Brian Miller - Urologic Cancer Flashcards by Alice Richards

why is penile cancer more common in less developed countries

bc it is more common in uncircumcised patients

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is penile cancer risk an indication for circumcision

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mean age of penile ca dx

60 yo

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rf for penile cancer

HPV

phimosis

uncircumcised → pathologic phimosis

HIV

smoking

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95% of penile cancer cases are __ carcinoma

squamous cell carcinoma

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penile cancer dx is almost always secondary to

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

some will have inguinal LAD

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

mass + LAD

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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

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topical tx for penile ca

fluorouracil

imiquimod

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tx for penile ca with high risk of recurrence

penectomy

interstitial brachytherapy if pt refuses penectomy

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mc malignancy of the urinary system

bladder ca

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mc histologic type of bladder ca

urothelial (transitional cell)

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bladder can also be found in the

ureter

kidney

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3 divisions of bladder ca

non-muscle invasive

muscle invasive

metastatic

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sx of bladder ca (3)

hematuria

irritative voiding sx

pain

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3 irritative voiding sx

frequency

urgency

hesitancy

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why is incidental dx of bladder ca rare

it is almost always symptomatic

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hematuria related to urethral source will be present

at the beginning of urination

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terminal hematuria indicates

bladder neck source

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hematuria present throughout voiding suggests what source

kidney

ureter

bladder

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bladder ca work up (4)

cystoscopy

cytology

a/p CT

imaging of upper tract collecting system

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what will you see on cytology for bladder ca

transitional cells

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

TURBT

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

1 dose of intravesical chemo

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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

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