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Urology > Cancers > Flashcards

Cancers Flashcards

1
Q

How common is prostate cancer? What helps dx prostate cancer? MC type?

A
  • 2nd most common cancer in men in America - 2nd greatest cause of mortality in men
  • PSA helps dx in 1/6 men w/ prostate cancer
  • clinical incidence doesn’t match prevalence at autopsy - over 40% of men over 50 are found to have cancer
  • MC type: adenocarcinoma
  • other types:
    sarcomas
    SCC
    transitional cell carcinoma
    neuroendocrine tumors
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2
Q

RFs for prostate cancer?

A
  • age: rare in men younger than 40, develops in 40s
  • race: higher rates in African American men (higher PSAs), lower rate in Asian-American/Hispanic latino men
  • family hx:
    2 fold greater risk w/ 1st degree relative
  • genetic:
    mutations especially on BRCA 2 increase risk in men, men w/ lynch syndrome (HNPCC)
  • enviro carcinogens: agent orange
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3
Q

Clinical presentation of prostate cancer?

A 
- men w/ early stage cancer usually have no sxs:
urinary frequency/urgency
nocturia
hesitancy
- hematuria/hematospermia
- bone pain (pathological fracture)
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4
Q

Dx of prostate cancer?

A

PE:

  • DRE: nodules, induration, asymmetry
  • TRUS: MRI guided
  • MRI
  • bone scan
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5
Q

Pathology of prostate CA? MC zones of prostate that are affected?

A
  • acinar cells of prostate will develp into adenocarcinoma
  • zones:
    peripheral zone - majority (70%)
    central: 2-5%
    transition: 10-20%
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6
Q

Gleason grading scale?

A
  • scoring system using numbers 1-5
  • grade 1: cancerous tissue looks like normal prostate tissue
  • grade 5: cancer cells and growth patterns look very abnormal
  • diff areas of prostate ahve diff cancer grades - gleason grade (sum) adds 2 grades together:
    primary tumor
    secondary tumor (minority of the tumor)
  • ex:
    majority: 3 (primary)
    less: 4 (secondary) - total gleason grade = 7
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7
Q

TMN staging system?

A
  • stage T1: cancer is found in prostate only, can’t be felt by DRE or seen on imaging
  • T2a and T2b: tumor that is too small to be felt or seen on image (2a) or slightly larger tumor that can be felt on DRE (2b)
  • stage T3: cancer has spread beyond outer layers of prostate into nearby tissues, and may have spread to seminal vesicles
  • stage T4: any tumor that has spread to other parts of the body
  • stage N+ or M+: spread to lymph nodes or met to other areas of body
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8
Q

Risk classificaiton of prostate cancer stages?

A

guidelines from ESMO
- low risk: T1-T2a and gleason score 6 or less and PSA 10 or less
- intermediate risk: T2b and/or Gleason score 7 and/or PSA 10-20 (usually go on to tx: prostatectomy)
- high risk:
T2c and greater or Gleason score 8-10 or PSA greater than 20 (get mets workup)

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9
Q

Diff tx options for prostate cancer?

A
  • active surveillance: Gleason 6 (slow growing)
  • open radical prostatectomy vs MIRP (gleason 6 and up)
  • radiation:
    external beam, high dose radiation (HDR), brachytherapy
  • HIFU (High intensity focused US)
  • hormone therapy:
    orchiectomy
    androgen deprivation LHRH (for older pts that can’t undergo surgery) - this suppresses testosterone
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10
Q

Advantages and disadvantages of external beam radiation therapy? CI?

A

advantages:
-effective long-term cancer control w/ high-dose txs, very low risk of urinary incontinence, available for cure of pts over wide range of ages and in those w/ significant comorbidity
disadvantages:
- sig risk of impotence, lack of lymph node removed, late rectal sxs more common than w/ brachytherapy or radical prostatectomy, up to half of pts have some temp. bowel and bladder sxs during tx
**Usually tx of choice if want to preserve continence and erection
CI:
previous pelvic irradiation
active inflammatory disease of rectum
very low bladder capacity
chronic moderate or severe diarrhea from any cause

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11
Q

Advantages and disadvantages of brachytherapy? CI?

A

advantages:
- cancer control rates appear equal to surgery and EBRT for organ confined tumors
- quicker than EBRT (single tx)
- available for cure over wide range of ages and in those w/ some comorbidity

disadvantages:

  • sig risk of impotence
  • lack of lymph node removed
  • up to half may have some temp. bladder or bowel sxs with tx

CI:

  • previous pelvic irradiation
  • large volume gland
  • marked voiding sxs
  • large or high grade tumors
  • chronic moderate or severe diarrhea
  • active inflammatory disease of rectum
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12
Q

Advantages and disadvantages of radical prostatectomy? CI?

A

advantages:

  • effective long term cancer control
  • predictions of prognosis can be more precise based on pathologic features in specimen
  • pelvic lymph node dissection is possible through same incision, PSA failure is easy to detect

disadvantages:

  • sig risk of impotence
  • risk of operative morbidity
  • low risk of long term incontinence

CI: higher medical operative risk, neurogenic bladder

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13
Q

Advantages and disadvantages of active survellience? CI?

A

advantages:

  • reduces overtx
  • avoids or postpones tx assoc complications

disadvantages:
tumor may progress past possibilty of cure
- later tx may result in more SEs
- living w/ untx cancer may cause anxiety

CI: high grade tumors (higher than gleason 6), not stage T1c
- prolonged expected survival

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14
Q

What pop group is testicular cancer most common?

Curable or not? MC types of cancers?

A
  • MC cancer in men b/t 15-35
  • accounts for 1% of all tumors in males
  • tumor spreads by lymphatics and blood
  • highly curable if discovered early
  • 90-95% of all primary tumors arise from germ cells
  • germ cell tumors:
    seminomas (50%)
    nonseminomas (more aggressive
  • non germ cell tumors (5%):
    leydig cell
    sertoli cell
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15
Q

Characteristics of seminomas?

A
  • germ cell tumor
  • slow growing
  • found in men in 30s and 40s
  • very sensitive to radiation
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16
Q

Characteristics of nonseminomas?

A
  • germ cell tumor
  • more common and quicker growing
  • 4 subtypes:
    embryonal carcinoma
    yolk sac carcinoma
    choricarcinoma
    teratoma
  • occur in teen yrs and early 40s
  • more sensitive to chemo
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17
Q

Causes of testicular cancer?

A
  • cyrptorchidism
  • family hx
  • klinefelter syndrome
  • previous hx of testicular cancer
  • caucasian
18
Q

Presenation of testicular cancer?

A
  • painless testicular lump**
  • enlarging testicle
  • accum around testicle
  • accumulation around testicle (hydrocele)
  • mets:
    swelling of lower extremities
    back pain
    cough
    gynecomastia
19
Q

Dx of testicular cancer?

A
  • scrotal US
  • CXR
  • CT
  • tumor markers:
    beta-hCG
    AFP
    LDH
  • if you find mass in testicle: it is cancer until proven otherwise
20
Q

Staging of testicular cancer?

A
  • stage 1: confined to testicle
  • stage 2: mets to retroperitoneal nodes
  • stage 3: mets above diaphragm or to visceral organs
21
Q

Tx of testicular cancer?

A
  • radical orchiectomy
  • depending on stage:
    seminoma: radiation, chemo or both
    nonseminoma: RPLND or survellience, chemo

**encourage self-testicular exams

22
Q

How common is penile cancer? RFs?

A 
rare type of cancer making up less than 1% of all cancers dx in men
- occurs mainly in uncircumcised men
- SCC (95%)
- RFs:
HPV
age: older than 50
smegma: poor hygiene
phimosis: uncircumcision
23
Q

Presentation and dx of penile cancer?

A
  • growth or sore on penis
  • skin thickening on penis
  • d/c w/ foul odor from under the foreskin
  • pain in penis
  • swollen lymph nodes in groin
  • irregular swelling at end of penis

-dx: bx

24
Q

Staging of penile cancer?

A
  • O: cancer hasn’t grown below surface of layer of the skin
  • 1: cancer has grown just below the surface layer of the skin
  • 2: invasion into the shaft or corpora: no nodes or mets
  • 3: tumor confined to penis, operable inguinal nodes mets
  • 4: tumor involves adjacent structures, inoperable inguinal lymph nodes and distant mets
25
Q

Tx of penile cancer?

A
  • laser therapy
  • mohs surgery
  • partial or total penectomy
  • lymph node disection
  • radiation
26
Q

How common is bladder cancer? Etiology?

A
  • one of MC urologic malignancy
  • majority of cases are transitional cell carcinoma (65-75%)
  • 60,000 new cases yearly w/ 13,000 deaths
  • 3-4x more common in women
  • etiology:
    tobacco exposure (even 2nd smoke)
    industrial exposure: aniline dyes, textile printing, rubber manufacturing
    chemo: cyclophosphamide and ifosfamide
27
Q

Presentation and dx of bladder cancer?

A

presentation:
- MC in painless microscopic or gross hematuria (85%)
- frequency
- dysuria
- back or flank pain

dx:
UA
cystoscopy
urine cytology
CT IVP
bx
28
Q

Staging of bladder cancer?

A
  • stage 0: papillary lesions relatively benign or carcinoma in situ
  • stage 1: tumor invades submucosa or lamina propria
  • stage 2: invasion into muscle (need to have bladder removed)
  • stage 3: extends beyond muscel into perivesical fat
  • stage 4: extension into adjacent organs
29
Q

Tx of bladder cancer?

A 
- biologic therapy:
uses pts immune system to fight cancer, BCG
- chemo
- surgery: 
TURBT
radical cystectomy w/ urinary diversion 
partial cystectomy 
- radiation
30
Q

Types of renal cancer? How common?

A
  • renal cell carcinoma: 85%
  • transitional cell: 10-15%
  • sarcoma
  • wilm’s tumor
  • 62,000 adults dx with renal cancer, w/ 14,000 deaths
  • 7th MC cancer, 10th MC cause of cancer death
  • 72% 5 yr survival rate
31
Q

RFs and presentation of renal cancer?

A

RFs:

  • smoking
  • male: 2-3x more than females
  • obesity
  • HTN
  • family hx

presentation:

  • hematuria
  • pain/pressure in flank (tumor pushing on psoas muscle)
  • fatigue
  • most found incidentally
  • R varicocele may be sign
32
Q

Dx renal cancer?

A
  • UA
  • bx
  • CT IVP
  • cystoscopy/nephro-ureteroscopy
33
Q

Staging of renal cancer?

A
  • stage 1: tumor is 7 cm or less w/in kidney (T1, N0, M0)
  • stage 2: tumor is larger than 7cm w/in the kidney (T2, N0, M0)
  • stage 3: tumor of any size w/ spread into regional lymph nodes or tumor grown into major veins or perinephric tissue (T1, T2, N1, M0), or (T3, N+, M0)
  • stage 4: tumor has spread beyond Gerota’s fascia into adrenal gland (same side) w/ lymph nodes but not to other body parts, or spread to other body parts (T4, N+, M0), or (T4, N+, M1)
34
Q

Tx of renal cancer?

A
  • radiofrequency ablation (RFA) - smaller tumors
  • surgery:
    radical nephrectomy
    partial nephrectomy (want to keep kidney fxn - esp if both kidneys are affected)
  • radiation
35
Q

How common is Wilms tumor? Male vs females? Mean age at dx?

A
  • kidney cancer in children
  • 500 kids dx each cancer
  • 5% of all childhood cancers
  • occur most often b/t 3-4, uncommon after age 6
  • male to female ratio:
    unilateral: 0.92:1
    bilateral: 0.60: 1
  • mean age at dx:
    44 months (unilateral)
    31 months (bilateral)
36
Q

RFs for Wilms?

A
  • mutated, damaged, missing gene
  • WAGR syndrome
  • Beckwith wiedemann syndrome
  • boys w/ deny-drash syndrome
  • family hx
37
Q

Presenation of wilms tumor?

A
  • parent may notice lump or mass in kid’s abdomen
  • hematuria
  • HTN
  • anemia
  • fatigue
  • fever that doesn’t go away
38
Q

Dx of Wilms tumor?

A
  • UA
  • US
  • CT
  • surgical bx
  • x’some test
39
Q

Stages of Wilms tumor?

A
  • stage 1: tumor is in one kidney and can be completel removed w/ surgery
  • stage 2: cancer is found in kidney, fat, soft tissue, or blood vessels near the kidney, tumor can be removed by surgery
  • stage 3: cancer found in areas near the kidney and can’t be removed w/ surgery, hasn’t spread outside the abdomen
  • stage 4: cancer has spread to distant organs
  • stage 5: cancer is both kidneys, each kidney staged separately
40
Q

Tx of wilms tumor?

A

surgery: radical nephrectomy, partial nephrectomy
- chemo
- radiation: stage 3 and 4
- clinical trials

Urology (12 decks)

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