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Urology > GU Cancer > Flashcards

GU Cancer Flashcards

1
Q

Types of GU Cancers

A 
Prostate
Testicular
Penile
Bladder
Renal
Wilms tumor
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2
Q

Epidemiology of Prostate Cancer

A

2nd most common cancer in men

Clinical incidence doesn’t match prevalence at autopsy

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3
Q

Types of Prostate Cancer

A 
Adenocarcinoma (most common)
Sarcomas
Small cell carcinomas
Transitional cell carcinomas
Neuroendocrine tumors
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4
Q

Risk Factors for Prostate Cancer

A 
Age: 40+ years
Race: higher in African-American men
Family history: two fold greater risk with 1st-degree relative
Genetic: BRCA2
Environmental carcinogens: agent orange
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5
Q

Clinical Presentation of Prostate Cancer

A

Early stage cancer: asymptomatic
Symptoms may include: urinary frequency/urgency, nocturne, hesitancy
Hematuria/hematospermia
Bone pain

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6
Q

Diagnosis of Prostate Cancer

A

DRE: nodules, induration, asymmetry
Transrectal ultrasound (TRUS)
MRI
Bone scan

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7
Q

Pathology of Prostate Cancer

A

Acinar cells develop into adenocarcinoma

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8
Q

Zones of the Prostate

A

Peripheral zone
Central zones
Transition zone

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9
Q

Which zone of the prostate are a majority of prostate cancers found?

A

Peripheral zone

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10
Q

Grading of Prostate Cancer

A

Gleason grade: well-differentiated (grade 1) to poorly differentiated (grade 5)
Gleason score = primary tumor grade + secondary tumor grade

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11
Q

Staging of Prostate Cancer

A

Stage 1: found in prostate only
Stage 2: tumor that is too small to be felt or seen on image test (2a) or larger tumor that can be felt on DRE (2b)
Stage 3: cancer has spread beyond the outer layers of the prostate into nearby tissues & maybe seminal vesicles
Stage 4: any tumor that has spread to other parts of the body

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12
Q

Risk Classification of Prostate Cancer

A

Low risk: T1-T2a & Gleason score T2c or Gleason score 8-10 or PSA >20

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13
Q

Define Gleason Score

A

Describes how aggressive the cancer is and how quickly it can spread

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14
Q

Treatment of Prostate Cancer

A 
Active surveillance
Open radical prostatectomy vs. minimally invasive radical prostatectomy (MIRP)
Radiation
High-intensity focused ultrasound (HIFU)
Hormone therapy
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15
Q

When can you use active surveillance in the treatment of prostate cancer?

A

Gleason score

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16
Q

When would you use an open radical prostatectomy or MIRP?

A

Gleason score 6+

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17
Q

Types of Radiation for Treatment of Prostate Cancer

A

External beam
High dose radiation (HDR)
Brachytherapy

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18
Q

When can you use hormone therapy for prostate cancer?

A

Diagnosed in their 70s & 80s & don’t want other treatment
Orchiectomy
Androgen deprivation LHRH

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19
Q

Advantages of External Beam Radiation Therapy

A

Effective long-term cancer control with high-dose treatment
Low risk of urinary incontinence
Available for cure of patients over a wide range of ages & in those with significant comorbidity

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20
Q

Advantages of Brachytherapy

A

Cancer control rates appear equal to surgery & EBRT for organ-confined tumors
Quicker than EBRT
Available for cure of patient over a wide range of ages & in those with some comorbidity

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21
Q

Advantages of Radical Prostatectomy

A

Effective long-term cancer control
Predictions of prognosis can be more precise based on pathologic features in specimen
Pelvic lymph node dissection is possible through the same incision
PSA failure is easy to detect

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22
Q

Advantages of Active Surveillance

A

Reduces over treatment
Avoids or postpones treatment-associated complications
Has no effect on work or social activities

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23
Q

Disadvantages of External Beam Radiation Therapy

A

Significant risk of impotence
Lack of lymph node removed
Knowledge of possible metastasis to lymph nodes not available
Up to half of patients have some temporary bladder or bowel symptoms during treatment

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24
Q

Disadvantages of Brachytherapy

A

Significant risk of impotence
Lack of lymph node removal
Up to half of patients have some temporary bladder or bowel symptoms with treatment

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25
Q

Disadvantages of Radical Prostatectomy

A

Significant risk of impotence
Risk of operative morbidity
Low risk of long-term incontinence

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26
Q

Disadvantages of Active Surveillance

A

Tumor may progress beyond possibility for cure
Later treatment may result in more SE
Living with untreated cancer may cause anxiety

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27
Q

Relative Contraindications to External Beam Radiation Therapy

A

Previous pelvic irradiation
Active inflammatory disease of the rectum
Very low bladder capacity
Chronic moderate or severe diarrhea from any cause

28
Q

Relative Contraindications to Brachytherapy

A 
Previous pelvic irradiation
Large-volume gland
Marked voiding symptoms
Large or high-grade tumor burdens
Chronic moderate or severe diarrhea
Active inflammatory disease of the rectum
29
Q

Relative Contraindications for Radical prostatectomy

A

Higher medical operative risk

Neurogenic bladder

30
Q

Relative Contraindications for Active Surveillance

A

Patients with high prostate cancer anxiety
High-grade tumors (>6 Gleason score)
Prolonged expected survival

31
Q

Epidemiology of Testicular Cancer

A

Most common cancer between 15-35 years old
Spread by lymphatic & blood
Curable if discovered early

32
Q

Testicular Cancer Germ Cell Tumors

A

Seminomas

Non-seminomas (more aggressive)

33
Q

Testicular Cancer Non-Germ Cell Tumors

A

Lydia cell

Sertoli cell

34
Q

Seminoma Testicular Cancer

A

Slow growing tumor
Men 30s & 40s
Sensitive to radiation

35
Q

Non-seminoma Testicular Cancer

A

More common
Quicker growing
4 sub-types: embyonal, yolk sac, choriocarcinoma, teratoma
Occur in teen years & early 40s

36
Q

Causes of Testicular Cancer

A 
Cryptochidism
Family history
Klinefelter syndrome
Previous history of testicular cancer
Caucasian
37
Q

Presentation of Testicular Cancer

A

Painless testicular lump
Enlarging testicle
Accumulation around the testicle (hydrocele)
Metastatic disease

38
Q

Symptoms of Metastatic Disease

A

Swelling of lower extremities
Back pain
Cough
Gynecomastia

39
Q

Diagnosis of Testicular Cancer

A

Scrotal ultrasound
Chest x-ray
CT scan
Tumor markers: beta-hCG, alpha-fetoprotein (AFP), lactate dyhydrogenase (LDH)

40
Q

Staging of Testicular Cancer

A

Stage I: confined to testicle
Stage II: metastases to retroperitoneal nodes
Stage III: metastases above the diaphragm or to visceral organs

41
Q

Treatment of Testicular Cancer

A

Radical orchiectomy
Depending on stage: seminoma (radiation, chemo, or both), non-seminoma (retroperitoneal lymph node dissection, surveillance, chemo)

42
Q

Most Common Type of Penile Cancer

A

Squamous cell carcinoma

43
Q

Risk Factors of Penile Cancer

A

HPV
Age: 50+
Smegma
Phimosis

44
Q

Presentation of Penile Cancer

A

Growth or sore on the penis
Skin thickening on penis
Discharge with foul odor from under the foreskin
Pain in the penis
Swollen lymph nodes in groin
Irregular swelling at the end of the penis

45
Q

Diagnosis of Penile Cancer

A

Biopsy

46
Q

Staging of Penile Cancer

A

Stage 0: not grown below the surface layer of the skin
Stage 1: grown just below the surface layer of the skin
Stage 2: invasion into the shaft or corpora; no nodes or mets
Stage 3: tumor confined to penis; operable inguinal nodal mets
Stage 4: tumor involves adjacent structures; inoperable inguinal lymph nodes and/or distant mets

47
Q

Treatment of Penile Cancer

A 
Laser therapy
Mohs surgery
Partial or total penectomy
Lymph node dissection
Radiation
48
Q

Epidemiology of Bladder Cancer

A

Most common urologic malignancy
Majority transitional cell carcinoma
Women > men: 3-4:1

49
Q

Etiology of bladder Cancer

A

Tobacco exposure
Industrial exposure
Chemotherapy

50
Q

Presentation of Bladder Cancer

A

Painless microscopic or gross hematuria
Frequency
Dysuria
Back/flank pain

51
Q

Diagnosis of Bladder Cancer

A 
Urinalysis
Cystoscopy
Urine cytology
CT IVP
Biopsy
52
Q

Staging of Bladder Cancer

A

Stage 0: papillary lesions relatively benign or carcinoma in situ
Stage 1: tumor invades submucosa or lamina propria
Stage 2: invasion into muscle
Stage 3: extends beyond muscle into the peri-vesical fat
Stage 4: extension into adjacent organs

53
Q

Treatment of Bladder Cancer

A

Biologic therapy
Chemotherapy
Surgery: TURBT, radical cystectomy with urinary diversion, partial cystectomy
Radiation

54
Q

Types of Renal Cancer

A

Renal cell carcinoma
Transitional cell carcinoma
Sarcoma
Wilms tumor

55
Q

Risk Factors for Renal Cancer

A 
Smoking
Male > Female (2-3:1)
Obesity
HTN
Family history
56
Q

Presentation of Renal Cancer

A

Hematuria
Pain/pressure in flank
Fatigue

57
Q

Diagnosis of Renal Cancer

A

UA
Biopsy
CT IVP
Cystoscopy/Nephro-ureteroscopy

58
Q

Staging of Renal Cancer

A

Stage 1: tumor

59
Q

Treatment of Renal Cancer

A

Radio frequency ablation (RFA)
Surgery: radical or partial nephrectomy
Radiation

60
Q

Wilms Tumor

A

Kidney cancer in children
Most frequently between ages 3-4
Female slightly greater than males

61
Q

Risk Factors of Wilms Tumor

A 
Mutated, damaged, missing gene
WAGR syndrome
Beckwith-Wiedemann syndrome
Boys with Deny-Drash syndrome
Family history
62
Q

Presentation of Wilms Tumor

A 
Parent may notice large lump or mass in child's abdomen
Hematuria
HTN
Anemia
Fatigue
Fever that won't go away
63
Q

Diagnosis of Wilms Tumor

A 
UA
Ultrasound
CT scan
Surgical biopsy
Chromosome test
64
Q

Staging of Wilms Tumor

A

Stage 1: tumor in one kidney & can be completely removed with surgery
Stage 2: cancer in kidney, fat, soft tissues, or blood vessels near kidney; tumor removed with surgery
Stage 3: cancer found in areas near kidney & can’t be removed with surgery; not spread outside of abdomen
Stage 4: cancer spread to distant organs
Stage 5: cancer in both kidneys

65
Q

Treatment of Wilms Tumor

A

Surgery: radical or partial nephrectomy
Chemotherapy
Radiation: stages 3 & 4
Clinical trials

Urology (12 decks)

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