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Cancers - GU Flashcards

1
Q

Bladder Carcinoma

A
  • usually adults-50-70 yo, rare under 40, White, Male
  • The age-adjusted incidence rate was 20.8 per 100,000 men and women per year.
  • 2013 estimated from NCI in US: New cases: 72,570, Deaths: 15,210

Risks-

  • Environmental toxins- chemicals-like Beta Naphthylamine,4-amino-diphenol Other Chemicals include arsenic and chemicals used in the manufacture of dyes, rubber, leather, textiles and paint products.
  • Chronic inflammation –infections- recurrent cystitis, schistosomiasis (sq cell), urinary catheter indwelling or repeated use
  • Radiation
  • Smoking
  • Chemo history especially Cytoxin
  • Personal h/o bladder cancer
  • Lynch syndrome-hereditary nonpolyposis colorectal cancer=increase GU cancers
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2
Q

Bladder cell types

A
  • Most common-Transitional cells=inner bladder lining
  • Squamous cells are thin and flat-usually result of inflammation (schistosomiasis)
  • Adenocarcinoma-secrete mucous-rare in US.
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3
Q

Bladder Cancer Symptoms

A

Changes:

  • Frequency
  • Color- dark yellow, bright red, bloody, cola colored, or no change
  • Painful urination
  • Back Pain
  • Pelvic Pain
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4
Q

Diagnosis of Bladder Cancer

A

Urinalysis-

  • Microscopic hematuria
  • Urine cytology
  • Cystoscopy
  • Biopsy of the bladder
  • X-rays-CT or IVP to look at structures
  • Blood test in near future noting immune cell methylation pattern is present.
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5
Q

Bladder Cancer Treatment

A
  • Depends on type and stage
  • Chemo-IV or Intravesical
  • Immunotherapy: Interferon-Alpha2B-turn on immune sx, BCG-Bacille Calmette-Guerin-used in Tb
  • Radiation
  • Surgery
  • Cystectomy total or partial
  • Create alternative urine exit
  • Neobladder-intestinal reservoir attached to urethra
  • Cutaneous Continent Urinary Diversion-intestinal reservoir catheter to abdominal opening
  • Urinary Conduit-to Urostomy bag
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6
Q

Renal Cell Carcinoma

A

-Kidney Cancer or Renal Adenocarcinoma
-Age-adults
-Male
-Obesity
Risk factors
-HTN
-Renal failure treatment
-Chemicals
-Von Hippel-Lindau disease-multiple tumors
-Hereditary papillary renal cell carcinoma
-smoking

Cancer in the renal tubules-adenocarcinoma
Estimated 2013 New cases: 65,150
Deaths: 13,680

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7
Q

Renal Cell Carcinoma - sxs

A
  • Blood in the urine
  • A lump in the abdomen
  • A pain in the side that doesn’t go away.
  • Loss of appetite
  • Weight loss for no known reason.
  • Anemia
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8
Q

Renal Cell Diagnosis

A
  • Symptoms previously
  • No reliable blood markers
  • Differential- bladder cancer, cystitis, urinary tract infection, if only red-food eg beets then no blood on urinalysis
  • Blood test-BUN/Creat
  • Urinalysis-cytology-microblood-proteins
  • Xrays-CT, MRI-(old KUB or IVP)
  • Biopsy of kidney
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9
Q

Renal Cell Treatment

A

Surgery
-Nephrectomy-remove entire kidney-laproscopic
-Partial nephrectomy-open procedure remove tumor
Radiation to affected areas
Ablation
-Cryoablation-gas cold to freeze the tumor
-Radiofrequency ablation-electric current to burn or heat up cancer cells
Chemotherapy-for metastatic disease
Biologic Therapy-Antibody cells or substances made by body or lab infused that are stimulated to kill the cancer cells
Targeted Therapy-
-Antiangiogenic drugs to stop blood vessel growth to tumor
-Eg: Monoclonal antibodies or Kinase inhibitors-to stop growth

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10
Q

Wilms Tumor

A

What: Nephroblastoma=Embryonal Kidney Tumor
Where: may be uni or bilateral
-children usually 3-4 yo less common over 5yo
-Female
-Black
-Family member with Wilm’s
Associated with
-Aniridia*-iris in part color partially formed
-Hemihypertrophy-one side of body larger than other
-Undescended Testicles-Cryptorchidism
-Hypospadias-urethral opening on underside of penis
Conditions with high risk of Wilm’s
-WAGR syndrome has *, Gu abn and MR
-Denys-Drash syndrome-pseudohermaphroditism, boy with testes but female in look
-Beckwith-Wiedemann syndrome- abd org protrude at umbilical cord, macroglossia,enlarged internal organs

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11
Q

Wilms Tumor Symptoms

A
  • Abdominal swelling
  • An abdominal mass you can feel
  • Abdominal pain
  • Fever
  • Blood in the urine
  • Often picked up on routine health exam
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12
Q

Wilm’s Diagnosis

A
  • Physical exam
  • Blood and Urine tests-not diagnostic
  • Imaging-U/S, CT, MRI
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13
Q

Wilm’s Staging

A
  • Stage I. The cancer is found only in one kidney, and generally can be completely removed with surgery.
  • Stage II. The cancer has spread to the tissues and structures near the affected kidney, such as fat or blood vessels, but it can still be completely removed by surgery.
  • Stage III. The cancer has spread beyond the kidney area to nearby lymph nodes or other structures within the abdomen, and it may not be completely removed by surgery.
  • Stage IV. The cancer has spread to distant structures, such as the lungs, liver, bones or brain.
  • Stage V. Cancer cells are found in both kidneys
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14
Q

Treatment Wilms

A 
-Surgery- 
Simple nephrectomy, 
Partial nephrectomy, 
Radical Nephrectomy
-Chemo
-Radiation
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15
Q

Prostate Cancer

A
  • Age-men rare under 40 yo, usually >60yo, most common cause of death >75 yo,
  • Family hx-father, brother
  • Black race
  • Exposure to: Agent Orange, Cadmium, Drinking too much ETOH
  • Occupational-Farmers, Tire Plant Workers
  • Diet-high fat esp animal fat(rare in Vegetarians)
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16
Q

Prostate Cancer Symptoms

A
  • Delayed or slow start of urine stream
  • Dribbling or leakage of urine, most often after urinating
  • Slow urinary stream
  • Straining when urinating, or not being able to empty out all of the urine
  • Blood in the urine or semen
  • Bone pain or tenderness, most often in the lower back and pelvic bones (only when the cancer has spread)
17
Q

Prostate Cancer Diagnosis

A
  • Symptoms occur in later stages- an Adenocarcinoma
  • PSA-screening test- will be elevated if BPH=common in older men-increasing levels most significant
  • Physical exam-enlarged & asymmetric, nodules, Firm usually non-tender prostate (BPH more diffusely enlarged softer, boggy-Prostatitis- is enlarged boggy and tender)
  • Other Physical changes consistent with cancer-abn bone pains in spots, wt loss
  • Biopsy of prostate, US, CT , Bone Scan to diagnose
18
Q

Prostate Cancer Treatment

A

Surgical
-Radical Prostitectomy-impotence, incontinence
-Abdominal, Perineal, Laproscopic, Robotic
Ablation
-Cryosurgery=Cryoablation-cold gas through needles to prostate
-Heating Prostate with High Intensity US to destroy, rectal probe
Radiation
-External Beam
-Brachytherapy-rice sized pellets placed into prostate
Hormonal Therapy- decrease testosterone
-LH-RH Lutenizing Hormone Releasing Hormone eg -Lupron-so testes not receive message to produce testosterone
-Anti-androgens-block testosterone from cancer cells-eg Casodex
-Orchiectomy-similar to LH-Rh but more rapid
Chemotherapy
-Not responding to hormonal- and useful in metastatic disease

19
Q

Prostate Cancer Stages

A
  • Stage I. confined to a small area of the prostate. under a microscope, the cancer cells aren’t considered aggressive.
  • Stage II. Cancer at this stage may still be small, but may be considered aggressive when cancer cells are viewed under the microscope. Or cancer that is stage II may be larger and may have grown to involve both sides of the prostate gland.
  • Stage III. The cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
  • Stage IV. The cancer has grown to invade nearby organs, such as the bladder, or spread to lymph nodes, bones (osteoblastic), lungs or other organs.
20
Q

Testicular Cancer

A
  • Undescended testicle-Cryptorchism
  • Abnormal testicle development- eg: Klinefelders
  • Family History
  • Age-15-35 yo
  • Race- White> Black
21
Q

Testicular Cancer Dx

A

-TSE-most often or on PE
-Firm nodule on the testes
-Confuse with Orchitis (tender), Epididymitis (tender and external to testes), Varicocoele ( non tender but soft), Atypical inguinal hernia into sac-usually soft.
-Imaging US: if lump internal or external
Blood test markers-
-AFP (alpha feta protein)
-HCG (human chorionic gonadotropin)
-LDH (lactate dehydrogenase)

22
Q

Testicular Cancer Treatment

A 
Surgery
-Orchiectomy inguinal w or w/o lymph node dissection (stage 1,Stage 2, perhaps 3)
Radiation
-External beam (esp if seminoma type ca)
Chemotherapy 
-For metastatic disease usually
23
Q

summary

A
  • Bladder Cancer-more common in men, smokers, toxins, chronic inflammatory stimulus
  • Renal Cell cancer-M>F, smokers,toxins, genetics
  • Wilms-young under 5-7, F>M,genetic abn
  • Prostate-male, age>40, high fat,black, exposure chemicals-agent orange etc, job exp
  • Testicular-young 15-34 M, Klinefelters, Cryptorchism, decreasing

GU (9 decks)

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