Genitourinary Neoplasms Flashcards
What is the peak age of incidence for renal cell carcinoma?
55 y.o. (50-70 years)
What are the risk factors of renal cell carcinoma?
Cigarette Smoking**
Obesity
Hypertension
Dialysis related acquired cysts
Several autosomal dominant familial causes
What type of cancer is renal cell carcinoma?
Adenocarcinoma
Other less common types: clear cell, papillary, chromophobe
Although RCC doesn’t typically metastasis, when it does what is the more common location?
Lungs
About 15% of patients with RCC will have this triad of presenting symptoms?
Hematuria
Flank or abdominal pain
Flank or abdominal mass
True or False: Any solid renal masses should be considered malignant until proven otherwise
True
*Why biopsies are rare
Are biopsies typically done to diagnose RCC?
No not commonly performed in practice although considered to be the gold standard. There are no tumor markers specific for RCC and the risk of seeding is too great
What is the standard workup for RCC?
- CT of abdomen/pelvis or MRI
- CXR (unless mets are suspected then do a CT)
- Urinanlysis
- Urine cytology
- Labs: CBC, BMP, LFT’s
What is the treatment for localized RCC?
- Radical or partial nephrectomy
What is the treatment for metastatic disease?
Surgery and chemo have a limited role in the treatment
Radiation for palliation of bone or brain metastases
Palliative care
What are the risk factors for bladder cancer?
- Smoking
- Occupational exposure to chemicals (hairdressers, workers with rubber, dye, leather etc.)
- Arsenic in well water in New England
What is the most common presenting symptom with bladder carcinoma?
Gross or microscopic hematuria
What is the test of choice for working up bladder carcinoma?
Cystoscopy (+/- biopsy of any tumors seen)
Due to the high reoccurrence rate of bladder cancer what is the follow-up cytoscopy schedule after cessation of treatment?
- Every 3 months for one year
- Then every 6 months x1 year
- Then annually thereafter
What is the first line treatment for bladder carcinoma in situ and large high grade, recurrent Ta or T1 masses?
Bacille Calmette-Guerin (attenuated strain of mycobacterium bovis) given weekly for 6-12 weeks
What are the risk factors for prostate cancer?
- African American
- Age
- Fhx
- FH of breast, ovarian cancer
- High fat diet
- Perhaps environmental carcinogenic influences
Does early prostate cancer typically present with symptoms?
No, usually identified via PSA screening
Is BPH a risk factor for prostate cancer?
No, but it does cause elevated PSA levels on screening which then leads to biopsy for cancer
With metastasis present in prostate cancer what are some of the presenting symptoms?
- Weight loss
- Anemia
- Bone pain (commonly the lumbosacral area)
- Acute neurologic deficit in the lower limbs
- Urinary retention
What is the way to definitively diagnose prostate cancer?
Transrectal ultrasound-guided biopsy
What is the treatment of localized prostate cancer?
Radical prostatectomy + radiation therapy
or Surgery open, lap or robotic
What is the most common cancer in men age 20 to 35?
Testicular cancer
What is the average age of testicular cancer?
33
What are the two classifications of testicular cancer?
Seminomas and non-seminomas
What are the types of non-seminoma testicular cancer?
- Embryonic cell carcinoma
- Teratoma
- Choriocarcinoma
- Mixed cell type (m/c)
What is the most common testicular cancer in kids?
Yolk sac (responds to chemo)
What is secreted by seminomas?
HCG
Are mets common at presentation with testicular cancer?
Yes, 50% of patients will have metastases when first evaluated
What is the most common presenting symptom of testicular cancer?
Painless mass or diffuse enlargement of the testicle
What sites are lymphadenopathy common in testicular cancer?
Supraclavicular or inguinal
What are some symptoms with advanced testicular cancer?
- Palpable retroperitoneal or supraclavicular nodes, particulary on the left side
- Cough, SOB, hemoptysis of lung mets
- LE edema from vena caval obstruction
- Back pain from retroperitoneal mets
What labs should be ordered in working up testicular cancer?
- Alpha-fetoprotein (AFP)
- hCG (not normally detectable in men)
- Lactate dehydrogenase (LDH)
What lab level maybe slightly elevated in those who use mariguana heavily?
hCG
What is the imaging modality of choice in working up testicular cancer?
Scrotal ultrasound
What is the gold standard treatment of testicular cancer?
Inguinal Orchiectomy
Is testicular associated with a high rate of recurrence?
Yes, recurrence in 20-30% of pats on active surveillance (usually w/in first 2 years)
What are some risk factors for penile cancer?
- Lack of circumcision
- HPV
- HIV
- Poor hygiene
- Number of sexual partners
- Smoking
- Increased age
What are some of the presenting symptoms of penile cancer?
- Lesion
- Pain
- Discharge
- Irritative voiding symptoms
- Bleeding
- Enlarged, palpable inguinal lymph nodes
