ca

Size: px

Start display at page:

Download "ca"

희지 구
6 years ago
Views:

1 Towards Global Eminence Renal Cancer Kidney Transplant JIA LEE College of Nursing Science Kyung Hee University 1

2 Contents Kidney Cancer Risk factor Symptom Diagnosis Treatment Nursing Kidney Transplantation Source of Kidney Compatibility Pre-op Operation Rejection 2

3 Kidney Cancer 3

4 Kidney cancer Most frequent: Renal cell cancer (adenocarcinoma) yrs M > F # Metastasis: lungs, liver, lymph nodes, bones 4

5 Risk factors Smoking Obesity High blood pressure Long-term dialysis Occupation: steel industry (asbestos, cadmium, gasoline) Gender: M > F 5

6 Symptoms Early Weight loss Fatigue Anemia Typical Blood in the urine (Hematuria) Pain in the side A lump or mass in the side or the abdomen 6

7 Diagnosis Physical exam: fever, HTN, mass Urine test: blood Blood test: Creatinine IVP: tumor CT scan: tumor Ultrasound test: tumor Biopsy: cancer cell Surgery: final diagnosis 7

8 Stage Stage I: 7cm, only in the kidney Stage II: >7cm, only in the kidney Stage III: lymph node, adrenal gland, but not beyond fibrous tissue Stage IV: Beyond fibrous tissue, lung 8

9 AJCC (TNM) staging system T indicates the size of the main (primary) tumor and whether it has grown into nearby areas. N describes the extent of spread to nearby (regional) lymph nodes. Lymph nodes are small bean-shaped collections of immune system cells that are important in fighting infections. M indicates whether the cancer has spread (metastasized) to other organs of the body. (The most common sites of spread are to the lungs, bones, liver, and distant lymph nodes.) 9

10 AJCC (TNM) staging system T indicates the size of the main (primary) tumor and whether it has grown into nearby areas. N describes the extent of spread to nearby (regional) lymph nodes. Lymph nodes are small bean-shaped collections of immune system cells that are important in fighting infections. M indicates whether the cancer has spread (metastasized) to other organs of the body. (The most common sites of spread are to the lungs, bones, liver, and distant lymph nodes.) 10

11 AJCC (TNM) staging system TX: The primary tumor cannot be assessed (information not available). T0: No evidence of a primary tumor. T1: The tumor is only in the kidney and is 7 cm (a little less than 3 inches) or less across: T1a: 4 cm or smaller, T1b: larger than 4 cm T2: The tumor is larger than 7 cm across but is still only in the kidney: T2a: not more than 10 cm, T2b: more than 10 cm T3: The tumor is growing into a major vein or into tissue around the kidney, but it is not growing into the adrenal gland (on top of the kidney) or beyond Gerota's fascia (the fibrous layer that surrounds the kidney and nearby fatty tissue): T3a: main vein or into fatty tissue, T3b: large vein (vena cava), T3c: vena cava within the chest or the wall of that blood vessel (the vena cava). T4: The tumor has spread beyond Gerota's fascia (fibrous layer that surrounds the kidney and nearby fatty tissue). The tumor may have grown into the adrenal gland (on top of the kidney). 11

12 AJCC (TNM) staging system NX: Regional (nearby) lymph nodes cannot be assessed (information not available). N0: No spread to nearby lymph nodes. N1: Tumor has spread to nearby lymph nodes. M0: There is no spread to distant lymph nodes or other organs. M1: Distant metastasis is present; includes spread to distant lymph nodes and/or to other organs. Kidney cancer most often spreads to the lungs, bones, liver, or brain. 12

13 Treatment Surgery: nephrectomy Arterial embolization Radiation therapy: 5 days a week for several weeks Biological therapy: interferon alpha, interleukin-2 Chemotherapy 13

14 14

15 Nursing Post-op monitoring: pain, fatigue, urine amount, bleeding, infection Arterial embolization: back pain, fever, nausea, vomiting Radiation therapy: fatigue, skin (red, dry, tender) Biological therapy: flu-like symptoms Chemotherapy: Infection, bruise, tired, hair loss, nausea, vomiting, diarrhea Nutrition: poor appetite, nausea, vomiting 15

16 정리하기 신장암의가장흔한유형 신장암의위험요인 신장암의증상 - 초기증상 - 전형적인증상 16

17 Kidney Transplant 17

18 18

19 Kidney Transplant Survival rate Living donor: 5-year survival : 85~90% Deceased: 5-year survival : 75~85% Costs Donor: Tests + Operation = 약 500만원 Recipient: Tests(200)+ Operation(800) = 약1,000만원 Total = 약 1,500만원 19

20 Source of Kidneys Donors Living donors Deceased donors (brain-death, cardiac death) 국립장기이식관리센터 (KONOS)Korean Network for Organ Sharing 20

21 Compatibility ABO blood group compatible Histocompatibility 21

22 ABO blood types Patient Donor O O A O, A B O, B AB O, A, B, AB 22

23 Human Lymphocyte Antigen (HLA) 면역체계에서 HLA를통해 self cell과 non-self cell구별 백혈구항원 (HLA) 조직형을검사하여공여자면역세포에대한수혜자에서의항체형성여부검사하여수술후거부반응방지 23

24 Human Lymphocyte Antigen (HLA) The HLA region is divided into classes I, II, and III. The locations of specific HLA loci for the DR, B, C, E, and A alleles are shown, as well as the tumor necrosis factor (TNF) gene location. Further amplification of the class III region shows the location of the CYP-21A pseudogene and the CYP-21B gene in relation to the two C4 loci, the Bf gene, and the C2 gene. (CYP-21, 21-hydroxylation) 24

25 Pre-op Care Pathway 수술 3 일전수술 2 일전수술 1 일전수술당일 격리요법시작 격리요법계속 격리요법계속 활력증상정상상태 ( 방소독, 베타 면역억제제투여 면역억제제투여 로수술실보냄 딘목욕 ) 빈혈, 고혈압, 전해 저녁식사후관장 수술실로보낸후병 질불균형조절 실시 실소독과준비 자정부터금식 수술전교육 수술용물품및약 품준비 25

26 Kidney Transplant 26

27 Operation 공여자의신장하나를떼어수혜자의우측장골와 (right iliac fossa) 내에이식 신혈관을수혜자의장골혈관에문합 동-정맥연결후요관을수혜자의방광에연결 일반적으로환자의본래신장은제거하지않음 27

28 Post-op Care Recovery to normal function: Living donor:3-5 days, cadava:7-15 days Immunosuppressive: tacrolimus, mycophenolate, prednisone Infection control Monitoring for rejection: fever, urine amount, body weight, Bp 28

29 Transplant rejection 형태이식후발생시기임상증상치료 초급성 수분내지 수시간이내 수술도중나타남 소변량이갑자기감소됨 없음 불가역적이므로곧제거함 급성 수일내지수개월 신장기능이갑자기악화됨 발열, 이식신장부위통증 스테로이드나단일항체면역억제제로치료가능 신장기능이점차 없음 만성 수개월내지수년 악화됨 단백뇨 불가역적 29

30 Kidney Transplant Operation 30

31 정리하기 신장이식수술전검사 신장이식후거부반응증상 31

32 문제 44 회 신장이식후주의해서관찰할내용중가장중요한것은? 1) 소변량감소 2) 요정체 3) 감염 4) 통증 5) 마비성장폐색 32

33 문제 43 회 신장공여자로서의적절성여부를결정하기위해고려해야할조건으로옳은것은? 가. 혈액형다. HLA 나. 혈색소라. 혈장내포타슘수준 1) 가, 나, 다 2) 가, 다 3) 나, 라 4) 라 5) 가, 나, 다, 라 33

34 34

김범수

김범수 Analysis of Outcomes after Resection of Sarcomatous Hepatocellular Carcinoma Purpose: Sarcomatous hepatocellular carcinoma (HCC) is rare. Therefore, the clinicopathologic characteristics and prognosis