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UROLOGY > GU CANCERS > Flashcards

GU CANCERS Flashcards

1
Q

2nd most common cancer in men in america

A

prostate cancer

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2
Q

most common type of prostate cancer

A

adenocarcinoma

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3
Q

most aggressive type of prostate cancer

A

small cell carcinoma

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4
Q

RISK FACTORS FOR PROSTATE CANCER

A

⦁ Age: rare in men < 40; develops in 4th decade of life

⦁ Race: higher rates in African-American men, lower in asian-american / hispanic-latino men

⦁ Family Hx: 2x greater risk with 1st degree relative

⦁ Genetics: Mutations especially on BRCA2 & men with Lynch syndrome

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5
Q

prostate cancer associated with what environmental carcinogen used in military

A

Agent Orange

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6
Q

men with early stage prostate cancer symptoms

A

usually don’t have symptoms!

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7
Q

symptoms of prostate cancer

A 
⦁	urgency / frequency
⦁	nocturia
⦁	hesitancy
⦁	hematuria / hematospermia
⦁	bone pain (mets)
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8
Q

diagnosis of prostate cancer

A
  • DRE (nodules, induration, asymmetry)
  • TRUS
  • MRI
  • Bone scan
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9
Q

pathology of prostate cancer = looking for _____ cells

A

ACINAR CELLS

will develop into Adenocarcinoma

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10
Q

what are the 3 zones of the prostate, and which zone is where the majority of prostate cancers are found

A

1) peripheral = where majority of prostate cancer is found
2) central (least amount found here)
3) transition

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11
Q

which prostate zone is where the majority of prostate cancers are found

A

peripheral

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12
Q

what grade system is used to grade prostate cancer

A

Gleason grading scale (grade 1-5)

⦁ grade 1 = where the cancerous tissue looks like normal prostate tissue

⦁ grade 5 = cancer cells & growth patterns look very abnormal

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13
Q

gleason grading scale

A

⦁ grade 1 = where the cancerous tissue looks like normal prostate tissue
⦁ grade 5 = cancer cells & growth patterns look very abnormal

  • different areas of the prostate can have different cancer grades = so add the grades together
    ex: if primary tumor (where majority of cancer cells are located) = grade 3, and if secondary tumor = grade 4, then have a Gleason grade 7

Need to biopsy the prostate to get a gleason grade; if take multiple biopsies from the primary tumor and they have different gleason grades, then take the higher score

a gleason score of 6 or less = usually more favorable & more slow growing

a gleason score of 8-10 = looking at more small cell cancer that is aggressive/fast growing

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14
Q

a gleason score of _________ = usually more favorable & more slow growing

A

6 or less!

a gleason score of 8-10 = looking at more small cell cancer that is aggressive/fast growing

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15
Q

PROSTATE CANCER TNM STAGING

A

-tumor / mets / nodes

⦁ Stage T1 = cancer only in prostate; can’t be felt by DRE or seen on imaging test

⦁ Stage T2a = tumor that is too small to be felt or seen on image test

⦁ Stage T2b = slightly larger tumor that can be felt on DRE

⦁ Stage T3 = cancer has spread beyond outer layers of prostate into nearby tissues, and may have spread to seminal vesicles

⦁ Stage T4 = any tumor that has spread to other parts of the body

Stage N+ or M+ = has spread to lymph nodes or has metastasized to other areas of the body

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16
Q

at which stage has prostate cancer spread beyond prostate into nearby tissues

A

stage 3

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17
Q

RISK CLASSIFICATION OF PROSTATE CANCER

A

⦁ Low risk = T1-T2A & Gleason score ≤ 6 and PSA ≤ 10

⦁ Intermediate Risk = T2b and/or Gleason score 7 and/or PSA 10-20

⦁ High Risk = ≥ T2c or Gleason score 8-10 or PSA > 20

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18
Q

low risk for prostate cancer

A

T1-T2A & Gleason score ≤ 6 and PSA ≤ 10

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19
Q

intermediate risk for prostate cancer

A

T2b and/or Gleason score 7 and/or PSA 10-20

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20
Q

high risk for prostate cancer

A

≥ T2c or Gleason score 8-10 or PSA > 20

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21
Q

SE of prostatectomy-

A
  • urinary incontinence
  • impotence / ED
  • surgical risks - bleeding
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22
Q

Most common cancer in men between the age of 15-35 y/o

A

TESTICULAR CANCER

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23
Q

testicular cancer spreads by

A

lymphatics & blood

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24
Q

90-95% of all primary testicular cancer tumors arise from

A

germ cells

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25
Q

germ cell vs non-germ cell tumors of testicular cancer

A

90-95% of all primary tumors arise from germ cells

Germ cell tumors (more common than non-germ cell tumors)
⦁ Seminomas
⦁ Nonseminomas (more aggressive/ more common)

Non-Germ cell tumors
⦁ Leydig Cells
⦁ Sertoli Cells

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26
Q

germ cell tumors

A

seminoma

non-seminoma = more aggressive & more common

27
Q

SEMINOMA GERM CELL TUMOR (testicular cancer)

A
  • slow growing tumor
  • found in men in 30-40s
  • very sensitive to radiation
28
Q

NON-SEMINOMA GERM CELL TUMOR (testicular cancer)

A
  • more common
  • quicker growing
- 4 types
⦁	Embryonal carcinoma
⦁	yolk sac carcinoma
⦁	choriocarcinoma
⦁	teratoma
  • occur in teen years & early 40s
  • most often get a mixed non-seminoma germ cell cancer = mixture of subtypes
29
Q

CAUSES OF TESTICULAR CANCER

A 
Cryptorchidism
Family history
Klinefelter syndrome
Previous history of testicular cancer
Caucasian
30
Q

PRESENTATION OF TESTICULAR CANCER

A 
⦁	Painless testicular lump
⦁	Enlarging testicle
⦁	Accumulation around the testicle
⦁	Metastatic disease
	- Swelling of lower extremities
	- Back pain 
	- Cough
	- Gynecomastia
31
Q

DIAGNOSIS OF TESTICULAR CANCER - IMAGING OF CHOICE

A

SCROTAL ULTRASOUND

32
Q

TUMOR MARKERS FOR TESTICULAR CANCER

A
  • AFP
  • BETA-HCG
  • LDH
  • AFP = not elevated with seminomas & choriocarcinoma - they do not produce AFP
  • beta-HCG = elevated with seminomas, choriocarcinoma and embryonal

LDH = any tumor type

33
Q

which testicular cancers don’t produce AFP

A

seminomas & choriocarcinomas

if AFP present = could be any nonseminomatous but chorio (embryonal, yolk sac or teratoma)

34
Q

80% of seminomas are in what stage

A

stage I (slow growing!)

35
Q

men with Non-seminomatous germ cell tumors

are in what stage

36
Q

chemo combo (BEP)

A

bleomycin, etoposide, and cisplatin

37
Q

treatment with testicular cancer

A

low grade (stage I) nonseminoma = orchiectomy with retroperitoneal lymph node dissection

low grade seminoma = orchiectomy & radiation

high grade seminoma = chemo, orchiectomy & XRT

38
Q

penile cancer occurs mainly in

A

uncircumcised men > 60

39
Q

most common type of penile cancer

A

squamous cell

40
Q

risk factors for penile cancer

A

⦁ HPV**
⦁ Age (> 50)
⦁ Smegma (poor hygiene)
⦁ Phimosis

41
Q

greatest risk factor for penile cancer

42
Q

PRESENTATION OF PENILE CANCER

A

⦁ growth or sore on penis
⦁ skin thickening on penis
⦁ discharge with foul odor from under foreskin
⦁ innguinal adenopathy present 30-60% of cases
⦁ distant mets = uncommon

43
Q

DIAGNOSIS OF PENILE CANCER

44
Q

PENILE CANCER STAGINNG

A

⦁ 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

45
Q

penile cancer treatment

A 
Laser therapy
Mohs surgery
Partial or total penectomy
Lymph node dissection
Radiation
46
Q

most cases of bladder cancer are

A

transitional cell carcinoma - Urothelial

47
Q

most common risk factor for bladder cancer

A

smoking*** (tobacco)

other causes == chemical exposure & chemo

48
Q

bladder cancer is more common in

49
Q

presentation of bladder cancer

A

⦁ **Most common = painless microscopic or gross hematuria
⦁ frequency
⦁ dysuria
⦁ back or flank pain - advanced / mets

50
Q

most common symptom of bladder cancer

A

painless hematuria

51
Q

diagnosis of bladder cancer

A
  • Urinalysis
  • urine cytology
  • GOLD STANDARD = CYSTOSCOPY**
52
Q

localizing the source

A

o hematuria only at beginning of urination = urethral source

o blood only with discharge between voidings or stain on undergarments and urine is clear = urethral meatus or anterior urethra

o terminal hematuria - blood appears towards end of voiding = originates from bladder neck or prostatic urethra

o hematuria throughout voiding = anywhere in urinary tract, including bladder, ureters or kidneys

53
Q

bladder cancer likes to spread to the

A

lungs
liver
bone

54
Q

TREATMENT FOR BLADDER CANCER

A

⦁ BCG - uses pt’s immune system to fight cancer
⦁ chemo
⦁ surgery = TURBT (bladder resection) or if advanced = radical cystectomy or partial cystectomy
⦁ radiation

  • if no detrusor muscle involved = TURBT & either BCG or chemo
55
Q

most common type of renal cancer

A

RENAL CELL CARCINOMA

56
Q

risk factors for renal cancer

A

⦁ smoking
⦁ male
⦁ obesity
⦁ family hx

57
Q

presentation of renal cancer

A

⦁ hematuria
⦁ pain/pressure in flank
⦁ fatigue

58
Q

diagnosis of renal cancer

A
  • UA
  • biopsy
  • CT IVP
  • Cystoscopy / Nephro-ureteroscopy
59
Q

staging of renal cancer

A

⦁ 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)

**7cm = magic number; < 7cm = stage 1, >7cm = stage 2

60
Q

renal cancer does NOT respond well to

A

chemo = have to do surgery +/- radiation

61
Q

treatment for renal cancer

A
  • RFA - radiofrequency ablation
  • Surgery - partial or radical nephrectomy
  • radiation
  • doesn’t respond well to chemo
62
Q

risk factors for wilm’s tumor

A 
Mutated, damaged, missing gene
WAGR syndrome 
Beckwith-Wiedemann syndrome
Boys with Deny-Drash syndrome
Family history
63
Q

presentation of wilm’s tumor

A 
Parent may notice a large lump or mass in child's abdomen***
Hematuria
HTN
Anemia
Fatigue
Fever that doesn’t go away
64
Q

diagnosis of wilm’s tumor

A
  • UA
  • abdominal ultrasound***** = best initial test
  • CT scan = (with contrast) = more accurate
  • surgical biopsy
  • chromosome test

UROLOGY (12 decks)

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