Genitourinary Malignancies

Question 1

What is the epidemiology of bladder cancer?

Answer 1

• Estimated new cases in 2015: 74,000 (M:F ratio – 3:1)
• Estimated deaths in 2014: 16,000
• Few clinical advances over the past 20 years
• Standard of care unchanged
• No targeted agents approved for bladder cancer

Question 2

What are some risk factors of bladder carcinoma?

Answer 2

• Transitional cell epithelium
• Tumor primary sites: 90% bladder, 8% renal pelvis, 2% ureter and urethra
• Risk factors
  
  • Smoking (2-4x higher risk in smokers)
  • Aniline dyes
  • Drugs:
    
    • phenacetin
    • chlornaphazine
    • cyclophosphamide
  • Schistosoma haematobium

Question 3

What are the pathological calssifications of bladder carcinoma?

Answer 3

• Transitional cell (95%)
• Squamous carcinoma (3%)
• Adenocarcinoma (2%)
• Small cell tumors (<1%)
• Others: melanoma, lymphoma

Question 4

What are the signs and symptoms of bladder carcinoma?

Answer 4

• Hematuria (>80%)
• Irritative urinary symptoms:
  
  • frequency, nocturia, urgency, precipitancy
• Flank pain
• Symptoms related to metastatic disease

Question 5

What is the epidemiology of prostate cancer?

Answer 5

• Estimated new cases in 2015: 220,800
• Estimated deaths in 2015: 27,540
• Trend in cancer incidence: -2% /yr
• Positive trend in 5-year survival rates:
  
  • 1975-77: 68%
  • 1987-89: 83%
  • 2004-10: >99%

Question 6

How is PSA used in screening for prostate cancer?

Answer 6

• American Cancer Society:
  
  • PSA at 50 yo
  • PSA < 2.5ng/ml: every 2 yrs testing
  • PSA > 2.5ng/ml: annual
  • Screening discussions 40-45 yo for high risk patients: African Americans and family history of 1st degree relative with prostate ca <65yo
  • Biopsy if PSA > 4ng/ml
• United State Preventive Services Task Force:
  
  • Men should not be screened for prostate cancer
• American Urological Association:
  
  • PSA screening 55-69 yo
  • Individualize decision for high risk patients (40-54 yo)
  • Do not screen:
    
    • >70 yo
    • Life expectancy < 10-15 yrs
• American College of Physicians:
  
  • Discuss with patients 50-69 yo
  • Do not screen:
    
    • <50 or >69 yo
    • Life expectancy < 10-15 yrs

Question 7

Ehat are the signs and symptoms of prostate cancer?

Answer 7

• Urinary symptoms: urgency, nocturia, hesitancy
• Hematuria
• Back pain

Question 8

What are the different pathological classifications of prostate cancer, and how are they graded/staged?

Answer 8

• Evaluation and staging
  
  • TRUS-guided needle biopsy
• Pathology:
  
  • Adenocarcinomas
  • Squamous or transitional cell carcinoma
  • Carcinosarcomas
  • Metastatic tumors
• Gleason score

Question 9

Ehat are the types of androgen depreivation therapy (ADT)?

Answer 9

• Surgery (orchiectomy)
• Injectable LHRH agonists (luprolide, goserelin)
• LHRH antagonists (degarelix)
• Antiandrogens (bicalutamide, flutamide, enzalutamide)
• Estrogens

Question 10

What is the epidemiology of testicular cancer?

Answer 10

• Estimated new cases in 2015: 8,430
• Estimated deaths in 2015: 380

Question 11

What are the types of testicular cancers and what are some risk factors?

Answer 11

• Primary germ cell tumors
• Patients 20-40 yrs old
• Nonseminoma
  
  • Embryonal carcinoma (AFP and/or hCG)
  • Teratoma
  • Choriocarcinoma (hCG)
  • Endodermal sinus (yolk sac) (AFP)
• Seminoma
• Other sites of primary germ cell tumors:
  
  • mediastinum
  • retroperitoneum
  • pineal gland
• Risk factors:
  
  • Cryptorchidism
  • Klinefelter’s syndrome

Question 12

What are the signs and symptoms as well as diagnosis of testicular cancer?

Answer 12

• Signs and symptoms
  
  • Painless testicular mass
  • Back pain
  • Dyspnea
  • Gynecomastia (hCG producing tumors)
• Evaluation and staging
  
  • Scrotal US
  • Radical inguinal orchiectomy
  • Alfa fetoprotein, hCG, LDH
  • CT scan chest/abdomen/pelvis

Question 13

What is the epidemiology of renal cell carcinoma?

Answer 13

• Estimated new cases in 2015: 61,560 (M:F ratio – 2:1)
• Estimated deaths in 2015: 14,080
• Positive trend in 5-year survival rates:
  
  • 1975-77: 50%
  • 1987-89: 57%
  • 2004-10: 74% (to to increased imaging)

Question 14

What are the risk factors of renal carcinoma?

Answer 14

• Smoking
• Acquired cystic disease associated end-stage kidney disease
• Tuberous sclerosis
• Genetic syndromes

Question 15

What are the types of sporadic renal cell carcinoma?

Answer 15

• Clear cell - proximal tubule cell origin, most common
• Papillary - proximal tubule cell origin, bilateral and multifocal
• Chromophobic - cortical collecting duct cell origin, indolent
• Collecting duct - medullary collecting duct, aggressive and least common

Question 16

What are the signs and symptoms of renal cell carcinoma?

Answer 16

• Hematuria, abdominal pain, flank mass (10-20% pts)
• Fever
• Anemia
• Weight loss
• Paraneoplastic syndromes:
  
  • Erythrocytosis
  • Hypercalcemia
  • Nonmetastatic hepatic dysfunction (Stauffer syndrome)
  • Dysfibrinogenemia