GU Cancers Flashcards
- What is the most common histological type of prostate cancer?
- Other types? 4
- Adenocarcinoma most common type
- Other types
- Sarcomas
- Small cell carcinomas
- Transitional cell carcinomas
- Neuroendocrine tumors
PROSTATE CANCER
Risk factors? 4
- Age
- Race
- Famil hx
- Genetic
- Environmental agents
Prostate CA risk factors:
Age
1. Rare in men of what age?
Race
- Higher rates in what race?
- Lower rates in what races? 2
Famil hx
4. Two fold greater risk with what?
Genetic
- Mutations especially with what?
- Men with what syndrome?
- Environmental causes?
Risk factors
Age
1. Rare in men younger than 40 y/o
-Develops in the 4th decade of life
Race
- Higher rates in African-American men
- Lower rate in
- Asian-American/
- Hispanic-Latino men
Family history
4. Two fold greater risk with first-degree relative
Genetic
- Mutations especially on BRCA2 increase risk in men
- Men with Lynch syndrome
- Environmental carcinogens
Agent Orange
Clinical presentation of prostate cancer?
6
- Men with early stage cancer usually have no symptoms
- Urinary frequency/urgency
- Nocturia
- Hesitancy
- Hematuria/Hematospermia
- Bone pain
Prostate cancer Dx?
4
- Physical exam/DRE
- Transrectal Ultrasound (TRUS)/MRI guided
- MRI
- Bone scan
What are you looking for on the DRE for prostate cancer?
3
- Nodules
- Induration
- Asymmetry
- Pathology: Prostate Cancer?
2. What are the zones of the prostate and state what percentage of cancer is found in each? 3
- Acinar cells of the prostate will develop into adenocarcinoma
- Zones of the prostate
- Peripheral zone (Majority of prostate cancer is found) 70%!
- Central zones (2-5% of prostate cancers are found)
- Transition zone (10-20% of prostate cancers are found)
PROSTATE CANCER
Describe the Gleason grade and staging?
Grading and Staging
Gleason grade
Scoring system using numbers 1-5
–Grade 1
Cancerous tissue looks like normal prostate tissue
–Grade 5
Cancer cells and growth patterns look very abnormal
Gleason grade
1. Different areas of the prostate have different what?
- Gleason grade (sum) adds what?
- Which ones?
Example
- Majority of the cancer is grade what?
- Less of the majority is grade what?
- 3 + 4 = Gleason grade __
- cancer grades
- two grades together
- Primary tumor and Secondary tumor - 3 (primary)
- 4 (secondary)
- 7
Staging
TMN system
describe the following:
1. Stage T1?
- Stage T2a and T2b?
- Stage T3?
- Stage T4?
- Stage N+ or M+?
- cancer is found in the prostate only. Cannot be felt by DRE or seen on imaging test
- a tumor that is to small to be felt or seen on image test (2a) or a slightly larger tumor that can be felt on DRE (2b)
- cancer has spread beyond the outer layers of the prostate into nearby tissues, and may have spread to seminal vesicles
- any tumor that has spread to other parts of the body
- Spread to lymph nodes or metastasized to other areas of the body
Prostate cancer risk classification: 1. Low risk?
- Intermediate risk?
- High risk?
- T1-T2a and gleason score less than or equal to 6 and PSA less than or equal to 10
- T2b and/or Gleason score 7 and/or PSA 10-20
- Greater than or equal to 8-10 or PSA greater than 20
Prostate CA Treatment?
5
Treatment
- Active surveillance
- Open Radical Prostatectomy vs MIRP (Gleason 6 and up)
- Radiation
- HIFU (High-Intensity Focused Ultrasound)
- Hormone therapy
Prostate cancer Tx:
1. Active surveillence at what staging level?
- When would you do Open Radical Prostatectomy vs MIRP?
- What are the kinds of radiation you could use? 3
- What kinds of hormone therapy? 2
- Gleason 6
- Gleason 6 and up
- External Beam
- High Dose Radiation (HDR)
- Brachytherapy
- Orchiectomy
- Androgen deprivation LHRH (Luteinizing Hormone-Releasing Hormone)
Testicular CA:
- Most common in what ages?
- Tumor spreads how? 2
- Prognosis?
- 90-95% of all primary tumors arise from what?
- Most common cancer in men between the age of 15-35 y/o
- Tumor spreads by lymphatics and blood
- Highly curable if discovered early
- 90-95% of all primary tumors arise from germ cells
Testicular CA
1. Germ cell tumor types? 2
- Non-germ cell tumors types? 2
- Germ cell tumors
- Seminomas (50%)
- Nonseminomas (more aggressive) - Non-Germ cell tumors (5%)
- Leydig cell
- Sertoli cell
TESTICULAR CANCER
- What is a seminoma?
- Found in what type of men?
- Very sensitive to what?
Nonseminoma
- How is it different than a seminoma?
- 4 sub-types?
- Occur in what years?
Seminoma
- Slow growing tumor
- Found in men in their 30’s and 40’s
- Very sensitive to radiation
Nonseminoma
- More common and quicker growing
- 4 sub-types
- Embryonal carcinoma
- Yolk sac carcinoma
- Choriocarcinoma
- Teratoma - Occur in teen years and early 40’s
- Causes of testicular cancer? 5
2. Presentation? 4
- Causes
- Cryptorchidism
- Family history
- Klinefelter syndrome
- Previous history of testicular cancer
- Caucasian - Presentation
- Painless testicular lump
- Enlarging testicle
- Accumulation around the testicle
- Metastatic disease
Testicular cancer: What would suggest metastatic disease? 4
- Swelling of lower extremities
- Back pain
- Cough
- gynecomastia
Testicular CA Dx? 4
Diagnosis
- Scrotal ultrasound
- Chest x-ray
- CT scan
- Tumor markers
What are the tumor markers for testicular cancer? 3
- Beta-HCG
- Alpha-fetoprotein (AFP)
- Lactate dyhydrogenase (LDH)
TESTICULAR CANCER
Describe staging I-III?
Staging
1. Stage I
Confined to the testicle
- Stage II
Metastases to retroperitoneal nodes - Stage III
Metastases above the diaphragm or to visceral organs
TESTICULAR CANCER
- Tx?
- Depending on the stage:
- Seminoma? 2
- Nonseminoma? 2 - Enourage what?
- Treatment
Radical orchiectomy - Depending on stage:
-Seminoma
Radiation, chemotherapy or both
-Nonseminoma
RPLND or surveillance
Chemotherapy
- Encourage self-testicular exams!
Penile Cancer
- Occurs mostly in who?
- Histological type?
- Risk Factor? 4
Rare type of cancer making up less than 1% of all cancers diagnosed in men
- Occurs mainly in uncircumcised men
- Squamous cell carcinoma (95%)
- Risk Factors
- HPV
- Age (>50 y/o)
- Smegma (Poor hygiene)
- Phimosis
PENILE CANCER
- Presentation? 6
- Dx? 1
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
Diagnosis
1. biopsy
PENILE CANCER
Describe staging 0-IV?
Staging
1. Stage 0
Cancer has not grown below the surface layer of the skin
- Stage I
Cancer has grown just below the surface layer of the skin - Stage II
Invasion into the shaft or corpora; no nodes or metz - Stage III
Tumor confined to the penis; operable inguinal nodal metz - Stage IV
Tumor involves adjacent structures, inoperable inguinal lymph nodes and/or distant metz
PENILE CANCER
Tx?5
Treatment
- Laser therapy
- Mohs surgery
- Partial or total penectomy
- Lymph node disection
- Radiation
Bladder Cancer
- Majority of the cancers are what tissue type?
- More common in what gender?
- Etiologies? 3
- One of the most common Urologic malignancy
- Majority of cases are Transitional Cell Carcinoma (65-75%)
- 3-4 times more common in women
- Etiology
- Tobacco exposure
- Industrial exposure (Aniline dyes, textile printing, rubber manufacturing)
- Chemotherapy (Cyclophosphamide and Ifosfamide)
BLADDER CANCER
- Presentation? 4
- Dx? 5
- Presentation
- Most common is painless microscopic or gross hematuria (85%)
- Frequency
- Dysuria
- Back or flank pain - Diagnosis
- Urinalysis
- Cystoscopy
- Urine cytology
- CT IVP
- Biopsy
Bladder Cancer Staging
Describe Stages 0-4?
5
- 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 perivesical fat
- Stage 4: extension into adjacent organs
BLADDER CANCER
Tx?
4
- Biologic therapy
- Chemotherapy
- Surgery
- Radiation
Bladder Cancer:
1. Describe what the biologic therapy is?
- What kinds of surgery? 3
- Biologic therapy
- Uses patients immune system to fight the cancer (BCG) - Surgery
- TURBT
- Radical cystectomy with urinary diversion
- Partial cystectomy
RENAL CANCER
- Types of renal cancer? 4
- Risk factors? 5
- Presentations? 3
- Types of renal cancer
- Renal cell carcinoma (85%)
- Transitional cell carcinoma (10-15%)
- Sarcoma
- Wilms Tumor - Risk factors
- Smoking
- Male (2-3 times more than females)
- Obesity
- HTN
- Family history - Presentation
- Hematuria
- Pain/pressure in flank
- fatigue
RENAL CANCER
Dx? 4
- Urinalysis
- Biopsy
- CT IVP
- Cystoscopy/Nephro-ureteroscopy
Renal Cancer Staging: Describe stage 1-4
Staging
1. Stage 1: tumor is 7cm or less within the kidney (T1,N0,M0)
- Stage 2: tumor is larger than 7cm within the kidney (T2,N0,M0)
- Stage 3: tumor of any size with spread into regional lymph nodes, or tumor grown into major veins or perinephric tissue (T1,T2,N1,M0) or (T3, N+,M0)
- Stage 4: tumor has spread beyond Gerota’s fascia into the adrenal gland (same side) with lymph nodes but not to other body parts, or spread to other body parts (T4,N+,M0) or (T4,N+,M1)
RENAL CANCER
Tx? 3
- Radiofrequency ablation (RFA)
- Surgery (Radical Nephrectomy and Partial Nephrectomy)
- Radiation
Wilms Tumor
- What is it?
- Occurs most often in which ages?
- Male to female ratio?
- Mean age at Dx?
- Kidney cancer in children
- Occur most often between ages 3 and 4, uncommon after age 6
- Male to female ratio
Unilateral 0.92:1.00
Bilateral 0.60:1.00
4. Mean age at diagnosis 44 months (unilateral) 31 months (bilateral)
WILMS TUMOR
- Risk factors? 5
- Presentation? 6
- Risk factors
- Mutated, damaged, missing gene
- WAGR syndrome
- Beckwith-Wiedemann syndrome
- Boys with Deny-Drash syndrome
- Family history - Presentation
- Parent may notice a large lump or mass in child’s abdomen
- Hematuria
- HTN
- Anemia
- Fatigue
- Fever that doesn’t go away
WILMS TUMOR
1. Dx? 5
- Describe the Stages? 5
- Diagnosis
- Urinalysis
- Ultrasound
- CT scan
- Surgical biopsy
- Chromosome test
Stages
1. Stage 1: tumor is in one kidney and can be completely removed with surgery
- Stage 2: cancer is found in the kidney, fat, soft tissues, or blood vessels near the kidney. Tumor can be removed with surgery
- Stage 3: cancer found in areas near the kidney and cannot be removed with surgery. Has not spread outside the abdomen
- Stage 4: cancer has spread to distant organs
- Stage 5: cancer is in both kidneys. Each kidney staged seperately
Wilms tumor Tx?
3
Treatment 1. Surgery (Radical Nephrectomy and Partial Nephrectomy) 2. Chemotherapy 3. Radiation -Stages 3 & 4
Clinical trials
