13 - Cancers Of Urinary Tract

Question 1

Who gets reanl cancer?

Answer 1

2:1 males

6th decade

Question 2

Renal cell carcinoma is ___%?

Answer 2

> 80% ofd all primary cancers (2.6% of all adult cancers)

Question 3

Cancer until proven otherwise?

Answer 3

Solid lesions of the kidney are renal cell carcinoma until proven otherwise

Question 4

S/s of renal cell carcinoma?

Answer 4

Classic triad

• flank pain
• hematuria
• mass

(Usually advanced disease)

Also see
- metastatic symptoms (cough, bone pain)

Question 5

How is renal cell carcinoma diagnosed?

Answer 5

Usually its an incidental finding on US/CT

Question 6

Labs for renal cell carcinoma?

Answer 6

UA - hematuria
Urine cytology
CBC - anemia
Hypercalcemia

Question 7

Imaging for renal cell carcinoma?

Answer 7

Best

• CT
• MRI

Dont forget to check for metastases

• pulm
• bone scan

Question 8

RCC tx?

Answer 8

Remove mass/cyst

Metastatic disease - oncology and urology referral

Question 9

Types of RCC removal tx?

Answer 9

Nephrectomy - primary tx

Partial nepnrectomy

Radical nephroctomy

NO CHEMO works

Question 10

Who gets partial nephrectomy?

Answer 10

• single kidney
• bilateral tumor
• sig medical renal disease
• small cancer

Question 11

Who gets radical nephrectomy?

Answer 11

Cancer >7cm

Partial nephrectomy not feasible

Question 12

Prognosis for RCC?

Answer 12

Confined to renal capsule (T1-T2)
- 5 yr - 90-100%

Beyond renal capsule (T3 - T4)
- 5 yr - 50-60%

Node-pos tumors
- 5 yr - 0-15%

Question 13

Other renal tumors types?

Answer 13

Primary

• oncocytomas (benign) (look like RCC)
• angiomyolipomas (rare) (mc in young/middle aged women)

Secondary
- metastases

Question 14

MC solid renal tumor in kids <15?

Answer 14

Wilms tumor (nephroblastoma)

2/3 diagnosed before age 5

Question 15

Kidneys affected w wilms tumor?

Answer 15

Its unilateral

Question 16

Presentation of wilms tumor?

Answer 16

Abd mass
Abd pain
Hematuria
Fever
HTN

Question 17

PE for wilms tumor?

Answer 17

Mass

• Firm
• Non-tender
• Smooth
• doesnt cross midline

Question 18

When doing PE on wilms tumor?

Answer 18

Be gentle, you can rupture it and spread the cancer

Question 19

Labs for wilms tumor (nephroblastoma)

Answer 19

UA - hematuria
Renal funciton (BUN/CR, eGFR)
CBC - anemia
LFT - H if metastases

Question 20

Imaging for wilms (nephroblastoma)

Answer 20

US - mass
- get a CT/MRI

CXR/chest CT - look for pulm mass

Question 21

Type of CT for wilms tumor?

Answer 21

Unenhanced CT scan

Question 22

Wilms tumor tx?

Answer 22

Multimodal

• surgery
• radiation
• chemo

Question 23

Prognosis for wilms tumor (nephroblastoma)?

Answer 23

5 yr - 90%

Question 24

Ureter and renal pelvis cancer is rare but more common in pts who?

Answer 24

Have bladder cancer
Smoke
Hx of analgesic abuse

Question 25

MC type of ureter/renal pelvis cancer?

Answer 25

Urothelial cell carcinoma | - mucosal surface of renal calyces or pelvis, ureters

Question 26

Presentation of ureter/renal pelvis cancer?

Answer 26

MC - hematuria - flank pain - Urine cytology pos - filling defect (CT)

Question 27

Tx of ureter/renal pelvis cancer?

Answer 27

Excision of lesion

Question 28

2nd MC urologic cancer?

Answer 28

Bladder cancer

Question 29

Who gets bladder cancer?

Answer 29

Men 3.1:1 73yo 98% are epithelial malignancy

Question 30

Essentials of diagnosis for bladder cancer?

Answer 30

Hematuria Irritative voiding symptoms Pos urine cytology US, CT, MRI - masses

Question 31

Risk factors for bladder cancer

Answer 31

``` Smoking Industrial dyes/solvents Schistosomiasis Vesical calculi Prolonged catheter use ```

Question 32

PE for bladder cancer?

Answer 32

Usually Unremarkable Large - abd mass Metastatic - hepatomegaly/lymphadenopathy Advanced - lower extremity lymphedema

Question 33

Bladder cancer labs?

Answer 33

UA - hematuria - pyruia - azotemia Urine cytology Exfoliated cells in urine CBC - anemia

Question 34

Bladder cancer diagnosis?

Answer 34

Confirmed by cystoscopy and biopsy US, MRI, CT

Question 35

Bladder cancer staging?

Answer 35

Ta, T1 - superficial T2+ - invasive Pic on slide 33

Question 36

Bladder cancer tx?

Answer 36

Ta, T1 - transurethral resection and intravesicular chemo T2, T3 - radical cystectomy OR chemo + surgery/irridation Muscle invasive urothelial cell carcinoma (T2+) - chemo prior to radical cystectomy

Question 37

What is intravesicular chemo?

Answer 37

Immunotherapeutic or chemotherapeutic agents delivered into bladder - reduced recurrence

Question 38

Initial tx for ALL bladder tumors?

Answer 38

Surgery - transurethral resection

Question 39

Explain radiotherapy (bladder cancer)

Answer 39

External beam radiotherpay - over 6-8 week period Radiotherapy alone - recurrence is common - combine w systemic chemo and it works much better

Question 40

Prognosis for bladder cancer?

Answer 40

Ta, TIS, T1 = 81% survival T2, T3 = 5 yr 50-75% (w tx) Metastatic - bad

Question 41

Any old person w hx of smoking (esp male) w painless hematuria?

Answer 41

Bladder cancer until proven other wise

Question 42

Hello, incontinence helpline?

Answer 42

Can you hold?