text: Primary renal cell carcinoma has had a slight increase in annual incidence. This is due to incidental detection with the more frequent use of ultrasound and CT imaging modalities. Often the kidney cancer is picked up at an earlier and smaller stage, where the tumour may be 2-4cm and well localised to the kidney. It is becoming less common to detect very large locally advanced or metastatic renal cell carcinoma.
  Larger kidney cancers, well above 8-10cm, can locally invade adjacent structures, or send a tongue of tumour into the renal vein and inferior vena cava. This requires a complex open operative approach. The smaller organ-confined cancers are best dealt with by way of partial nephrectomy, where the kidney cancer, along with a rim of normal healthy surrounding kidney is removed and the defect is sewn up in several layers.
  Robotic partial nephrectomy is ideal for cancers up to 4cm in diameter, in certain positions within the kidney, that are amenable, in terms of ease of access during dissection.
  It is important to persist with nephron sparing approaches where possible, especially in patients with higher risks of chronic kidney disease, which mostly relates to those with hypertension or diabetes.
  Convalescence using the robotic key hole approach is more rapid with less post operative analgesic requirements than the open approach. Certain central endophytic tumours are not amenable to robotic partial nephrectomy.
  Referral to a medical oncologist may be required for advanced renal cell carcinoma, where there are metastases and a Tyrosine-kinase receptor inhibitor or other molecular targeted therapies may be required. Their administration and management of side effects is best left with the oncologist.
  Cystic lesions of the kidney are classified based on the Bosniak scoring system and cysts that are simply fluid filled with no irregularities are watched. Renal cysts are common and certain cysts containing enhancing septations or nodularity or soft tissue, may require surgical excision.
  In general, it is thought that 70% of kidney tumours detected on ultrasound or CT are malignant renal cell carcinomas, a small proportion of them may be rarer malignancies, such as lymphoma, sarcoma or a metastasis to the kidney from elsewhere. 20-30% of renal tumours are benign. Renal tumour biopsy by way of image guided core needle or fine needle biopsies can be performed by an interventional radiologist for histopathologic confirmation of the type of tumour and its grade. This helps in decision making and allocates suitability to an active surveillance program.
  In the elderly co-morbid age group, smaller renal tumours, even if they are malignant, can be watched by way of active surveillance, however renal tumour biopsy is preferable.
  Biopsy requires that all blood thinners are temporarily withheld. Radiofrequency ablation (RFA) or cryotherapy, are less invasive methods to either cauterise or freeze a renal tumour and have medium term oncologic efficacy rates of approximately 90-95%, in terms of cancer clearance.
  Minimalist layout and focus on main contents, it may helps freelancers & photographers, who are looking for inspirations for their personal site.
  In my introductory post to my Love-e-logue, I mentioned the intuitive reading with Alisabeth Shelman from The Cosmic Womb. Before we started, Alise asked me what my intention was or what I hoped to gain from the reading. I told her I wanted to unblock my heart chakra.
  Every time I did any chakra meditations I would always experience ice cold when I got to my heart. Literally, I could place my hand over my heart and feel ice. I had no idea why, because I don’t consider myself to be a heartless person by any stretch of the imagination. Yet I even had several energy workers tell me my heart chakra was blocked!
  Within short order, she told me I struggled greatly with being human. That I would much rather dwell in pure energy than function as flesh and blood. Whether you believe in the esoteric or not, at the very least this was a powerful metaphor for me. All my life I have focused on imagination and creation, as opposed to interaction and engagement. In short, accomplishments over relationships.
  At the end of my life, do I want my tombstone to read “she accomplished a lot” or “she cared deeply”?
  Then it occurred to me — and yes, I am slow on the uptake — relationships ARE the ultimate act of creation.
  Posted on November 18, 2017 by Eliza Fayle •	This entry was posted in Blog and tagged Personal. Bookmark the permalink.
  Just before Christmas, Hubby announced that he needed to take charge of his health. Part of this came from his entire wardrobe being too small. It also came from him stepping on the scales and completely freaking out at the number that glowed up at him.
  Several of our family, friends and acquaintances were on the Keto Diet and experiencing fantastic health benefits; weight loss being one of them. Hubby did some research and asked me if I would like to eat this way.
  Posted on January 26, 2018 by Eliza Fayle •	This entry was posted in Blog and tagged Personal. Bookmark the permalink.