GU neoplasms

Question 1

What is the biggest environmental risk factor for RCC

Answer 1

Smoking

Question 2

What type of cancer is RCC

what are the subtypes

Answer 2

adenocarcinoma

clear cell, papillary, chromophobe

Question 3

Where do adenocarcinomas originate within the kidney

Answer 3

proximal renal tubular epithelium

Question 4

How do RCC proliferate

Answer 4

through VEGF stimulating angiogenesis = overexpression of RCC

Question 5

What is the most common area of metastesis for RCC

Answer 5

Lungs

Question 6

What is the classic triad for RCC presentation

Answer 6

Hematuria
flank / abdominal pain
Flank/abdominal mass

Question 7

If someone has bilateral RCC, what should you think of

Answer 7

von Hippel-Lindau

Question 8

How is RCC often diagnosed

Answer 8

incidentally on CT / US

Question 9

Is RCC biopsied for diagnosis

why

Answer 9

No, needle tends to seed the tumor in other tissue with a bx

Technically needed for definitive dx but rarely preformed

Question 10

How large is the tumor in stage 2 RCC

Answer 10

> 7cm but limited to the kindey

Question 11

What is the most common urologic cancer in females

Which gender is more effected by bladder carcinoma

mean age at diagnosis?

Answer 11

bladder carcinoma

Men

73

Question 12

What is the greatest risk factor for bladder carcinoma

what type of cancer is it

Answer 12

smoking

epithelial

Question 13

How much have bladder carcinomas typically progressed to once it is diagnosed

Answer 13

Stage one
in-situ

Question 14

What are the different types of bladder carcinoma

Answer 14

papillary
flat inasive
carcinoma in situ

Question 15

What is the most common presenting symptom of bladder carcinoma

Answer 15

gross/microscopic hematuria

*any painless hematuria is cancer until proven otherwise

Question 16

What is the study of choice for bladder carcinoma workup

Answer 16

cystoscopy

Question 17

How does a low grade bladder tumor present

Answer 17

well differentiated

Question 18

How does a high grade bladder tumor present

Answer 18

poorly differentiated, more likely to grow and recur

Question 19

What is the first line and gold standard treatment for bladder carcinoma

What if the patient is immunocompromised

Answer 19

Bacille Calmette-Guerin (BCG)

endoscopic resection and intravesical chemotherapy

treat with anti TB agents

Question 20

how frequently do cystoscopy need to be preformed with bladder cancer

Answer 20

Every 3months x 1year
every 6 months x 1 year
annually thereafter

Question 21

How do you treat someone with bladder cancer that is invading the muscle (MIBC)

Answer 21

Radical cystectomy & pelvic lymphnode dissection + systemic chemo

Question 22

What is the most common cancer in American men

Race?

Answer 22

Prostate cancer

Black

Question 23

what type of cancer is prostate cancer

Where does it occur

Answer 23

adenocarcinoma

arising primarily in peripheral zone

Question 24

What are some protective factors with prostate cancer

Answer 24

not smoking healthy weight physical activity more frequent ejaculation

Question 25

what is the most common site of mets associated with prostate cancer

Answer 25

axial skeleton, generally lumbar spine

Question 26

What test can identify prostate cancer

Answer 26

PSA

Question 27

What screening techniques are used for prostate cancer screening

Answer 27

DRE PSA

Question 28

When do avg risk patients get screened for prostate cancer | What about high risk prostate cancer

Answer 28

45-50 | 40-45

Question 29

When is PSA most useful for prostate cancer screening | What is normal

Answer 29

better for detecting high grade tumors more predicitve when levels are higher | <4

Question 30

What gives a difinitive dx of prostate cancer | how many samples are needed

Answer 30

transrectal US guided bx | around 12

Question 31

at what stage can prostate cancer be felt

Answer 31

Stage 2 *hasnt spread outside the prostate

Question 32

At what stage has prostate cancer invaded local organs such as the bladder

Answer 32

Stage 4

Question 33

What is the treatment for localized prostate cancer | What about metastatic disease

Answer 33

radical prostatectomy + radiation | Palliative tx (androgen blocking therapy (LHRH))

Question 34

which LHRH agonists for prostate cancer do NOT require an orchiectomy

Answer 34

Leuprolide Goserelin

Question 35

What prostate cancer tx is used when spinal cord compression, DIC, or bilat ureteral obstruction is present

Answer 35

Ketoconazole

Question 36

What is the most common cancer in men age 20-35 | What is the avg age of diagnosis

Answer 36

Testicular cancer | 33

Question 37

What will significantly increase someones risk for testicular cancer

Answer 37

cryptorchidism | The higher up the testical, the higher the risk of cancer

Question 38

What are the catagories of testicular cancer

Answer 38

Non-seminomas Seminomas

Question 39

What type of cancers make up non-seminoma testicular cancer | What are seminomas and what do they secrete

Answer 39

* embryonic cell carcinoma- agressive secrete HCG and AFP * teratoma- resistant to chemo/rad * choriocarcinoma- agressive, secretes HCG * Mixed (m/c) | slow growing germ cell tumor and only secrete HCG ## Footnote *spermatocytic seminoma in older men

Question 40

What type of tumors are stromal tumors

Answer 40

leydig cells sertoli cells | non-germ cell tumor with excellent prognosis

Question 41

Which testical is most commonly effected

Answer 41

R

Question 42

What is the most common symptoms of testicular cancer

Answer 42

painless mass or diffuse enlargement of the testicle | *sensation of heaviness

Question 43

What tumor markers will be elevated with testicular cancer

Answer 43

AFP hCG LDH

Question 44

What is the imaging of choice for testicular cancer | What test is for a definitive dx?

Answer 44

Scrotal US | Histology

Question 45

What is the gold standard tx for testicular cancer

Answer 45

inguinal orchiectomy

Question 46

What age group is penile cancer most common

Answer 46

50-70y/o | *generally uncircumsized men

Question 47

What type of cells make up penile cancer most commonly | Where on the penis do they generally begin ## Footnote Where do they generally metastesize to

Answer 47

Epithelial *squamous cell carcinoma most common | Foreskin / glans ## Footnote Superficial / deep inguinal nodes

Question 48

What is the most common complaint at presentation for penile cancer

Answer 48

lesion itself | Ulcer, small nodule, exophytic growth, induartion/erythema

Question 49

What is mandatory to establish a dx of malignancy

Answer 49

bx

Question 50

What treatment for penile cancer can be used with small, noninfiltrating lesions

Answer 50

5-FU cream radiation Mohs surgery laser ablation