Genitourinary Neoplasms Flashcards
what is the common groups we see renal cell carcinoma in
M>F
uncommon in patients < 45 yo
peak incidence: 55 yo (50-70)
More common in black and native american people
what are risk factors for renal cell carcinoma
cigarette smoking *
obesity
HTN
dialysis related acquired cystic disease of the kidney
severe autosomal dominant familial causes
what type of cancer is renal cell carcinoma
adenocarcinoma
other types: clear cell, papillary, chromophobe
where do renal cell adenocarcinomas dervice from
proximal renal tubular epithelium
What is VEGF
vascular endothelial growth factor
What can be targeted as part of systemic treatment for metastatic RCC
VEGF
what are common sites of metastasis from RCC
lungs
adjacent renal hilar lymph nodes
ipsilateral adrenal
What is the classic triad for RCC presentation
Hematuria
flank/abdominal pain
flank/abdominal mass
fever, weight loss, anemia, varicocele (other presentations)
if RCC is associated with paraneoplastic syndromes, what is the presentation
fever
erythrocytosis - results in polycythemia
hypercalcemia
nonmetastatic hepatic dysfunction
what is the standard workup for RCC
CT of abdomen/pelvis or MRI
CXR
urinalysis
urine cytology
what is the standard lab for for RCC
CBC
BMP
LFTs
what other radiology studies are done for RCC
bone scans for large tumors, bone pain
Head CT/MRI
what is the definitive diagnostic tests for RCC
Biopsy - risk of seeding the tract, rarely performed in practice
what is the treatment of choice for localized RCC
radical or partial nephrectomy
what is the treatment of metastatic RCC disease
Palliative nephrectomy for intractable local symptoms
radiation therapy for bone or brain mets
chemo has no role
systemic therapies: anti-angiogenic agents (-nib)
Palliative care
What are the risk factors for bladder carcinomas
smoking - dose related, risk decreases with quitting
occupational exposure to chemicals
arsenic in well water in new england, esp. “dug wells”
what does exophytic mean for bladder carcinomas
grow outwards from bladder wall aka predunculated, or lie right on wall aka sessile
what is the most common presenting symptom with bladder carcinoma
gross or microscopic hematuria
Chronic or intermittent
ANY PAINLESS HEMATURIA IS CANCER UNTIL PROVEN OTHERWISE
what labs are done for bladder cell carcinoma
Urinalysis
LFTs
CBC
elevated BUN/creatinine
Urine cytology
what diagnostic tests are run for bladder carcinomas
US, MRI or CT
cystoscopy is study of choice
how is bladder carcinoma staged and graded?
staged by how deep it invades
grading based on differentiation
what is the gold standard treatment of bladder carcinomas
*Bacille Calmette-Guerin (BCG) (not done here)
endoscopic resection and intravesical chemotherapy
what can be a curative treatment
resection of superficial and submucosally invasive low-grade tumors
What is TURBT
TransUrethral Resection of Bladder Tumor
What is MIBC
Muscle invasive bladder cancer
what is the surveillance schedule for Bladder cancer
cystoscopy every 3 months for 1 year
then every 6 months for 1 year
then annually thereafter
what are the risk factors for prostate cancer
African american
Age
+ FH (2x)
+FH of breast, ovarian CA
high fat diet
perhaps environmental carcinogenic influences
what are protective factors for prostate cancer
not smoking
healthy weight
physical activity
more frequent ejaculation
where does a majority of prostate cancers arise from
peripheral zone
what is the presentation if a patient has metastasis from prostate cancer
weight loss
anemia
bone pain (axial skeleton is m/c site of distal mets)
acute neurologic deficit in lower limbs
urinary retention
what are the benefits of PSA screening
better for detecting high-grade tumors than low-grade tumors
more predictive when levels are higher
what is the definitive diagnosis for prostate cancer
transrectal ultrasound-guided biopsy
what is the tumor grading and score used for prostate cancer
Gleason grade and gleason score
what is the treatment for localized prostate cancer
radical prostatectomy + radiation
what is the treatment for metastatic prostate cancer
palliative care
what does prostate cancer respone to
what medication therapies can be used for prostate cancer
androgens- use of drugs that block androgen production +/- orchiectomy
androgen deprivation therapy
Luteinizing hormone-releasing hormone (LHRH) agonists
what is the most common cancer in men ages 20-35 years old
testicular cancer
What are the risk factors for developing testicular cancer
cryptorchidism
personal hx of testicular cancer
+FHx; Klinefelter’s syndrome
HIV infection
Carcinoma in situ of testicle
race/ethnicity
what are the categories of testicular cancer
seminomas vs non-seminomas
what are non-seminomas
embryonic cell carcinomas
teratoma
choriocarcinoma
mixed cell type
what is the most common type of testicular cancer
germ cell tumors
what are the types of germ cell tumors
seminomas - slower growing, less spreading; secrete only HCG
non-seminomatous (4 main subtypes)
what are the 4 subtypes of non-seminomatous germ cell tumors
Embryonal carcinoma - aggressive, secretes HCG and AFP
choriocarcinoma - aggressive, secreted HCG
Teratoma - mixed - resistant to chemo and rads
yolk sack carcinoma - m/c TC in kids, secrete AFP. response to chemo
what is the less common testicular cancer
stromal tumors
- have excellent prognosis:
Leydig cell tumors
Sertoli cell tumors
which testicle is more commonly affected by cancer
Right Vs. Left
reflective of increased incidence of Right cryptochidism
what is the most common symptom of testicular cancer
painless mass or diffuse enlargement of testicle
-sensation of heaviness, acute testicular pain from intratesticular hemorrhage, development of hydrocele)
What is the presentation of advanced testicular cancer
palpable retroperitoneal or supraclavicular nodes (left side)
cough, SOB, hemoptysis of lung mets
LE edema from vena cava obstruction
back pain from retroperitoneal mets
what tumor markers may be elevated with testicular cancer
Alpha-fetoprotein (AFP)
hCG
Lactate dehydrogenase (LDH)
what is the imaging of choice for testicular cancer
scrotal ultrasound
may also do abdominal and pelvic CT and chest XR/CT scan
how is testicular cancer definitively diagnosed
histology
what is the gold standard treatment of testicular cancer
inguinal orchiectomy
-includes removal of testicle and spermatic cord to level of internal inguinal ring
what is the treatment of testicular cancer if positive retroperitoneal nodes or mets
combination chemotherapy
resection of residual masses after normalization of tumor markers
+/- retroperitoneal lymphadenectomy
what is the follow up schedule for testicular cancer
every 2-6 months x 2 years
then every 4-6 months in year 3
includes tumor markers, CXR, and CT for non-seminomas
CT for seminomas; tumor markers and CXR as needed
when is penile cancer most common
age groups 50-70 years old
primarily uncircumcised males
what are the risk factors for penile cancer
lack of circumcision
HPV
HIV
Poor genital hygiene
phimosis
Smegma
number of sexual partners
smoking
increased age
hx of precancerous lesions (leukoplakia, condyloma accuminata)
what is the primary type of penile cancer
squamous cell carcinoma
where does penile cancer typically begin
on the foreskin or on the glans
what is the presentation of penile cancer
most common complaint is the lesion itself
pain
discharge
irritative voiding symptoms
bleeding
enlarged, palpable inguinal lymph nodes
what is mandatory for the diagnosis of penile cancer
biopsy of the primary lesion
what is the treatment for penile cancer
goal: organ-sparing procedure if at all possible
small, noninfiltrating lesions: 5FU cream, radiation, MOHS surgery, laser ablation
when is total penectomy with formation of perineal urethrostomy necessary
deeply infiltrating and proximal lesions for penile cancer
