05b: Urinary tract/Kidney Flashcards
Most common presenting feature of genitourinary tract cancer
Hematuria
The vast majority of renal tumors in adults prove to be (X), (benign/malignant) tumors.
X = clear cell renal tumors (80%)
Malignant
T/F: Autosomal dominant polycystic kidney disease (ADPKD) does not increase risk of renal cancer.
True
T/F: Renal cancer accounts for under 3% of all malignancies in adults.
True (2.6%)
T/F: Cancer of renal pelvis arises from renal epithelium and accounts for 40% of renal cancers.
False - considered urothelial (transitional cell) cancer and accounts for 5% of renal cancers
Genetic disorders that increase irsk of CCRC carcinoma:
- von Hippel-Lindau disease
- Familial chromosome 3 translocations
- Tuberous sclerosis
Non-genetic diseases/factors that increase irsk of CCRC carcinoma:
- ESRD (acquired cystic kidney disease)
- Smoking (2-4x risk)
- Heavy metal exposure (2-4x risk)
CCRC carcinoma: cells of origin?
Prob proximal tubule
CCRC carcinoma: cells are filled with (X) and express high levels of (Y) growth factor.
X = lipid (high glycogen content) Y = VEGF (highly vascular)
Classic triad of CCRC:
- Flank pain
- Hematuria
- Abdominal mass
**found in less than 10% of cases! So many various Sx presentation
The “internist’s tumor”
CCRC (due to wide breadth of paraneoplastic features/Sx)
CCRC carcinoma: most effective therapy
Nephrectomy
CCRC carcinoma: 5y survival if disease confined in renal capsule is (X)%.
X = 90
CCRC carcinoma: 5y survival if disease invades renal capsule but has not spread past (X) is (Y)%.
X = Gerota's fascia Y = 60
Stage III
CCRC carcinoma: 5y survival if disease spreads beyond Gerota’s fascia is (X)%
X = 10%
Locally invasive - Stage IV
(X) renal cell cancers may undergo spontaneous remission. Which characteristic of this cancer may account for this?
X = CCRC carcinoma
This carcinoma may be relatively responsive to chances in host immunity
T/F: Renal cancer responds poorly to conventional cytotoxic chemotherapy and radiation therapy.
True
T/F: Renal cancer that responds to chemo “completely” implies the patient has been cured.
False! Indicates disappearance of radiographic evidence of tumor, but relapses may occur
CCRC carcinoma: 5y survival if disease spread to renal vein is (Y)%.
Y = 60%
Stage IIIA
CCRC carcinoma: 5y survival if disease spread to one lymph node is (Y)%.
X = 20%
Stage IIIB
Von Hippel-Lindau (VHL) disease: most common cause of death
CCRC carcinoma
Major renal cancer cell gene in adults:
VHL (tumor suppressor)
Von Hippel-Lindau (VHL) disease: inheritance pattern
AD
VHL protein function
Down-regulates hypoxia-induced genes by targeting HIF-alpha (TF) for destruction
Renal cancer: VHL loss results in overexpression of which key factors?
- VEGF
- PDGF-beta
- TGF-beta
Angiogenic factors!
Renal cancer: VHL loss allows cancer cell to form cooperative relationship with (X)
X = neighboring endothelial cell (gives it oxygen, nutrients via neovascularization)
T/F: loss of second VHL allele results in renal cancer
False -forms cyst that (with additional mutations)can become cancer
(X) renal tumors are small (<5mm), present in (cortex/medulla) as pale yellow nodule with papillary growth pattern. If larger than (Y) size, they’re re-classified as…
X = renal papillary adenoma
Cortex
Y = 3 cm
RCC (due to malignant potential)
List some tyrosine kinase inhibitor targets for RCC
VEGF-R
PDGF-R
List the urothelial tumor cell types and star the most common
- Transitional cell* (95%)
- Squamous Cell
- Adenocarcinoma
Bladder cancer: (X) is the major risk factor and is responsible for (Y)% of cases
X = smoking (4x risk) Y = 50
Chronic inflammation, such as in (X) conditions, increases risk of which urothelial cancers?
X = catheter or schistosomiasis
Squamous and transitional cell carcinomas of bladder
Which drug causes 9x increased risk of bladder cancer?
Cyclophosphamide
Bladder cancer: T1 involves (X) layer. T2 involves (Y) layer. T3 involves (Z) layer.
X = mucosa Y = mucosa and muscularis Z = mucosa, muscularis, and fat
Bladder cancer: Rx and prognosis for stage T1
TUR (Transurethral resection)
Good prognosis, but can recur
Bladder cancer: Rx and prognosis for stage T2
Cystectomy
60% 5y survival
Bladder cancer: prognosis for stage T3
10% 5y survival
Bladder cancer can be identified early with thorough work-up of (X) patients that present with (Y)
x = >40 years old Y = hematuria (evaluate by cytoscopy)
Bladder cancer: Deletion of (X) is an early event. Deletion of (Y) happens later and has been linked to poorer prognosis.
X = chromosome 9q Y = Rb and p53
List the two main benign tumors of the kidney
- Renal papillary adenoma
2. Oncocytoma
(X) renal tumors are small (<5mm), present in (cortex/medulla) as pale yellow nodule with papillary growth pattern. If larger than (Y) size, they’re re-classified as…
X = renal papillary adenoma
Cortex
Y = 3 cm
RCC (due to malignant potential)
Oncocytoma: composed of (small/large) (eosinophilic/basophilic) cells thought to arise from the (X) cells.
Large; eosinophilic
X = interacalated cells of collecting duct
Oncocytoma: (X) color and can grow up to (Y).
X = mahogany-brown Y = 12 cm
Pt has renal mass resected that shows numerous mitochondria on EM. Which type of tumor is this a characteristic of?
Oncocytoma
Aside from the most common malignant renal tumor, (X), which other malignant tumors can arise in kidney? Star the one with the best prognosis.
X = CCRC carcinoma (80%)
- Papillary carcinoma
- Chromophobe renal carcinoma*
Characteristic chromosomal abnormalities of CCRC largely involve chromosome (X).
X = 3
loss of the short arm of chromosome 3 or translocations involving chromosome 3
