GU Cancer Flashcards
Types of GU Cancers
Prostate Testicular Penile Bladder Renal Wilms tumor
Epidemiology of Prostate Cancer
2nd most common cancer in men
Clinical incidence doesn’t match prevalence at autopsy
Types of Prostate Cancer
Adenocarcinoma (most common) Sarcomas Small cell carcinomas Transitional cell carcinomas Neuroendocrine tumors
Risk Factors for Prostate Cancer
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
Clinical Presentation of Prostate Cancer
Early stage cancer: asymptomatic
Symptoms may include: urinary frequency/urgency, nocturne, hesitancy
Hematuria/hematospermia
Bone pain
Diagnosis of Prostate Cancer
DRE: nodules, induration, asymmetry
Transrectal ultrasound (TRUS)
MRI
Bone scan
Pathology of Prostate Cancer
Acinar cells develop into adenocarcinoma
Zones of the Prostate
Peripheral zone
Central zones
Transition zone
Which zone of the prostate are a majority of prostate cancers found?
Peripheral zone
Grading of Prostate Cancer
Gleason grade: well-differentiated (grade 1) to poorly differentiated (grade 5)
Gleason score = primary tumor grade + secondary tumor grade
Staging of Prostate Cancer
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
Risk Classification of Prostate Cancer
Low risk: T1-T2a & Gleason score T2c or Gleason score 8-10 or PSA >20
Define Gleason Score
Describes how aggressive the cancer is and how quickly it can spread
Treatment of Prostate Cancer
Active surveillance Open radical prostatectomy vs. minimally invasive radical prostatectomy (MIRP) Radiation High-intensity focused ultrasound (HIFU) Hormone therapy
When can you use active surveillance in the treatment of prostate cancer?
Gleason score
When would you use an open radical prostatectomy or MIRP?
Gleason score 6+
Types of Radiation for Treatment of Prostate Cancer
External beam
High dose radiation (HDR)
Brachytherapy
When can you use hormone therapy for prostate cancer?
Diagnosed in their 70s & 80s & don’t want other treatment
Orchiectomy
Androgen deprivation LHRH
Advantages of External Beam Radiation Therapy
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
Advantages of Brachytherapy
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
Advantages of Radical Prostatectomy
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
Advantages of Active Surveillance
Reduces over treatment
Avoids or postpones treatment-associated complications
Has no effect on work or social activities
Disadvantages of External Beam Radiation Therapy
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
Disadvantages of Brachytherapy
Significant risk of impotence
Lack of lymph node removal
Up to half of patients have some temporary bladder or bowel symptoms with treatment
Disadvantages of Radical Prostatectomy
Significant risk of impotence
Risk of operative morbidity
Low risk of long-term incontinence
Disadvantages of Active Surveillance
Tumor may progress beyond possibility for cure
Later treatment may result in more SE
Living with untreated cancer may cause anxiety
Relative Contraindications to External Beam Radiation Therapy
Previous pelvic irradiation
Active inflammatory disease of the rectum
Very low bladder capacity
Chronic moderate or severe diarrhea from any cause
Relative Contraindications to Brachytherapy
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
Relative Contraindications for Radical prostatectomy
Higher medical operative risk
Neurogenic bladder
Relative Contraindications for Active Surveillance
Patients with high prostate cancer anxiety
High-grade tumors (>6 Gleason score)
Prolonged expected survival
Epidemiology of Testicular Cancer
Most common cancer between 15-35 years old
Spread by lymphatic & blood
Curable if discovered early
Testicular Cancer Germ Cell Tumors
Seminomas
Non-seminomas (more aggressive)
Testicular Cancer Non-Germ Cell Tumors
Lydia cell
Sertoli cell
Seminoma Testicular Cancer
Slow growing tumor
Men 30s & 40s
Sensitive to radiation
Non-seminoma Testicular Cancer
More common
Quicker growing
4 sub-types: embyonal, yolk sac, choriocarcinoma, teratoma
Occur in teen years & early 40s
Causes of Testicular Cancer
Cryptochidism Family history Klinefelter syndrome Previous history of testicular cancer Caucasian
Presentation of Testicular Cancer
Painless testicular lump
Enlarging testicle
Accumulation around the testicle (hydrocele)
Metastatic disease
Symptoms of Metastatic Disease
Swelling of lower extremities
Back pain
Cough
Gynecomastia
Diagnosis of Testicular Cancer
Scrotal ultrasound
Chest x-ray
CT scan
Tumor markers: beta-hCG, alpha-fetoprotein (AFP), lactate dyhydrogenase (LDH)
Staging of Testicular Cancer
Stage I: confined to testicle
Stage II: metastases to retroperitoneal nodes
Stage III: metastases above the diaphragm or to visceral organs
Treatment of Testicular Cancer
Radical orchiectomy
Depending on stage: seminoma (radiation, chemo, or both), non-seminoma (retroperitoneal lymph node dissection, surveillance, chemo)
Most Common Type of Penile Cancer
Squamous cell carcinoma
Risk Factors of Penile Cancer
HPV
Age: 50+
Smegma
Phimosis
Presentation of Penile Cancer
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
Diagnosis of Penile Cancer
Biopsy
Staging of Penile Cancer
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
Treatment of Penile Cancer
Laser therapy Mohs surgery Partial or total penectomy Lymph node dissection Radiation
Epidemiology of Bladder Cancer
Most common urologic malignancy
Majority transitional cell carcinoma
Women > men: 3-4:1
Etiology of bladder Cancer
Tobacco exposure
Industrial exposure
Chemotherapy
Presentation of Bladder Cancer
Painless microscopic or gross hematuria
Frequency
Dysuria
Back/flank pain
Diagnosis of Bladder Cancer
Urinalysis Cystoscopy Urine cytology CT IVP Biopsy
Staging of Bladder Cancer
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
Treatment of Bladder Cancer
Biologic therapy
Chemotherapy
Surgery: TURBT, radical cystectomy with urinary diversion, partial cystectomy
Radiation
Types of Renal Cancer
Renal cell carcinoma
Transitional cell carcinoma
Sarcoma
Wilms tumor
Risk Factors for Renal Cancer
Smoking Male > Female (2-3:1) Obesity HTN Family history
Presentation of Renal Cancer
Hematuria
Pain/pressure in flank
Fatigue
Diagnosis of Renal Cancer
UA
Biopsy
CT IVP
Cystoscopy/Nephro-ureteroscopy
Staging of Renal Cancer
Stage 1: tumor
Treatment of Renal Cancer
Radio frequency ablation (RFA)
Surgery: radical or partial nephrectomy
Radiation
Wilms Tumor
Kidney cancer in children
Most frequently between ages 3-4
Female slightly greater than males
Risk Factors of Wilms Tumor
Mutated, damaged, missing gene WAGR syndrome Beckwith-Wiedemann syndrome Boys with Deny-Drash syndrome Family history
Presentation of Wilms Tumor
Parent may notice large lump or mass in child's abdomen Hematuria HTN Anemia Fatigue Fever that won't go away
Diagnosis of Wilms Tumor
UA Ultrasound CT scan Surgical biopsy Chromosome test
Staging of Wilms Tumor
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
Treatment of Wilms Tumor
Surgery: radical or partial nephrectomy
Chemotherapy
Radiation: stages 3 & 4
Clinical trials
