Neooplastic diseases Flashcards
This cancer is most commonly asymptomatic in early stages. It is the second most common cancer in males
Prostate Ca
What are the risk factors for prostate ca?
1) age
2) AA
3) high fat diet
4) FHx
5) Exposure to pesticides
What symptoms are common in late stage prostate Ca?
urethra obstruction, urinary retention, urinary frequency…..mets cause bone pain, wt loss
Although screening for prostate cancer is controversial, what are the current recommendations?
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
What are the tx’s for prostate cancer?
Radiation (SEEDS)
prostatectomy
Anti androgens
watchful waiting
The cause of this cancer is unknown, but it accounts for about 85% or primary renal cancers and is twice as common in men.
Renal Cell Carcinoma (RCC)
What are risk factors for RCC?
***smoking, heavy use of analgesics, polycystic kidney dz, chronic dialysis, heavy metal exposure, htn
How does RCC present?
1) hematuria
2) abdominal/flank pain
3) abdominal mass
4) wt loss, fever
How can you definitively dx RCC?
CT w/ and w/o to DIAGNOSE and stage. (U/S good for detection of “mass” only)
How do you treat RCC?
nephrectomy. (partial nephrectomy for small local tumor). Chemo is not effective
Where does RCC originate?
PCT cells
2% of all RCC is hereditary
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.
You have a newly dx’ed RCC patient. What do you expect to see on labs?
hematuria (usually), erythrocytosis (increased erythropoietin) OR anemia (decreased erythropoietin, yhpercalcemia
This cancer is most common in men b/t 20-35 years old. It has a high cure rate (95%) compared to other cancers
Testicular cancer
Testicular cancer is almost always an abnormal proliferation of the _________cells.
Germ cells (I’m pretty sure testicles are full of germs)
Tumors in what 2 cells are typically benign?
Leydig cells and Sertoli cells
What are the risk factors for testicular cancer?
cryptorchidism (even after surgical correction) and Klinefelter’s syndrome
What s/s will you look for when screening for testicular cancer?
painless mass of the testicle and gynecomastia (sometimes) b/c some germ cells produce gonadotropins
How do you make a definitive dx of testicular cancer?
Mass on exam–>U/S to localize,check tumor markers (beta-hCG and AFP), AND ORCHIECTOMY
How do you treat testicular cancer?
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
Where would you expect to find testicular cancer metastases? And what symptoms would be red flags?
Retroperitoneal mets (back pain), lungs (cough), vena cava (LE edema)
It appears that clinicians MISDIAGNOSE testicular cancer about 25% of the time. So they remove the testicle and find not cancer, but ___________________
an epidermoid cyst (totally benign, can be small or large, located under the tunica albuginea)
When removing a testicle, should you approach through the scrotum or the inguinal ring? why?
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
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.
Bladder cancer
Does bladder cancer typically recur after removal?
yes
What are the risk factors for bladder cancer?
male, smoking, industrial carcinogens, the drug cyclophaosphamide
what is the first sign of bladder cancer? Any additional symptoms?
***hematuria (typically painless), and then some patients will have dysuria or frequency
How do you make a diagnosis?
1) UA C&S–to r/o infection
2) urine cytology to detect malignant cells
3) cystoscopy + biopsy
4) Stage with CT of chest
What is the tx of bladder cancer?
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
What are common lab findings for patients with bladder cancer?
UA = gross hematuria. Azotemia (post-renal failure). Anemia (blood loss or mets to bone marrow). Occasionally a/w UTI
What is neat about the chemo for bladder cancer?
It can be administered directly to the bladder via the urethra.
At what stage is bladder cancer typically detected? What is the prognosis?
up to 80% detected in stage 0 or stage 1, prognosis is good with 81% survival at 5 years.
___________is a rare kidney cancer that primarily affects children. It is also known as a nephroblastoma.
Wilms’ tumor
What age is most susceptible to Wilms’ tumor?
Ages 2-5 years
How does the Wilms’ tumor typically present?
asymptomatic abdominal mass/swelling (83%), htn (25%), fever (23%), hematuria (21%)
Also: GU malformation (meaning kids with congenital defects are at higher risk)
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?
Wilms’ tumor (my point is, labs are pretty normal, just trace anemia and UA has trace blood/wbc’s)
How do you diagnose a Wilms’ tumor?
U/S or CT of abdomen. Stage with CT of chest. (Mets likely in vena cava, lungs, and liver)
What is the treatment for Wilms’ tumor?
Surgical excision followed by both chemo (5 days s/p sx) and radiation (10 days s/p sx)
