Genitourinary cancers

Question 1

What organs make up the male reproductive system?

Answer 1

Penis, scrotum/testes, epididymis, vas deferens, urethra,
seminal vesicles, prostate gland, bulbourethral glands.

Question 2

What organs make up the urinary system?

Answer 2

Kidneys, ureters, urinary bladder, urethra

Question 3

What organ serves a role in both
urinary and reproductive functions?

Answer 3

only the male urethra serves a role in both
urinary and reproductive functions.

Question 4

The bladder, ureters, and renal pelvis are lined by?

Answer 4

transitional cell epithelium

Question 5

98% of bladder tumors are of what origin?

Answer 5

98% of bladder tumors are epithelial in origin, most of which are transitional cell carcinomas

Question 6

Tumors most often occur where?

Answer 6

The Trigone area

Question 7

The most common risk factor for bladder cancer is?

Answer 7

smoking

Question 8

bladder cancer demographics

Answer 8

It affects men more than women (4:1), whites more than African-Americans (2:1), and 90% of patients are over the age of 55

Question 9

What percent of each type of tumor stage are diagnosed in bladder cancer at the time of diagnosis?

Answer 9

50% of tumors are diagnosed while still in non- invasive stages (confined to inner layer of bladder)

35% are diagnosed while the tumor is still contained within the bladder, but the tumor has started to invade deeper tissue layers

The remainder 15% of tumors have spread beyond the bladder at the time of diagnosis

Question 10

What kind of patients with bladder cancer are more likely to have more advanced disease at diagnosis?

Answer 10

African-American patients are slightly more likely to have more advanced disease when they are diagnosed

Question 11

What are the symptoms of bladder cancer?

Answer 11

Early stage tumors may not present any signs or symptoms

Presenting symptoms can include blood in the urine, painful urination, and trouble urinating (hesitation)

Question 12

What is the treatments of choice for superficial lesions in bladder cancer?

Answer 12

Surgery is the treatment of choice for superficial lesions, but due to the high likelihood of recurrence, these tumors must be monitored for the rest of the patient’s life

Question 13

What is the standard procedure for invasive tumors in bladder cancer?

Answer 13

Surgery followed by radiation is the standard procedure for invasive tumors

Question 14

What are the kidneys & what is their main function?

Answer 14

A pair of bean-shaped organs, each about the size of a fist

Their main job is to filter the blood to remove excess water, salt, and waste products

Question 15

What percent of kidney tumors are transitional cell carcinomas?

Answer 15

90% of kidney tumors are transitional cell
carcinomas

Question 16

How do RCCs generally present?

Answer 16

RCCs usually grow in a single mass within the kidney, and are not usually detected before growing to be quite large

They are generally diagnosed, however, before metastasizing

Detection and diagnosis usually happens when searching for non-related conditions

Question 17

What are the age related demographics for kidney cancer?

Answer 17

Kidney cancer is very uncommon in people younger than age 45, and it most often occurs in people 55 and older

Question 18

Does kidney cancer affect men or women more?

Answer 18

It affects men slightly more than women

Question 19

Are the rates of kidney cancer incidence increasing or decreasing?

Answer 19

For reasons that are not totally clear, the rate of people developing kidney cancer has been rising steadily since the late 1990s, death rates have gone down slightly

Question 20

What are the two most common risk factors for kidney cancer?

Answer 20

The two most common risk factors are smoking and obesity

Question 21

What are the symptoms of kidney cancer?

Answer 21

Early, small tumors do not usually cause signs or symptoms

People with larger tumors may have: blood in their urine, lower back pain on one side, a palpable mass, unexplained weight loss and/or fever, anemia

Question 22

How are kidney tumors staged?

Answer 22

Kidney tumors are staged using the TNM system

Question 23

How does Renal cell carcinoma spread?

Answer 23

Renal cell carcinoma spreads via local/direct extension, lymph, and blood

Question 24

What are common distant metastases for renal cell carcinoma?

Answer 24

Common distant metastases include: lung, soft tissue, bone, liver, cutaneous areas, and CNS

Question 25

What is the treatment of choice for renal cell carcinoma?

Answer 25

The treatment of choice for renal cell carcinoma is surgery if possible; otherwise radiation therapy is the main treatment

Question 26

What are the three main cancers of the male reproductive system?

Answer 26

The three main cancers of the male reproductive system are penile, testicular, and prostate tumors

Question 27

What is the only male reproductive cancer that has a screening test?

Answer 27

Only prostate cancer has screening tests (PSA, rectal exam), but the use of these in non-symptomatic, average-risk populations is currently debated

Question 28

Anatomy: Where is the prostate located? And what are the surrounding structures?

Answer 28

In front of the rectum and below the urinary bladder

Just behind the prostate are the seminal vesicles and the urethra goes through the center of the prostate

Question 29

Anatomy: what is the size of the prostate?

Answer 29

The size of the prostate varies with age - in younger men, it is about the size of a walnut, but it can be much larger in older men

Question 30

What percent of prostate cancers are adenocarcinomas?

Answer 30

Over 95% of prostate tumors are adenocarcinomas

Question 31

Anatomy: Where does Prostate cancer arise?

Answer 31

70% of tumors arise from the peripheral part of the
gland compared with benign growths (BPH) which
begin centrally around the urethra

Question 32

Prostate cancers are graded according to…?

Answer 32

Tumors are graded according to the Gleason system and staged according to TNM

Question 33

Demographics for prostate cancer?

Answer 33

 Most men are diagnosed after age 65

 African-American men have one of highest rates in world, and significantly higher than white males

Answer 34

Prostate cancer
 It is the most common cancer in men (excluding skin cancer) and the second leading cause of cancer death in males

 However, most men with prostate cancer do not die from the disease

 More than 2.5 million men in the United States who have been diagnosed with prostate cancer at some point are still alive today

 It is associated with high fat intake, high testosterone levels, and heredity factors

Answer 35

Prostate cancer
 Symptoms include decreased urinary stream, increased urinary frequency, difficulty in starting urination, and painful urination

 Prognostic indicators include: tumor stage/grade, age, race, PSA level, and lymph involvement

 Spread is via direct invasion (usually of the bladder, seminal vesicles, and rectum),
lymphatics, and blood

 Blood-borne bone metastases are the most common distant site

Answer 36

Prostate cancer
 Treatment options for prostate cancer include observation, surgery, radiation, hormone therapy, and chemo

 The “best” treatment option is a complex decision which should take into account a patient’s: age, life expectancy, general health, and feelings about treatment and side effects

 Additional treatment factors include stage and grade of the tumor and the chance for cure with each treatment option

Answer 37

Testicular cancer
 It typically develops in one or both testicles in young men

 The most common risk factor is an undescended testis

 Because treatment is so successful, the risk of dying from this cancer is very low: about 1 in 5,000

 More than 90% of cancers of the testicle develop in special cells known as germ cells (cells that produce
sperm)

 There are 2 main types, seminomas and non-seminomas, and they occur at about equal rates

Question 38

Testicular cancer: Seminomas

Answer 38

These usually occur in men
between 25-45

Pure seminomas are more
likely to stay localized or
involve only lymph nodes

The treatment of choice is
surgery and radiation, or
chemo for late stages

Question 39

Testicular cancer: Non-seminomas

Answer 39

These usually occurs in
men between their late
teens and early 30s

They may spread via lymph
or blood

Common metastasis sites
are the lungs and liver

The treatment of choice is
surgery and chemo

Question 40

Demographics for testicular cancer?

Answer 40

In general, testicular cancer is relatively rare, with highest rates for white males in the U.S.

For reasons unknown, however, this cancer is on the rise in both the U.S. and Europe

Question 41

What are the presenting symptoms for testicular cancer?

Answer 41

Most patients present with a painless swelling or nodular mass in scrotum and rarely with symptoms of metastatic disease

50% of patients also have decreased sperm count (which is only determined after testing)

Question 42

What is the most important prognostic indicator for testicular cancer?

Answer 42

The most important prognostic indicator is tumor stage

Question 43

Who does penile cancer most commonly affect?

Answer 43

Mostly it effects older uncircumcised men (50-70)

There is a strong association with HPV and genital warts

Question 44

In what countries is penile cancer most common?

Answer 44

This is an incredibly rare cancer in the U.S.

However it is common in SE Asia, China, and Africa

Question 45

What are the treatments of choice for penile cancer?

Answer 45

Surgery and radiation are the treatments of choice, with consideration given to the ability to retain sexual function and standing urination

Question 46

What type of tumors are associated with penile cancer?

Answer 46

These tumors are slow-growing SCCs