GU Cancer Flashcards
Prostate CA:
- MC type
- other types
- risk factors
- clinical presentation
MC type is adenocarcinoma
Others: sarcomas, small cell carcinomas, transitional cell carcinomas, neuroendocrine tumors
Risk factors:
- age: greater than 40YO
- Race: highest in african american men
- FHx
- Genetics: BRCA 2 or Lynch syndrome
- environmental agents: agent orange
Presentation:
- early stages have no sx
- later:
- -urinary frequency/urgency
- -nocturia
- -hesitancy
- hematuria/hematospermia
- bone pain
Prostate CA:
-dx
Dx:
-DRE: nodules, induration, asymmetry
- TRUS (Transrectal US)
- MRI
- Bone Scan
- pathology: peripheral zone cells develop into adenocarcinoma
Prostate CA:
- grading
- staging
Grading:
-Gleason grade = scoring system using numbers 1-5. 1 = cancerous tissue looks like normal prostate tissue, 5 = cancer cells and growth patterns loo very abnormal.
*different areas of the prostate have different cancer grades, the gleason grade sums two grades together, the primary and secondary tumor.
EXAMPLE: majority of CA is grade 3(primary), less majority of the grade is 4 (secondary) so, gleason grade is 7.
Staging:
- TNM system;
- -Stage T1 CA is found in the prostate only
- -Stage T2a and T2b
- -Stage T3 - spread to seminal vesicles
- -Stage T4 is any tumor that has spread to other parts of the body.
Stage N+ or M+: spread to lymph nodes or metastasized to other areas of the body.
Prostate CA:
- risk classification:
- -what stage, grade, and PSA is considered low risk, intermediate risk, andd high risk?
Low risk:
-stage T1-T2a and Gleason less than 6, PSA less than/= 10
Intermediate:
-stage T2b, gleason score 7 and PSA 10-20
High risk:
-stage greater than T2C, gleason score 8-10 or PSA greater than 20
Prostate CA:
- tx
- which tx option has the highest risk of ED and incontinence?
Tx:
- active surveillance with gleason 6
- open radical prostatectomy vs MIRP w/ gleason 6 and up.
- radiation; external beam, high dose radiation, brachytherapy
- HIFU (high intensity focus US)
- Hormone therapy (orchiectomy, androgen deprivation LHRH) (LHRH = LH releasing hormone)
highest risk of ED and incontinence is open radical prostateectomy and MIRP. (minimally invasive radioguided prostate surgery)
Testicular CA:
- MC in what ages?
- 90-95% of tumors arise from what cells?
- MC type of tumor
- causes
MC in 15-35YO
90-95% of all primary tumors arise from germ cells
MC type of tumor are germ cell tumors:
- seminomas (50%)
- nonseminomas (more aggressive)
non-germ cell tumors: (5%)
- leydig cell
- sertoli cell
Causes:
- cryptochidism
- FHx
- Klinefelter syndrome
- previous hx of testicular CA
- caucasian
Testicular Ca:
- presentation
- dx
Presentation:
- painless testicular lump
- enlarging testicle
- accumulation around the testicle
- metastatic dz:
- -swelling of lower extremities
- -back pain
- -cough
- -gynecomastia
Dx:
- scrotal US
- Chest xray
- CT scan
- Tumor markers
- -beta HCG
- -alpha-fetoprotein
- -LDH
Testicular CA:
- staging
- tx
Stage 1: confined to testicle
Stage II: mets to retroperitoneal nodes
Stage III: mets above the diaphragm or to visceral organs
Tx:
- radical orchiectomy
- depends upon stage:
- -seminoma = radiation, chemo, or both
- -nonseminoma = RPLND or surveillance or chemo
**encourage self-testicular exam
RPLND = retroperitoneal lymph node dissection
Penile CA:
- MC in males who are circumsized or not?
- type of CA
- risk factors
- presentation
- dx
MC in those who are uncircumcised
Squamous cell carcinoma
risk factors:
- HPV
- age: greater than 50YO
- smegma (poor hygiene)
- phimosis
Presentation:
- 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.
Dx: bx
Penile CA:
-staging
Staging:
-Stage 0 = CA has not grown below surface layer of skin
-Stage 1 = CA has 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 LN and or distant mets
Penile CA:
-tx
Tx:
- laser therapy
- Mohs surgery
- Partial or total penectomy
- LN dissection
- radiation
Bladder CA :
- MC type?
- cause
- presentation
MC type is transitional cell carcinoma
Cause:
- tobacco exposure
- industrial exposure (aniline dyes, textile printing, rubber)
- chemotherapy (cyclophosphamide and ifosfamide)
Presentation:
- MC is painless microscopic or gross hematuria
- frequency
- dysuria
- back or flank pain
Dx:
- urinalysis
- cystoscopy
- urine cytology
- CT IVP
- Bx
Bladder CA:
- staging
- tx
Stage 0 = lesions benign or carcinoma in situ
Stage 1 = invades submucosa or lamina propria
Stage 2 = invsaion into muscle
Stage 3 = extends beyond muscle into perivesical fat
stage 4 = extension into adjacent organs
Tx:
- biologic therapy: uses pt immune system to fight CA, BCG
- chemotherapy
- surgery:
- -TURBT
- -Raddical cystectomy with urinary diversion
- -radical cystectomy
- radiation
Renal CA:
- types
- MC type
- risk factors
- presentation
Types :
- renal cell carcinoma (MC)
- transitional cell carcinoma
- sarcoma
- wilms
Risk:
- smoking
- male
- obesity
- HTN
- FHx
Presentation:
- hematuria
- pain/pressure in flank
- fatigue
Renal CA:
- dx
- staging
- tx
Dx;
- urinalysis
- bx
- CT IVP
- Cystoscopy
Staging:
- Stage 1 = tumor less than 7cm within the kidney
- stage 2: tumor larger than 7cm within the kidney
- stage 3: tumor of any size with spread to regional LN
- stge 4: tumor spread beyond Gerotas fascia into the adrenal gland with LN but not to other body parts or spread to other body parts
Tx:
- radiofrequency ablation (RFA)
- surgery:
- -radical nephrectomy
- -partial nephrectomy
- Radiation
