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Renal > Large Group 7 > Flashcards

Large Group 7 Flashcards

1
Q

What will BPH feel like? Cancer?

A

cancer=hard/nodular

BPH=squishy

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2
Q

What do pts with BPH tend to presen with?

A

LUTS (lower urinary tract symptoms):

Frequency
Urgency
Nighttime urination
Weak Stream
Pushing and Straining.
Not emptying.
Intermittency.

many of these pts do NOT have BPH

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3
Q

What things can cause urinary retention?

A

outflow obstruction

increased sympathetic response (physical/mental stress, EtOH, cold temp, drugs)

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4
Q

Where does prostate cancer typically start? Which direction does it spread?

A

starts peripherally and spreads outward

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5
Q

What are the management options in BPH? (4)

A

Watchful waiting.

Pharmacotherapy.

Minimally Invasive therapy.

Surgical Prostatectomy.

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6
Q

What kinds of medications are used in BPH?

A
  • treat the size of the prostate (acinar-glandular volume): 5-alpha reductase inhibitors: Finasteride/ Dutasteride
  • treat the opening of the urethra: Alpha Blockers, Relaxes Smooth Muscle of Prostate and Bladder Neck: Terazosin, Doxazosin, Tamsulosin, Alfuzosin:
  • Dual drug regimen
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7
Q

What do placebo studies in BPH pharm treatment show?

A

a significant decrease (-5.7 compared to meds 8.3-8.5) in prostate symptoms and a slight increase in peak flow

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8
Q

What are the indications for surgery in BPH? (5)

A

Urinary Retention.

Recurrent Urinary Tract Infections.

Recurrent or Persistent Gross Hematuria.

Bladder Stones.

Renal Insufficiency.

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9
Q

What is the gold standard for prostate surgeries (BPH)?

A

Transurethral Resection (TURP)

Resected electrosurgically, creating cavity.

Prostate chips.

Hospitalization.

Complication:
Bleeding, 0.8% transfusion.
Fluid Absorption.
Retrograde Ejaculation
Erectile Dysfunction
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10
Q

How is BPH diagnosed?

A

diagnosis of exclusion***

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11
Q

What is the problem with PSA?

A

a lot of false positives–> over diagnosed

can be elevated by cancer, BPH, prostatitis, inflammation, infection, manipulation by biopsy, unknown

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12
Q

What is the best chance for a cure of prostate cancer?

A

early detection

metastases cannot be cured, only slowed

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13
Q

What are the symptoms of early stage prostate cancer?

A

none!

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14
Q

What screening tests should be done for men 55-70 yo?

A

BOTH digital rectal exam and PSA

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15
Q

How is PSA adjusted to reduce false positives?

A

PSA with DRE, age, ethnicity, comorbidities, prior bx history.

Age adjusted PSA.

PSA Density: PSA/Prostate volume. Bx if greater than 0.15.

PSA Velocity: Three Measurements over three years.

Free PSA percentage.

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16
Q

What are the treatment options for prostate cancer? What determines which treatment you should use?

A

treatment based on age, health of pt, and characteristics of cancer

  1. radiation
  2. surgery
  3. watchful waiting: gleason <10 year life expectancy
17
Q

What are the treatments for non-localized prostate cancer? Is this curative?

A

Palliative NOT curative.

Prostate CA is hormone sensitive, responds favorably to androgen hormonal deprivation

LH-RH agonists: ↓ pituitary-testis axis -> ↓ testosterone production

Anti-androgens: testosterone receptor blockers

Adrenal gland testosterone blockers: block remaining 5% of testosterone made by adrenals

18
Q

When is surgery generally preferred in prostate cancer?

A

younger pt with >10 year life expectancy and localized disease

19
Q

When is radiation generally preferred in prostate cancer?

A

older pt (> 70 yo), localized disease.

20
Q

What values of total PSA and free PSA are more worrisome?

A

total PSA higher

Free PSA low

21
Q

What are the risk factors for bladder cancer?

A

cigarette smoking

occupational exposure (aniline dyes, acrolein, coal)

Chronic cystitis/infections (chronic folley, bladder stone, schistosoma haematobium)

pelvis irradiation

Cyclophosphamide (Cytoxan)

22
Q

What is the most common bladder cancer?

A

Transitional cell carcinoma

23
Q

What cancer is Schistosoma haematobium linked to?

A

squamous cell bladder cancer

24
Q

What is the typical progression of bladder cancer?

A

inward!!

ureothelium–> lamina propria –> muscularis propria (detrussor)–> perivesical fat

can then get into lymphatic system or blood stream

25
Q

What is the treatment for Ta bladder cancer (localized to the epithelium)?

A

TURBT

cystoscopy (q 3 mos x 2 yrs, q 6 mos x 2 yrs, then q yr)

Urine cytology

Upper imaging tract studies (ie CT scan of the ureter and kidney) (q 1-2 yrs)

26
Q

What is the most common chemotherapy given for bladder cancer?

A

BCG (bacillus calmette guerin)

Helps delay tumor progression and prevent recurrences

27
Q

What is the treatment for bladder cancer with muscle invasion (or deeper) (>=T2)?

A

Radical cystectomy with urinary diversion

Male: cystoprostatectomy

Female: cystectomy, TAH- BSO

Bilateral pelvic lymph node dissection

AND urinary diversion (make a “new bladder” or a catheterizable stoma or a ileal conduit that drains to a collection bag

OR chemo/radiation therapy

28
Q

What is painless gross hematuria a concern for?

A

cancerous growth of bladder

order labs, x ray and scope

29
Q

What will renal cell carcinoma look like on CT?

A

heterogeneous enhancing renal mass

do not normally need a biopsy to diagnose

30
Q

What is the classic triad of renal cell carcinoma? What percent of RCC patients present with this?

A

Gross hematuria, flank pain, palpable abdominal mass

10-15% of patients

other pts can present with symptoms secondary to metastatic disease (cough, dyspnea, seizures, headache, bone pain, weight loss, night sweats, fever)

31
Q

What is the clinical presentation of most RCCs?

A

asymptomatic –> incidental when CT scanning for OTHER symptoms

32
Q

What does the kidney normally secrete?

How can renal malignancies present?

A

prostaglandins, 1,25- dihydroxycholecalciferol, renin, erythropoetin

renal malignancies can increase the amount of these things secreted –> can present with hypercalcemia, polycithemia and hypertension

33
Q

What is more concerning, a varicocele on the right or the left? Why?

A

right because it is a lower pressure system and varicocele indicates an increase in pressure

34
Q

What is a major risk factor for renal cell carcinoma?

A

SMOKING

renal failure pts on dialysis with cystic changes in kidney (>30x inc risk)

35
Q

What is the most common genetic risk factor for RCC?

A

von Hippel-Lindau disease

36
Q

What is the preferred surgical treatment for renal tumors?

A

partial nephrectomy

for solitary kidney, bilateral kidney and normal contralateral kidney disorders

37
Q

What renal lesions can be observed?

A

Small lesions (<3.0 cm on CT scan)

Slow growing lesions
Growth rate of 0 to 1.3 cm per year (Bosniak, 1995)
Elderly patients with multiple comorbidities
Smaller lesions may not be cancerous

38
Q

Is metastatic renal cell cancer responsive to conventional chemotherapy? What treatment is best for metastatic RCC?

A

NO!

Treatment based on molecular pathways for RCC (targeted therapy)

targets above VHL genes and blocks the activation of genes (VEGF, PDGF, HIF-alpha)

Renal (9 decks)

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