify the renal cyst? Why is this important?
    Answer this question
    A useful classification scheme has been devised primarily based on CT imaging criteria that divides renal cystic lesions into categories that are distinct from one another in terms of the likelihood of malignancy.
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  • Were guidelines for follow-up evaluations given to the patient? Why is this important?
    Answer this question
    Careful surveillance following surgical resection is important to permit early diagnosis of recurrence.
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  • Did the clinician perform tumor staging? Why is this important?
    Answer this question
    Renal carcinomas can grow locally into very large masses and invade through surrounding fascia into adjacent organs. The most common sites of metastases are the regional lymphatics, lungs, bone, liver, brain, ipsilateral adrenal gland and contralateral kidney.
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  • Was surgical resection performed? Why is this important?
    Answer this question
    The mainstay of treatment of primary renal cell carcinoma is surgical excision or nephrectomy. Nephrectomy represents the only proven curative modality.
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