Brian Miller - Urologic Cancer Flashcards
why is penile cancer more common in less developed countries
bc it is more common in uncircumcised patients
is penile cancer risk an indication for circumcision
no
mean age of penile ca dx
60 yo
rf for penile cancer
HPV
phimosis
uncircumcised → pathologic phimosis
HIV
smoking
95% of penile cancer cases are __ carcinoma
squamous cell carcinoma
penile cancer dx is almost always secondary to
the patient noticing a lump, mass, or ulceration on penis
some will have inguinal LAD
indications for bx if you see a penile lesion (even if you suspect infection)
mass + LAD
tx options for penile cancers w. low risk of recurrece
organ-preserving strategies:
partial penectomy
xrt
laser ablation, glans surfacing (Tis)
mohs micrographic surgery
topical tx
topical tx for penile ca
fluorouracil
imiquimod
tx for penile ca with high risk of recurrence
penectomy
interstitial brachytherapy if pt refuses penectomy
mc malignancy of the urinary system
bladder ca
mc histologic type of bladder ca
urothelial (transitional cell)
bladder can also be found in the
ureter
kidney
3 divisions of bladder ca
non-muscle invasive
muscle invasive
metastatic
sx of bladder ca (3)
hematuria
irritative voiding sx
pain
3 irritative voiding sx
frequency
urgency
hesitancy
why is incidental dx of bladder ca rare
it is almost always symptomatic
hematuria related to urethral source will be present
at the beginning of urination
terminal hematuria indicates
bladder neck source
hematuria present throughout voiding suggests what source
kidney
ureter
bladder
bladder ca work up (4)
cystoscopy
cytology
a/p CT
imaging of upper tract collecting system
what will you see on cytology for bladder ca
transitional cells
how do you differentiate muscle invasive vs no muscle invasive bladder ca
TURBT
how do you tx low risk non-muscle invasive bladder ca
1 dose of intravesical chemo
how do you tx intermediate non-muscle invasive ca
extended course of intravesical chemo
how do you tx high risk non-muscle invasive ca
extended course of intravesicle chemo
+/- systemic chemo
+/-cystectomy
tx for muscle invasive bladder ca
radical cystectomy
tx for metastatic bladder ca
platinum based chemo
after melanoma and lung ca, mc cause of cancer deaths
prostate ca
risk of prostate bx
sepsis
what med can cause falsely low psa
5-alpha reductase inhibitors (proscar, avodart)
evaluation of prostate ca (2)
PSA
DRE
if you have a pt w. elevated PSA and/or abnormal DRE what do you need to do
repeat PSA
prostate bx → TRUS (transurethral US guided bx)
if TRUS is (+)…
if TRUS is (-)…
(+): consider tx
(-): obs
prep for TRUS
enema
2 days of cipro (sepsis risk)
what score is used to guide tx options for prostate ca
gleason
tx for lower risk prostate ca
surveillance
+/- xrt
tx for higher risk prostate ca
xrt
radical prostatectomy
tx for stage IV prostate ca (lymph node involvement/distant mets)
xrt
chemo
follow w. PSA/CT
primary testicular ca that we need to know about
germ cell tumors
germ cell tumor markers
AFP
bHCG
2 types of germ cell tumors
seminoma
non-seminoma
seminoma tumors originate from
seminiferous tubules
non-seminoma tumors originate from
sperm/ova cells
4 types of non seminoma tumors
yolk sac
embryonal carcinoma
choriocarcinoma
teratoma
mc malignancy in men 15-35 yo
testicular ca
rf for testicular cancers
personal hx cryptochordism
fam hx testicular ca
personal hx testicular ca
intra-tubular germ cell neoplasia (ITGCN)
if you have any suspicion of testicular ca…
do an US
have a low threshold
first step in work up for testicular ca
scrotal US!!!
other steps in testicular ca work up
tumor markers
staging imaging
sperm banking
tumor markers for testicular ca
bHCG
AFP
LDH
pre op imaging to r.o mets for testicular ca
cxr
tx for testicular ca for post pubertal male or if tumor markers are positive
inguinal radical orchiectomy
what serum markers are used for stating of testicular ca
post orchiectomy levels
AFP half life
5-7 days
AFP is elevated in
yolk sac tumor
embryonal carcinoma
infants
liver dz
bHCG half life
24-36 hr
bHCG can be elevated in
seminoma
choriocarcinoma
EC
marijuana
elevated LH (hypogonadism)
80-85% of renal neoplasms
renal cell carcinoma
2 types of peds renal carcinoma
wilms tumor
nephroblastoma
median age of dx for rcc
66
3 cm GU cancer
rcc
rf for rcc
smoking!!
leather tanners, shoe workers
asbestos workers
obesity
htn
long term dialysis
rcc triad
flank pain
hematuria
palpable abd mass
3 mc sites of metastasis for rcc
lung → 75%
soft tissue → 36%
bone → 20%
labs for rcc
CBC
BMP
LFTs
alk phos
UA
imaging for rcc
CT/MRI abd/pel
CT for mets
only curative tx for rcc stage I-III
surgery
__ is rarely used in rcc
chemo
high rates of resistance
rf for anal ca
hpv
hiv
multiple partners
receptive anal intercourse
smoking
cancer located on skin/hair containing surface of anus
perianal ca
mc histologic type of anal ca
squamous cell carcinoma
tx to consider for perianal ca
local excision
mc type of colon ca
adenocarcinoma
anal ca is NOT related to
hemorrhoids
fissures
fistulas
in women, there is a high link between anal ca and
cervical ca
presenting sx of anal ca
rectal bleeding
anorectal pain
sensation of mass/fullness
asymptomatic
work up for anal ca
DRE
inguinal lymph node eval
bx
CT abd/pel
+/- PET
anoscopy
HIV testing
primary tx for anal ca
xrt PLUS chemo
+/- surgery
