Renal Cell Carcinoma

with Hepatic Metastasis

IntroductionUnderlying Disease:

Renal Cell Carcinoma- Most common type of cancer- Carcinoma “Karkinos” meaning crab forming cancer.

Secondary Disease:

-Hepatic Metastasis-Pneumonia-Severe Fatty Liver

IntroductionEtiology:

Smoking Obesity Hypertension

Pathophysiology:

2 forms of RCC

Hereditary Sporadic

Methodology

Patient Finding

Gathering of Data

Analysis and Interpretation

Evaluation and Implication

Recommendation

SubjectiveCase: RCC with Hepatic MetastasisSubject: Mr. Levi O. FernandezAge: 58 yrs. oldCivil Status: Married, with 3 sonsOccupation: Former Electrical

Engineer in Japan

Subjective Prior to his diagnosis, he experiences

difficulty in urinating, fever, malaise, night sweats and hypertension.

He loves eating salty foods, softdrinks and sweets.

The foods he doesn’t like are pork and alcoholic beverages in relation to his religion as an Adventist.

Objective

Table 1. Quantitative analysis of his 24-hour food recall

Meal No. of

exchanges

CHO (g) PRO (g) FATS (g) ENERGY

(kcal)

Rice 10 230 20 - 1000

Meat          

Low fat 1 - 8 1 41

Medium fat 1 - 8 6 86

Veg. A 2 3 - - 6

Coffee (free

food)

3 - - - -

TOTAL - 233 36 7 1133

Objective Nutrient Adequacy = Actual Nutrient Intake/Recommended Nutrient Intake *100

Protein = 36/60(100) = 60%

Energy = 1133/2320(100)= 49%

ObjectiveFood group Recommended

servings

Actual intake Variance

grains 6-11 6 0-5

vegetables 3-5 2 1-3

fruits 2-4 0 2-4

dairy 2-3 0 2-3

Meat/poultry/fish 2-3 2 0-1

Fats, oils and

sweets

Use sparingly 5 -

Table 2. Qualitative analysis of his 24-hour food recall

Assessment Anthropometric

Patient’s Height and Weight

Pt. Ht. = 5’7= 67 inches= 67 inches x 2.54 cm= 170.18 cm or 1.70 m

Pt. Wt. = 73 kg

AssessmentDesirable Body Weight

DBW = 170.18- 100 = 70.18= 70.18-7.018 (10% of 70.18)=63.162 or 63 kg

AssessmentBody Mass Index

BMI = wt. (kg)/ ht. (m)²= 73 kg/ 2.9= 25.21

AssessmentTotal Energy Allowance

TEA = Activity x DBW= 35.0 (light) x 63 kg= 2205 kcal

Assessment Biochemical

Clinical Chemistry Laboratory Findings/Result Reference Range Implication

- LDL Cholesterol 4.41 <4.07 HIGH

- Creatinine 135.2 umol/L 53.0-115.0 HIGH

- CHOLE-HDL Ratio 8.28 <4.40 HIGH

Table 3. Significant Laboratory Findings on Blood Chemistry

HEMATOLOGY Laboratory Findings/Result Reference Range Implication

WBC COUNT 12.20 10^9/L 5.0-10.0 HIGH

Segmenters 0.83% 0.45-0.65 HIGH

Lymphocytes 0.17% 0.20-0.35 LOW

Table 4. Significant Laboratory Findings on Hematology

Urinalysis Laboratory Findings/Result Reference Range Implication

Physical examination      

- Color Brown red Yellow  

- Transparency cloudy Clear  

- Reaction Acidic   ACIDIC

Chemical Examination      

- Nitrite Positive NEGATIVE BACTERIURIA

Table 5. Significant Laboratory Findings on Urinalysis

Sonography:

Radiological Test:

Final Histophatologic Diagnosis

 

Kidney, Radical nephrectomy (left):

RENAL CELL CARCINOMA, CLEAR CELL TYPE, FUHRMAN GRADE 2,

8.4 CM IN WIDEST TUMOR DIMENSION.

RENAL CAPSULAR INVASION AND LYMPHOVASCULAR SPACE

INVASION ARE PRESENT.

 

  

Plan Diet Rx: 2520kcal; C445; P38; F792000 mg Na1600 mg K (41 mEq)500 mg P (39 mEq)1200 Ca(60 mEq)1500 ml fluidHBV - 2/3 (25.2)LBV - 1/3 (12.6)

Food group # of

exchanges

Pro Na K Ca P Fluid Cho Fat

Milk

A.powder

½ 4 80 200 180 125 0.3 6 5

Meat ¾ 26 - - - - - - -

Lean Meat

(V-A)

1 - 30 200 15 70 31.0 - 1

Fish

(V-A)

1 ½ - 45 300 22.5 105 46.5 - 1.5

Egg (V-C) ¾ - 82.5 71.25 37.5 86 33.75 - 4.5

Total - 30 237.5 771.25 255 386 111.55 6 12

Food group # of

exchanges

Pro Na K Ca P Fluid Cho Fat

Veg. B1 2 0.6 16 220 60 20 60 3 -

Rice 6 12 - - - - - 118 -

A 4 - 8 240 60 140 300 - -

B 1 - 230 60 20 35 10 - -

Total - 12.6 254 1520 140 195 370 121 -

Total 3 & 4 - 42.6 492 1292 395 581 482 127 12

Food group # of

exchanges

Pro Na K Ca P Fluid Cho Fat

Fruits 3 0 - - - - - - -

A 2 0.8 6 240 20 20 95 20 -

B 1 0.2 2 60 5 5 42 10 -

Sugar 63.6 - - - - - - 384 -

Total - 1.0 8 300 25 25 137 414 -

445 (prescribed)127 (milk and vegetable and rice)318 /5 = 63.6 or 64

Food group # of

exchanges

Pro Na K Ca P Fluid Cho Fat

Fat - - - - - - - - -

A 8 0.5 320 16.0 8.0 8.0 8.0 - 4.0

B ½ - 9 22.0 4.0 10.0 9.0 - 2.5

Free foods 4 - - - - - - - 20

Total 3,4,5

and 6

  44.1 829 1630 432 624 636 541 74.5

Fat milk 5 Meat 12

17 – 79 = 62 / 5 = 12.4 or 12

Fluid rx = 1500 ml Inherent 636 ml

864 ml (additional oral fluid)

Na rx = 2000 mg/day Inherent 829 mg

1171 mg/day (additional oral)

1200 – 432 = 768 = 1 tablet

InterventionMedical  Omeprazole, to maintain healing of erosive esophagitis

Vit. B complex, to treatment To Prevent Vitamin Deficiency Medications

Inherited Disease Marked by Excretion of Sulfur in Urine Medications

Paracetamol, Taken as required for relief of mild-to-moderate pain or fever.

Clonidine, treat high blood pressure

Tramadol, treat moderate to severe pain

Tranexamic acid, used to control unwanted bleeding

Ceftriaxone, given before certain types of surgery to prevent infections that may develop after the operation

Centrum silver , For Multivitamins and minerals deficiency Neobloc, H TN & chronic angina pectoris. 

InterventionDiet

Maintain A Healthy Body Weight Eating more vegetables and fruit  Potassium and sodium restriction fluid Low calorie diet

Evaluation To check if the patient will follow the

dietary plan, there should be a regular visit and report about the progress of his condition. Regular checkup in his physician is also recommended to have an update about his health status.

The End.