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When curative care must transition to end-of-life care for a patient with renal cell carcinoma.

Article Excerpt
BKB was a 53-year-old female who presented to her primary care physician (PCP) with a 3 to 4-month history of intermittent left flank and abdominal pain. Generally, she felt well, was involved in all activities of daily living, and remained employed full time as an insurance agent, although she did complain of increased fatigue more frequently. She had been happily married to her husband--her first marriage--for five years. Having had extremely poor visual acuity since childhood, she was preoccupied for several weeks with bilateral lens implants and corrective ophthamalogy surgery. On June 29, 2008, she was diagnosed with advanced renal cell carcinoma. After further laboratory work-up, ultrasound, magnetic resonance imaging, and renal biopsy, the final diagnosis was Stage 4 renal adenocarcinoma. The tumor wrapped around her left renal vein and extended toward the diaphragm, with the tumor circumventing the aorta. There was no metastasis to the liver, lung, bone, or brain. Her eGFR was greater than 60%, and her hemoglobin and hematocrit levels were slightly low at 12 gm and 36%, respectively. Although she had ceased smoking, she had a history of cigarette smoking for at least three decades.

Anticipated Outcomes

* The patient will receive aggressive chemotherapy and/or radiology therapy with the goal of halting the tumor growth and shrinking the existing tumor.

* With...

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