Diagnosis and Management of Localized, Locally Advanced and Advanced Kidney Cancer Webcast (2020)
Kidney cancer is not a single disease, it is made up of a number of different types of cancer, each with a different histology, a different clinical course, responding differently to therapy and caused by different genes. After completing this course, attendees be able to describe the different types of kidney cancer and the genes that cause each. They will learn how to identify the different types of inherited versus sporadic forms of kidney cancer. They will differentiate between indolent and slow growing tumors, such as clear cell RCC, type 1 papillary RCC and chromophobe RCC, and more aggressive tumors, such as type 2 papillary RCC and TFE3 RCC which can infiltrate into the renal parenchyma and have a propensity to spread when the tumors are small. Attendees will apply this knowledge to decide between active surveillance and surgical intervention and when to utilize renal tumor biopsy. Attendees will integrate knowledge of tumor biology to choose between minimally invasive surgical enucleation techniques for indolent cancers versus open surgical approach with wide margins for aggressive forms of RCC.
Attendees will learn how to perform open and minimally invasive partial nephrectomy. Laparoscopic and robotic port placement will be reviewed as well as the role of retroperitoneal surgery in the management of posterior renal tumors. Critical surgical techniques such as hilar exposure and recommendations about when and how to clamp the hilum, appropriate warm and cold ischemia guidelines and the use kidney cooling will be reviewed. The critical role of intraoperative ultrasound in patients undergoing open as well as minimally invasive partial nephrectomy will be discussed. New surgical techniques for stopping bleeding and safely closing the renal cortex after removal of multiple renal tumors will be discussed. Surgical approaches for re-operative surgery in patients with recurrent, multiple renal tumors will be reviewed. The critical role of intraoperative resuscitation of patients who have undergone significant blood loss will also be discussed.
Attendees will learn approaches for management of patients with large renal tumors involving the renal vein and vena cava, how to safely get exposure and management of vascular structures and when to involve vascular surgery and potentially cardiopulmonary bypass in tumors that extend above the portal vein. Discussion of when to perform lymph node removal and the surgical techniques for ipsilateral, aorto-caval and contralateral nodal dissection will be conducted.
There have been significant advances in the systemic therapeutic approaches with targeted therapies and immunotherapies for patients with locally advanced and advanced forms of renal cell carcinoma. The most recent immunotherapy and targeted therapies will be discussed for patients with both clear and non-clear cell RCC, including agents such as nivolumab, ipilimumab, cabozantinib and pazopanib in combination and as single agents. The role of surgery in patients with advanced RCC with the primary kidney tumor in place will be discussed, i.e., when to recommend cytoreductive nephrectomy and when to recommend immediate systemic therapy. Recent findings in the role of adjuvant or neo-adjuvant therapy in patients with locally advanced RCC will be discussed.
Support provided by independent educational grants from:
- Bristol-Myers Squibb
- Pfizer, Inc.
- Sanofi Genzyme
- Advanced Practice Providers (Nurse Practitioners & Physician Assistants)
After completing this activity, participants will be able to:
- Differentiate among the subtypes of kidney cancer, with emphasis on clinical management decisions and outline ways in which knowledge of kidney cancer subtypes can alter surgical approach.
- Apply advanced strategies for partial nephrectomy for patients with endophytic, hilar and multiple tumors including role of warm ischemia, intraoperative ultrasound, techniques for hemostatic control, the role of off-clamp and selective hilar clamping, the use of the retroperitoneal approach, and methods for renorrhaphy.
- Describe techniques for management of large and/or locally advanced tumors including management of renal vein or inferior vena cava invasion and the use of lymphadenectomy.
- Identify the role of cytoreductive nephrectomy and/or resection of metastatic foci in patients with advanced disease.
- Describe new and emerging targeted therapy and immuno-oncology options for patients with locally-advanced and advanced kidney cancer and the role of adjuvant therapy.
Education Council Disclosures
AUA Office of Education Staff has nothing to disclose.
METHOD OF PARTICIPATION:
Learners will participate in this online educational activity by taking the pretest, viewing the webcast and completing the posttest and evaluation. To claim CME credit for this enduring material, learners must complete the posttest, passing with 80% accuracy and submit the program evaluation.
Estimated time to complete this activity: 1.50 hours
Release Date: July, 2020
Expiration Date: July, 2021
The American Urological Association (AUA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The American Urological Association designates this enduring material for a maximum of 1.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The AUA is not accredited to offer credit to participants who are not MDs or DOs. However, the AUA will issue documentation of participation that states that the activity was certified for AMA PRA Category 1 Credit™.
EVIDENCE BASED CONTENT:
It is the policy of the AUA to ensure that the content contained in this CME activity is valid, fair, balanced, scientifically rigorous, and free of commercial bias.
AUA DISCLOSURE POLICY:
All persons in a position to control the content of an educational activity (i.e., activity planners, presenters, authors) are required to disclose to the provider any relevant financial relationships with any commercial interest. The AUA must determine if the individual’s relationships may influence the educational content and resolve any conflicts of interest prior to the commencement of the educational activity. The intent of this disclosure is not to prevent individuals with relevant financial relationships from participating, but rather to provide learners information with which they can make their own judgments.
RESOLUTION OF IDENTIFIED CONFLICT OF INTEREST:
All disclosures will be reviewed by the program/course directors or editors for identification of conflicts of interest. Peer reviewers, working with the program directors and/or editors, will document the mechanism(s) for management and resolution of the conflict of interest and final approval of the activity will be documented prior to implementation. Any of the mechanisms below can/will be used to resolve conflict of interest:
- Peer review for valid, evidence-based content of all materials associated with an educational activity by the course/program director, editor, and/or Education Content Review Committee or its subgroup.
- Limit content to evidence with no recommendations
- Introduction of a debate format with an unbiased moderator (point-counterpoint)
- Inclusion of moderated panel discussion
- Publication of a parallel or rebuttal article for an article that is felt to be biased
- Limit equipment representatives to providing logistics and operation support only in procedural demonstrations
- Divestiture of the relationship by faculty
OFF-LABEL OR UNAPPROVED USE OF DRUGS OR DEVICES:
The audience is advised that this continuing medical education activity may contain reference(s) to off-label or unapproved uses of drugs or devices. Please consult the prescribing information for full disclosure of approved uses.
- 1.50 AMA PRA Category 1 Credit™
- 1.50 Non-Physician Participation