GU Oncology Pt. 1 (Fran) Flashcards
Recall MC sxs of renal carcinoma: (4)
- often asxs until dz is advanced
- 25% w/ distant mets and/or advanced dz
- MC presenting sxs include:
1- weight loss
2- abdominal mass
3- pain
4- hematuria (60% present w/ gross or microscopic hematuria)
Recall the incidence of histologic cell types found in renal cell carcinoma: (7)
Various cell precursors: 1- MC- Clear Cell (75-80% of all RCCs) 2- papillary 3- sarcomatpoid 4- collecting duct 5- chromophobe 6- chromophilic 7- oncocytic
Differentiate between the 4 stages of Renal carcinoma
- Stage 1: Tumor <7 cm in greatest dimension and limited to the kidney; 5 year survival - 95%
- Stage 2: Tumor >7 cm in greatest dimension and limited to the kidney; 5 year survival - 88%
- Stage 3: Tumor in major veins or adrenal gland, tumor w/in Gerota’s fascia, OR 1 regional lymph node involvement; 5 year survival - 59%
- Stage 4: Tumor beyond Gerotia’s fascia OR >1 lymph node involved; 5 year survival rate - 20%
Recall the MOA for tyrosine kinase inhibitors used in treatment of renal cell carcinoma:
–Sunitinib and Pazopanib
- inhibit the actions of VEGF (vascular endothelial growth factor)
- targets the enzymes on the BV cells and tumor cells
Recall the SXS of Wilms tumor:
- MC presentation
- SXS - (4)
- MC renal malignancy in children
- Most children present w/ abdominal mass
- SXS:
1- abdominal pain
2- hematuria
3- fever
4- HTN
Recall risk criteria for children with Wilms tumor:
- 3 Criteria for very low risk tumors
- Prognosis
- 3 Criteria for very low risk tumors: 1- age <2 years old 2- Stage 1 w/ favorable histology 3- tumor weighs <550 gms - Balstemal cells w/ worst prognosis - Overall 90% survival rates in children w/ wilms tumor
Recall SXS of testicular cancer:
- MC SXS at presentation
- Other Associated SXS (5)
- Advanced dz (2)
- Metastatic dz (3)
- MC sxs: painless enlargement of the testis
SXS:
1- sensation of “heaviness” (w/ 3-6 month delay to tx)
2- a discrete mass or diffuse testicular enlargement in most cases
3- Hydrocele (5-10% of cases)
4- Gynecomastia (5%)
5- if pain is present, likely due to intra-testicular hemorrhage - Advanced dz: - (2)
1- supraclavicular adenopathy
2- PE w/ abdominal mass - Metastatic dz: (10% of cases) - (3)
1- back pain (retroperitoneal mets)
2- cough (pulmonary mets)
3- lower extremity (vena cava obstruction)
Differentiate between serum markers used in the DX and monitoring of testicular carcinomas: (4)
- alpha-fetoprotein (AFP) - never elevated w/ pure seminomas; only elevated w/ nonseminomatous tumors
- Human Chorionic Gonadotropin (HCG) - serum CA marker; occasionally elevated w/ seminomas but lower than with nonseminomatous tumors
- LDH: elevated w/ both
- LFTS: elevated w/ mets or anemia in advanced dz
Differentiate between the 3 stages of testicular carcinoma:
Stage 1: lesion is confined to the testis
Stage 2: demonstrates regional lymph node involvement in the retroperitoneum
Stage 3: distant mets
Recall presentation SXS of penile carcinoma aka squamous cell carcinoma of the penis:
- painless, nonindurated, ulcerated mass involving the glans penis
- delay in dx is common
- exclusive to uncircumcised men (2/2 due to chronic inflammation and irritation)
Recall risk factors associated with penile carcinoma: (3)
1 - exclusive to uncircumcised men (2/2 to chronic inflammation and irritation) and neonatal circumcision linked w/ protective effects
2 - Research linking penile cancer w/ HPV (types 16 and 18) and penile warts
3 - smoking and other forms of tobacco
95% of primary testicular tumors are germ cell tumors and can be further divided into 2 major categories:
1- Nonseminomas (65%) - AKA MC ----Mixed Cell Type (40%) ----Embryonal cell carcinomas (20%) ----Teratoma (5%) ----Choriocarcinoma (<1%) 2- Seminomas (35%)
