Date:
Patient:
Reason for Visit:
Follow-up for renal cell carcinoma (RCC)
Assessment of treatment response or disease progression
Evaluation for symptoms or complications
Management plan discussion
History:
Presenting Illness:
Date of initial RCC diagnosis
Stage and Fuhrman grade of RCC on initial diagnosis
Presenting symptoms (e.g., hematuria, flank pain, fatigue, weight loss)
Current symptoms and any changes since last visit
Past Medical History (PMH):
Underlying medical conditions (e.g., hypertension, chronic kidney disease)
Prior surgeries or treatments for RCC (e.g., nephrectomy, targeted therapy, immunotherapy)
Family History:
History of RCC or other cancers in first-degree relatives
Social History:
Smoking history (major risk factor)
Physical Exam:
General: Assess for signs of fatigue, weight loss, or abdominal masses.
Abdominal: Palpate for flank masses or tenderness.
Blood Pressure: Evaluate for hypertension (a potential complication).
Diagnostic Tests (may be ordered depending on clinical presentation):
Laboratory Tests:
Complete blood count (CBC) – May show anemia with advanced disease.
Kidney function tests – Assess kidney function and potential impact of RCC or treatment.
Liver function tests – Monitor for potential medication side effects.
Tumor markers (e.g., CA-IX) – Not diagnostic but may be used to monitor response to therapy in some cases.
Imaging Studies:
Chest X-ray – Evaluate for signs of lung metastases.
CT scan with contrast – Assess primary tumor size, spread to lymph nodes, and other organs.
Bone scan (may be used in some cases) – Evaluate for bone metastases.
Assessment:
Disease status: Based on imaging studies, consider response to treatment (reduction in tumor size), stable disease, or progression of RCC.
Presence of symptoms: Evaluate for new or worsening symptoms suggestive of RCC progression or complications.
Management plan:
Active surveillance: For patients with small, localized RCC and no symptoms, especially if elderly or with other health conditions.
Further treatment: Options depend on stage, grade, and overall health. May include surgery (nephrectomy or partial nephrectomy), targeted therapy, immunotherapy, or radiation therapy.
Palliative care: To manage symptoms and improve quality of life in advanced stages.
Plan:
Management approach based on assessment:
Continue current treatment plan if responding well.
Consider referral to a medical oncologist or urologic oncologist for discussion of treatment options if progression is identified.
Schedule imaging studies at defined intervals to monitor disease status.
Management of symptoms: Pain medication, anti-emetics (for nausea), or other supportive measures as needed.
Blood pressure control: Important for overall health and may reduce risk of complications.
Patient education: Provide information about RCC, stage, and treatment options in a clear and understandable manner.
Discuss potential side effects of treatment and the importance of reporting any new symptoms promptly.
Address the patient’s emotional well-being and offer support resources.
Follow-up:
Schedule for follow-up appointments based on disease status:
More frequent visits for patients on active treatment or with advanced RCC.
Less frequent visits for patients with stable disease on active surveillance.
Emphasize the importance of attending all scheduled appointments and reporting any new symptoms promptly.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of renal cell carcinoma