Neooplastic diseases

Question 1

This cancer is most commonly asymptomatic in early stages. It is the second most common cancer in males

Answer 1

Prostate Ca

Question 2

What are the risk factors for prostate ca?

Answer 2

1) age
2) AA
3) high fat diet
4) FHx
5) Exposure to pesticides

Question 3

What symptoms are common in late stage prostate Ca?

Answer 3

urethra obstruction, urinary retention, urinary frequency…..mets cause bone pain, wt loss

Question 4

Although screening for prostate cancer is controversial, what are the current recommendations?

Answer 4

Use combination of
1)  PSA
2)  DRE
3)  TRUS
4)  bx
PSA  >10ng/mL = TRUS+bx
\+DRE = TRUS+bx
PSA = 4-10 with neg DRE, discretion
Neg PSA, Neg DRE = annual f/u

Question 5

What are the tx’s for prostate cancer?

Answer 5

Radiation (SEEDS)
prostatectomy
Anti androgens
watchful waiting

Question 6

The cause of this cancer is unknown, but it accounts for about 85% or primary renal cancers and is twice as common in men.

Answer 6

Renal Cell Carcinoma (RCC)

Question 7

What are risk factors for RCC?

Answer 7

***smoking, heavy use of analgesics, polycystic kidney dz, chronic dialysis, heavy metal exposure, htn

Question 8

How does RCC present?

Answer 8

1) hematuria
2) abdominal/flank pain
3) abdominal mass
4) wt loss, fever

Question 9

How can you definitively dx RCC?

Answer 9

CT w/ and w/o to DIAGNOSE and stage. (U/S good for detection of “mass” only)

Question 10

How do you treat RCC?

Answer 10

nephrectomy. (partial nephrectomy for small local tumor). Chemo is not effective

Question 11

Where does RCC originate?

Answer 11

PCT cells

Question 12

2% of all RCC is hereditary

Answer 12

That’s just some fun FYI. They are crazy names like Von Hippel-Lindau syndrome and hereditary leiomyoma-renal cell carcinoma and my fave, the Birt-Hogg-Dube syndrome…..but I doubt we need to go that far.

Question 13

You have a newly dx’ed RCC patient. What do you expect to see on labs?

Answer 13

hematuria (usually), erythrocytosis (increased erythropoietin) OR anemia (decreased erythropoietin, yhpercalcemia

Question 14

This cancer is most common in men b/t 20-35 years old. It has a high cure rate (95%) compared to other cancers

Answer 14

Testicular cancer

Question 15

Testicular cancer is almost always an abnormal proliferation of the _________cells.

Answer 15

Germ cells (I’m pretty sure testicles are full of germs)

Question 16

Tumors in what 2 cells are typically benign?

Answer 16

Leydig cells and Sertoli cells

Question 17

What are the risk factors for testicular cancer?

Answer 17

cryptorchidism (even after surgical correction) and Klinefelter’s syndrome

Question 18

What s/s will you look for when screening for testicular cancer?

Answer 18

painless mass of the testicle and gynecomastia (sometimes) b/c some germ cells produce gonadotropins

Question 19

How do you make a definitive dx of testicular cancer?

Answer 19

Mass on exam–>U/S to localize,check tumor markers (beta-hCG and AFP), AND ORCHIECTOMY

Question 20

How do you treat testicular cancer?

Answer 20

Eval testicle s/p orchiectomy. Then stage cancer. This can be done with serial tumor markers to check progress. Also stage by obtaining CT of chest, abd/pelv. Some testicular cancers (seminoma) do well with radiation after orchiectomy. Rarely, chemo is used for cancer when tumor markers do not decrease s/p orchiectomy

Question 21

Where would you expect to find testicular cancer metastases? And what symptoms would be red flags?

Answer 21

Retroperitoneal mets (back pain), lungs (cough), vena cava (LE edema)

Question 22

It appears that clinicians MISDIAGNOSE testicular cancer about 25% of the time. So they remove the testicle and find not cancer, but ___________________

Answer 22

an epidermoid cyst (totally benign, can be small or large, located under the tunica albuginea)

Question 23

When removing a testicle, should you approach through the scrotum or the inguinal ring? why?

Answer 23

Inguinal ring for 2 reasons.

1) Scrotal approach can lead to tumor seeding of the scrotum (BAD)
2) Inguinal approach allows exploration of spermatic chord for advancement of cancer

Question 24

This is one of the most common types of tumor of the GU tract and can occur anywhere from the kidney to the bladder. 90% of the time, this is a transitional cell carcinoma.

Answer 24

Bladder cancer

Question 25

Does bladder cancer typically recur after removal?

Answer 25

yes

Question 26

What are the risk factors for bladder cancer?

Answer 26

male, smoking, industrial carcinogens, the drug cyclophaosphamide

Question 27

what is the first sign of bladder cancer? Any additional symptoms?

Answer 27

***hematuria (typically painless), and then some patients will have dysuria or frequency

Question 28

How do you make a diagnosis?

Answer 28

1) UA C&S–to r/o infection
2) urine cytology to detect malignant cells
3) cystoscopy + biopsy
4) Stage with CT of chest

Question 29

What is the tx of bladder cancer?

Answer 29

Stage 0 - limited to mucosa = transurethral resection +/- chemo
Stage A - lamina propria = same as above
Stage B - muscle invasion = cystectomy, remove prostate/hysterectomy
Stage C - extends to fat = same as above
Stage D - mets = cystectomy + chemo

Question 30

What are common lab findings for patients with bladder cancer?

Answer 30

UA = gross hematuria. Azotemia (post-renal failure). Anemia (blood loss or mets to bone marrow). Occasionally a/w UTI

Question 31

What is neat about the chemo for bladder cancer?

Answer 31

It can be administered directly to the bladder via the urethra.

Question 32

At what stage is bladder cancer typically detected? What is the prognosis?

Answer 32

up to 80% detected in stage 0 or stage 1, prognosis is good with 81% survival at 5 years.

Question 33

___________is a rare kidney cancer that primarily affects children. It is also known as a nephroblastoma.

Answer 33

Wilms’ tumor

Question 34

What age is most susceptible to Wilms’ tumor?

Answer 34

Ages 2-5 years

Question 35

How does the Wilms’ tumor typically present?

Answer 35

asymptomatic abdominal mass/swelling (83%), htn (25%), fever (23%), hematuria (21%)

Also: GU malformation (meaning kids with congenital defects are at higher risk)

Question 36

Your 4 year old patient has a normal CBC, mild anemia, normal BUN/creat, trace blood and leuks on UA. She has a smooth, well demarcated, nontender abdominal mass. What is your diagnosis?

Answer 36

Wilms’ tumor (my point is, labs are pretty normal, just trace anemia and UA has trace blood/wbc’s)

Question 37

How do you diagnose a Wilms’ tumor?

Answer 37

U/S or CT of abdomen. Stage with CT of chest. (Mets likely in vena cava, lungs, and liver)

Question 38

What is the treatment for Wilms’ tumor?

Answer 38

Surgical excision followed by both chemo (5 days s/p sx) and radiation (10 days s/p sx)