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Clin Med II - Exam 5 > Brian Miller - Urologic Cancer > Flashcards

Brian Miller - Urologic Cancer Flashcards

1
Q

why is penile cancer more common in less developed countries

A

bc it is more common in uncircumcised patients

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2
Q

is penile cancer risk an indication for circumcision

A

no

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3
Q

mean age of penile ca dx

A

60 yo

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4
Q

rf for penile cancer

A

HPV

phimosis

uncircumcised → pathologic phimosis

HIV

smoking

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5
Q

95% of penile cancer cases are __ carcinoma

A

squamous cell carcinoma

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6
Q

penile cancer dx is almost always secondary to

A

the patient noticing a lump, mass, or ulceration on penis

some will have inguinal LAD

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7
Q

indications for bx if you see a penile lesion (even if you suspect infection)

A

mass + LAD

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8
Q

tx options for penile cancers w. low risk of recurrece

A

organ-preserving strategies:

partial penectomy

xrt

laser ablation, glans surfacing (Tis)

mohs micrographic surgery

topical tx

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9
Q

topical tx for penile ca

A

fluorouracil

imiquimod

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10
Q

tx for penile ca with high risk of recurrence

A

penectomy

interstitial brachytherapy if pt refuses penectomy

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11
Q

mc malignancy of the urinary system

A

bladder ca

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12
Q

mc histologic type of bladder ca

A

urothelial (transitional cell)

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13
Q

bladder can also be found in the

A

ureter

kidney

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14
Q

3 divisions of bladder ca

A

non-muscle invasive

muscle invasive

metastatic

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15
Q

sx of bladder ca (3)

A

hematuria

irritative voiding sx

pain

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16
Q

3 irritative voiding sx

A

frequency

urgency

hesitancy

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17
Q

why is incidental dx of bladder ca rare

A

it is almost always symptomatic

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18
Q

hematuria related to urethral source will be present

A

at the beginning of urination

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19
Q

terminal hematuria indicates

A

bladder neck source

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20
Q

hematuria present throughout voiding suggests what source

A

kidney

ureter

bladder

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21
Q

bladder ca work up (4)

A

cystoscopy

cytology

a/p CT

imaging of upper tract collecting system

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22
Q

what will you see on cytology for bladder ca

A

transitional cells

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23
Q

how do you differentiate muscle invasive vs no muscle invasive bladder ca

A

TURBT

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24
Q

how do you tx low risk non-muscle invasive bladder ca

A

1 dose of intravesical chemo

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25
Q

how do you tx intermediate non-muscle invasive ca

A

extended course of intravesical chemo

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26
Q

how do you tx high risk non-muscle invasive ca

A

extended course of intravesicle chemo

+/- systemic chemo

+/-cystectomy

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27
Q

tx for muscle invasive bladder ca

A

radical cystectomy

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28
Q

tx for metastatic bladder ca

A

platinum based chemo

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29
Q

after melanoma and lung ca, mc cause of cancer deaths

A

prostate ca

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30
Q

risk of prostate bx

A

sepsis

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31
Q

what med can cause falsely low psa

A

5-alpha reductase inhibitors (proscar, avodart)

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32
Q

evaluation of prostate ca (2)

A

PSA

DRE

33
Q

if you have a pt w. elevated PSA and/or abnormal DRE what do you need to do

A

repeat PSA

prostate bx → TRUS (transurethral US guided bx)

34
Q

if TRUS is (+)…

if TRUS is (-)…

A

(+): consider tx

(-): obs

35
Q

prep for TRUS

A

enema

2 days of cipro (sepsis risk)

36
Q

what score is used to guide tx options for prostate ca

A

gleason

37
Q

tx for lower risk prostate ca

A

surveillance

+/- xrt

38
Q

tx for higher risk prostate ca

A

xrt

radical prostatectomy

39
Q

tx for stage IV prostate ca (lymph node involvement/distant mets)

A

xrt

chemo

follow w. PSA/CT

40
Q

primary testicular ca that we need to know about

A

germ cell tumors

41
Q

germ cell tumor markers

A

AFP

bHCG

42
Q

2 types of germ cell tumors

A

seminoma

non-seminoma

43
Q

seminoma tumors originate from

A

seminiferous tubules

44
Q

non-seminoma tumors originate from

A

sperm/ova cells

45
Q

4 types of non seminoma tumors

A

yolk sac

embryonal carcinoma

choriocarcinoma

teratoma

46
Q

mc malignancy in men 15-35 yo

A

testicular ca

47
Q

rf for testicular cancers

A

personal hx cryptochordism

fam hx testicular ca

personal hx testicular ca

intra-tubular germ cell neoplasia (ITGCN)

48
Q

if you have any suspicion of testicular ca…

A

do an US

have a low threshold

49
Q

first step in work up for testicular ca

A

scrotal US!!!

50
Q

other steps in testicular ca work up

A

tumor markers

staging imaging

sperm banking

51
Q

tumor markers for testicular ca

A

bHCG

AFP

LDH

52
Q

pre op imaging to r.o mets for testicular ca

A

cxr

53
Q

tx for testicular ca for post pubertal male or if tumor markers are positive

A

inguinal radical orchiectomy

54
Q

what serum markers are used for stating of testicular ca

A

post orchiectomy levels

55
Q

AFP half life

A

5-7 days

56
Q

AFP is elevated in

A

yolk sac tumor

embryonal carcinoma

infants

liver dz

57
Q

bHCG half life

A

24-36 hr

58
Q

bHCG can be elevated in

A

seminoma

choriocarcinoma

EC

marijuana

elevated LH (hypogonadism)

59
Q

80-85% of renal neoplasms

A

renal cell carcinoma

60
Q

2 types of peds renal carcinoma

A

wilms tumor

nephroblastoma

61
Q

median age of dx for rcc

A

66

62
Q

3 cm GU cancer

A

rcc

63
Q

rf for rcc

A

smoking!!

leather tanners, shoe workers

asbestos workers

obesity

htn

long term dialysis

64
Q

rcc triad

A

flank pain

hematuria

palpable abd mass

65
Q

3 mc sites of metastasis for rcc

A

lung → 75%

soft tissue → 36%

bone → 20%

66
Q

labs for rcc

A

CBC

BMP

LFTs

alk phos

UA

67
Q

imaging for rcc

A

CT/MRI abd/pel

CT for mets

68
Q

only curative tx for rcc stage I-III

A

surgery

69
Q

__ is rarely used in rcc

A

chemo

high rates of resistance

70
Q

rf for anal ca

A

hpv

hiv

multiple partners

receptive anal intercourse

smoking

71
Q

cancer located on skin/hair containing surface of anus

A

perianal ca

72
Q

mc histologic type of anal ca

A

squamous cell carcinoma

73
Q

tx to consider for perianal ca

A

local excision

74
Q

mc type of colon ca

A

adenocarcinoma

75
Q

anal ca is NOT related to

A

hemorrhoids

fissures

fistulas

76
Q

in women, there is a high link between anal ca and

A

cervical ca

77
Q

presenting sx of anal ca

A

rectal bleeding

anorectal pain

sensation of mass/fullness

asymptomatic

78
Q

work up for anal ca

A

DRE

inguinal lymph node eval

bx

CT abd/pel

+/- PET

anoscopy

HIV testing

79
Q

primary tx for anal ca

A

xrt PLUS chemo

+/- surgery

Clin Med II - Exam 5 (23 decks)

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