My Flight Surgeon
Sr. Aviation Medical Examiner
This is another in the series of condition for which the FAA grants Special Issuance certificates.
As with all other conditions, the FAA will want to review the entire medical record. Your AME or www.faaspecialissuance.com can assist you in preparing your records for submission.
The topic today is Renal Carcinoma (Cancer of the Kidney).
[FONT="]Alternative names[/FONT]
[FONT="]Renal cancer; Kidney cancer; Hypernephroma; Adenocarcinoma of renal cells; Cancer - kidney [/FONT]
[FONT="]Definition[/FONT]
[FONT="]Renal cell carcinoma is a type of kidney cancer. The cancerous cells are found in the lining of very small tubes (tubules) in the kidney. It is the most common type of kidney cancer in adults.[/FONT]
[FONT="]Causes, incidence, and risk factors[/FONT]
[FONT="]Renal cell carcinoma affects about 3 in 10,000 people, resulting in about 32,000 new cases in the US per year. Every year, about 12,000 people in the US die from renal cell carcinoma. It occurs is most common in people between 50 and 70 years of age, and typically affects men.[/FONT]
[FONT="]The exact cause is unknown.[/FONT]
[FONT="]Risk factors include:[/FONT]
[FONT="]Symptoms[/FONT]
[FONT="]Palpation of the abdomen may show a mass or organ enlargement, particularly of the kidney or liver. [/FONT]
[FONT="]Surgical removal of all or part of the kidney (nephrectomy) is recommended. This may include removal of the bladder or surrounding tissues or lymph nodes.[/FONT]
[FONT="]Radiation therapy does not usually work for renal cell carcinoma and, therefore, is not often used. Hormone treatments may reduce the growth of the tumor in some cases.[/FONT]
[FONT="]Medications such as alpha-interferon and interleukin have been successful in reducing the growth of some renal cell carcinomas, including some that have spread. In December 2005, the US Food and Drug Administration approved a new type of drug called Nexavar for adults with advanced renal cell carcinoma. The drug works by blocking a tumor's blood supply.[/FONT]
[FONT="]Chemotherapy may be used in some cases, but cure is unlikely unless all the cancer is removed with surgery.[/FONT]
[FONT="]Expectations (prognosis)[/FONT]
[FONT="]The outcome varies depending on the degree of metastasis. The 5-year survival rate is around 60 - 75% if the tumor is in the early stages and has not spread outside the kidney. If it has metastasized to the lymph nodes, the 5-year survival is around 5 - 15%. If it has spread to other organs, the 5-year survival at less than 5%.[/FONT]
[FONT="]Complications[/FONT]
AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations
(14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first time issuance of an Authorization for the above disease/condition, and the applicant has all of the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or Regional Flight Surgeon for the initial determination.
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: [/FONT]
As with all other conditions, the FAA will want to review the entire medical record. Your AME or www.faaspecialissuance.com can assist you in preparing your records for submission.
The topic today is Renal Carcinoma (Cancer of the Kidney).
[FONT="]Alternative names[/FONT]
[FONT="]Renal cancer; Kidney cancer; Hypernephroma; Adenocarcinoma of renal cells; Cancer - kidney [/FONT]
[FONT="]Definition[/FONT]
[FONT="]Renal cell carcinoma is a type of kidney cancer. The cancerous cells are found in the lining of very small tubes (tubules) in the kidney. It is the most common type of kidney cancer in adults.[/FONT]
[FONT="]Causes, incidence, and risk factors[/FONT]
[FONT="]Renal cell carcinoma affects about 3 in 10,000 people, resulting in about 32,000 new cases in the US per year. Every year, about 12,000 people in the US die from renal cell carcinoma. It occurs is most common in people between 50 and 70 years of age, and typically affects men.[/FONT]
[FONT="]The exact cause is unknown.[/FONT]
[FONT="]Risk factors include:[/FONT]
- [FONT="]Smoking[/FONT]
- [FONT="]Genetics[/FONT]
- [FONT="]Family history of the disease[/FONT]
- [FONT="]Dialysis treatment[/FONT]
- [FONT="]von Hippel-Lindau disease, a hereditary disease that affects the capillaries of the brain[/FONT]
[FONT="]Symptoms[/FONT]
- [FONT="]Blood in the urine[/FONT]
- [FONT="]Abnormal color to the urine(dark, rusty, or brown) [/FONT]
- [FONT="]Flank pain[/FONT]
- [FONT="]Back pain[/FONT]
- [FONT="]Abdominal pain[/FONT]
- [FONT="]Unintentional weight loss of more than 5% of body weight [/FONT]
- [FONT="]Emaciated, thin, malnourished appearance [/FONT]
- [FONT="]Enlargement of one testicle [/FONT]
- [FONT="]Swelling or enlargement of the abdomen[/FONT]
[FONT="]Palpation of the abdomen may show a mass or organ enlargement, particularly of the kidney or liver. [/FONT]
- [FONT="]Complete blood count [/FONT]
- [FONT="]Urine test may show red blood cells[/FONT]
- [FONT="]Serum calcium levels may be high[/FONT]
- [FONT="]SGPT (ALT) and alkaline phosphatase may be high[/FONT]
- [FONT="]A urine cytology[/FONT]
- [FONT="]Liver function tests[/FONT]
- [FONT="]An ultrasound of the abdomen and kidney [/FONT]
- [FONT="]Kidney x-ray [/FONT]
- [FONT="]IVP[/FONT]
- [FONT="]Renal arteriography[/FONT]
- [FONT="]An abdominal CT scan may show a liver mass.[/FONT]
- [FONT="]Abdominal MRI can determine if the cancer has spread to any surrounding blood vessels and whether it can be surgically removed.[/FONT]
- [FONT="]A chest x-ray may show mass in the chest.[/FONT]
- [FONT="]A bone scan may show involvement of the bones.[/FONT]
[FONT="]Surgical removal of all or part of the kidney (nephrectomy) is recommended. This may include removal of the bladder or surrounding tissues or lymph nodes.[/FONT]
[FONT="]Radiation therapy does not usually work for renal cell carcinoma and, therefore, is not often used. Hormone treatments may reduce the growth of the tumor in some cases.[/FONT]
[FONT="]Medications such as alpha-interferon and interleukin have been successful in reducing the growth of some renal cell carcinomas, including some that have spread. In December 2005, the US Food and Drug Administration approved a new type of drug called Nexavar for adults with advanced renal cell carcinoma. The drug works by blocking a tumor's blood supply.[/FONT]
[FONT="]Chemotherapy may be used in some cases, but cure is unlikely unless all the cancer is removed with surgery.[/FONT]
[FONT="]Expectations (prognosis)[/FONT]
[FONT="]The outcome varies depending on the degree of metastasis. The 5-year survival rate is around 60 - 75% if the tumor is in the early stages and has not spread outside the kidney. If it has metastasized to the lymph nodes, the 5-year survival is around 5 - 15%. If it has spread to other organs, the 5-year survival at less than 5%.[/FONT]
[FONT="]Complications[/FONT]
- [FONT="]Hypertension [/FONT]
- [FONT="]Metastasis of the cancer[/FONT]
AME Assisted Special Issuance (AASI) is a process that provides Examiners the ability to re-issue an airman medical certificate under the provisions of an Authorization for Special Issuance of a Medical Certificate (Authorization) to an applicant who has a medical condition that is disqualifying under Title 14 of the Code of Federal Regulations
(14 CFR) part 67.
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14 CFR 67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first time issuance of an Authorization for the above disease/condition, and the applicant has all of the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or Regional Flight Surgeon for the initial determination.
Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following: [/FONT]
- [FONT="]An Authorization granted by the FAA; and[/FONT]
- [FONT="]A current status report performed within 90 days that must include all the required follow-up items and studies as listed in the Authorization letter and that confirms absence of recurrent disease.[/FONT]
- [FONT="]There has been any recurrence of the cancer; or[/FONT]
- [FONT="]Any new treatment is initiated.[/FONT]
