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CLIN MED3: GU/Renal > Genitourinary Neoplasms > Flashcards

Genitourinary Neoplasms Flashcards

1
Q

what is the common groups we see renal cell carcinoma in

A

M>F
uncommon in patients < 45 yo
peak incidence: 55 yo (50-70)
More common in black and native american people

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2
Q

what are risk factors for renal cell carcinoma

A

cigarette smoking *
obesity
HTN
dialysis related acquired cystic disease of the kidney
severe autosomal dominant familial causes

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3
Q

what type of cancer is renal cell carcinoma

A

adenocarcinoma
other types: clear cell, papillary, chromophobe

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4
Q

where do renal cell adenocarcinomas dervice from

A

proximal renal tubular epithelium

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5
Q

What is VEGF

A

vascular endothelial growth factor

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6
Q

What can be targeted as part of systemic treatment for metastatic RCC

A

VEGF

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7
Q

what are common sites of metastasis from RCC

A

lungs
adjacent renal hilar lymph nodes
ipsilateral adrenal

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8
Q

What is the classic triad for RCC presentation

A

Hematuria
flank/abdominal pain
flank/abdominal mass

fever, weight loss, anemia, varicocele (other presentations)

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9
Q

if RCC is associated with paraneoplastic syndromes, what is the presentation

A

fever
erythrocytosis - results in polycythemia
hypercalcemia
nonmetastatic hepatic dysfunction

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10
Q

what is the standard workup for RCC

A

CT of abdomen/pelvis or MRI
CXR
urinalysis
urine cytology

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11
Q

what is the standard lab for for RCC

A

CBC
BMP
LFTs

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12
Q

what other radiology studies are done for RCC

A

bone scans for large tumors, bone pain
Head CT/MRI

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13
Q

what is the definitive diagnostic tests for RCC

A

Biopsy - risk of seeding the tract, rarely performed in practice

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14
Q

what is the treatment of choice for localized RCC

A

radical or partial nephrectomy

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15
Q

what is the treatment of metastatic RCC disease

A

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

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16
Q

What are the risk factors for bladder carcinomas

A

smoking - dose related, risk decreases with quitting
occupational exposure to chemicals
arsenic in well water in new england, esp. “dug wells”

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17
Q

what does exophytic mean for bladder carcinomas

A

grow outwards from bladder wall aka predunculated, or lie right on wall aka sessile

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18
Q

what is the most common presenting symptom with bladder carcinoma

A

gross or microscopic hematuria
Chronic or intermittent
ANY PAINLESS HEMATURIA IS CANCER UNTIL PROVEN OTHERWISE

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19
Q

what labs are done for bladder cell carcinoma

A

Urinalysis
LFTs
CBC
elevated BUN/creatinine
Urine cytology

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20
Q

what diagnostic tests are run for bladder carcinomas

A

US, MRI or CT

cystoscopy is study of choice

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21
Q

how is bladder carcinoma staged and graded?

A

staged by how deep it invades
grading based on differentiation

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22
Q

what is the gold standard treatment of bladder carcinomas

A

*Bacille Calmette-Guerin (BCG) (not done here)
endoscopic resection and intravesical chemotherapy

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23
Q

what can be a curative treatment

A

resection of superficial and submucosally invasive low-grade tumors

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24
Q

What is TURBT

A

TransUrethral Resection of Bladder Tumor

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25
Q

What is MIBC

A

Muscle invasive bladder cancer

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26
Q

what is the surveillance schedule for Bladder cancer

A

cystoscopy every 3 months for 1 year
then every 6 months for 1 year
then annually thereafter

27
Q

what are the risk factors for prostate cancer

A

African american
Age
+ FH (2x)
+FH of breast, ovarian CA
high fat diet
perhaps environmental carcinogenic influences

28
Q

what are protective factors for prostate cancer

A

not smoking
healthy weight
physical activity
more frequent ejaculation

29
Q

where does a majority of prostate cancers arise from

A

peripheral zone

30
Q

what is the presentation if a patient has metastasis from prostate cancer

A

weight loss
anemia
bone pain (axial skeleton is m/c site of distal mets)
acute neurologic deficit in lower limbs
urinary retention

31
Q

what are the benefits of PSA screening

A

better for detecting high-grade tumors than low-grade tumors
more predictive when levels are higher

32
Q

what is the definitive diagnosis for prostate cancer

A

transrectal ultrasound-guided biopsy

33
Q

what is the tumor grading and score used for prostate cancer

A

Gleason grade and gleason score

34
Q

what is the treatment for localized prostate cancer

A

radical prostatectomy + radiation

35
Q

what is the treatment for metastatic prostate cancer

A

palliative care

36
Q

what does prostate cancer respone to

A
37
Q

what medication therapies can be used for prostate cancer

A

androgens- use of drugs that block androgen production +/- orchiectomy
androgen deprivation therapy
Luteinizing hormone-releasing hormone (LHRH) agonists

38
Q

what is the most common cancer in men ages 20-35 years old

A

testicular cancer

39
Q

What are the risk factors for developing testicular cancer

A

cryptorchidism
personal hx of testicular cancer
+FHx; Klinefelter’s syndrome
HIV infection
Carcinoma in situ of testicle
race/ethnicity

40
Q

what are the categories of testicular cancer

A

seminomas vs non-seminomas

41
Q

what are non-seminomas

A

embryonic cell carcinomas
teratoma
choriocarcinoma
mixed cell type

42
Q

what is the most common type of testicular cancer

A

germ cell tumors

43
Q

what are the types of germ cell tumors

A

seminomas - slower growing, less spreading; secrete only HCG
non-seminomatous (4 main subtypes)

44
Q

what are the 4 subtypes of non-seminomatous germ cell tumors

A

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

45
Q

what is the less common testicular cancer

A

stromal tumors
- have excellent prognosis:
Leydig cell tumors
Sertoli cell tumors

46
Q

which testicle is more commonly affected by cancer

A

Right Vs. Left
reflective of increased incidence of Right cryptochidism

47
Q

what is the most common symptom of testicular cancer

A

painless mass or diffuse enlargement of testicle
-sensation of heaviness, acute testicular pain from intratesticular hemorrhage, development of hydrocele)

48
Q

What is the presentation of advanced testicular cancer

A

palpable retroperitoneal or supraclavicular nodes (left side)
cough, SOB, hemoptysis of lung mets
LE edema from vena cava obstruction
back pain from retroperitoneal mets

49
Q

what tumor markers may be elevated with testicular cancer

A

Alpha-fetoprotein (AFP)
hCG
Lactate dehydrogenase (LDH)

50
Q

what is the imaging of choice for testicular cancer

A

scrotal ultrasound
may also do abdominal and pelvic CT and chest XR/CT scan

51
Q

how is testicular cancer definitively diagnosed

A

histology

52
Q

what is the gold standard treatment of testicular cancer

A

inguinal orchiectomy
-includes removal of testicle and spermatic cord to level of internal inguinal ring

53
Q

what is the treatment of testicular cancer if positive retroperitoneal nodes or mets

A

combination chemotherapy
resection of residual masses after normalization of tumor markers
+/- retroperitoneal lymphadenectomy

54
Q

what is the follow up schedule for testicular cancer

A

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

55
Q

when is penile cancer most common

A

age groups 50-70 years old
primarily uncircumcised males

56
Q

what are the risk factors for penile cancer

A

lack of circumcision
HPV
HIV
Poor genital hygiene
phimosis
Smegma
number of sexual partners
smoking
increased age
hx of precancerous lesions (leukoplakia, condyloma accuminata)

57
Q

what is the primary type of penile cancer

A

squamous cell carcinoma

58
Q

where does penile cancer typically begin

A

on the foreskin or on the glans

59
Q

what is the presentation of penile cancer

A

most common complaint is the lesion itself
pain
discharge
irritative voiding symptoms
bleeding
enlarged, palpable inguinal lymph nodes

60
Q

what is mandatory for the diagnosis of penile cancer

A

biopsy of the primary lesion

61
Q

what is the treatment for penile cancer

A

goal: organ-sparing procedure if at all possible
small, noninfiltrating lesions: 5FU cream, radiation, MOHS surgery, laser ablation

62
Q

when is total penectomy with formation of perineal urethrostomy necessary

A

deeply infiltrating and proximal lesions for penile cancer

63
Q
A

CLIN MED3: GU/Renal (11 decks)

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