From the Guidelines
The appropriate evaluation for intermittent right axillary lymph node swelling in a patient with newly diagnosed kidney cancer includes a thorough physical examination, complete medical history, and laboratory evaluation, but does not necessarily require a dedicated imaging study for the axillary lymph node swelling at this time. According to the NCCN clinical practice guidelines in oncology for kidney cancer, version 2.2017 1, the initial workup for kidney cancer should include a thorough physical examination and a complete medical history. The guidelines recommend laboratory evaluation, including a CBC count and comprehensive metabolic panel, as well as imaging studies such as CT of the abdomen with or without pelvic CT and chest radiograph to evaluate for metastatic disease 1. However, the guidelines do not specifically recommend imaging studies for axillary lymph node swelling unless there are symptoms or signs suggestive of metastatic disease. In this case, the patient's intermittent right axillary lymph node swelling may be monitored as part of their overall clinical evaluation, but it does not necessarily require a dedicated imaging study at this time. The patient's upcoming partial nephrectomy for kidney cancer and post-surgical follow-up with their urologist or primary care physician will provide opportunities to reassess the axillary lymph node swelling and determine if further evaluation is needed. Key considerations in the evaluation of kidney cancer include the use of abdominal imaging studies, such as CT or MRI, to evaluate the primary tumor and potential metastases, as well as the importance of classifying histologic subtypes and using the current TNM classification to guide treatment decisions 1. Ultimately, the evaluation and management of the patient's axillary lymph node swelling should be individualized based on their overall clinical presentation and the results of their initial workup for kidney cancer.
From the Research
Evaluation of Intermittent Right Axillary Lymph Node Swelling
- The evaluation of intermittent right axillary lymph node swelling in a patient with newly diagnosed kidney cancer requires careful consideration of various imaging modalities and their limitations.
- According to 2, PET/CT has proven helpful in the diagnosis and management of many cancers, but its value in renal cell carcinoma (RCC) is still evolving.
- In the context of lymph node evaluation, 3 suggests that PET/CT can provide additional information on distant metastasis and should be considered in the initial staging of certain cancers.
Imaging Modalities for Lymph Node Evaluation
- 4 compares the diagnostic performance of [(68)Ga]DOTATOC PET/CT and whole-body MRI in patients with neuroendocrine tumours, highlighting the importance of considering multiple imaging modalities for accurate staging.
- 5 evaluates the detection, characterization, and staging of suspected renal masses using triphasic helical CT and fast MRI, demonstrating the value of both modalities in renal lesion evaluation.
- 6 emphasizes the importance of close attention to both the PET and CT portions of a PET/CT study to evaluate the kidneys in oncology patients, particularly in cases of lymphoma, leukemia, or metastatic disease.
Considerations for Kidney Cancer Patients
- When evaluating intermittent right axillary lymph node swelling in a patient with newly diagnosed kidney cancer, it is essential to consider the potential for metastatic disease and the role of imaging modalities in staging and treatment planning.
- A comprehensive evaluation may involve multiple imaging modalities, including PET/CT, CT, and MRI, to accurately assess the extent of disease and guide treatment decisions.