neoplasms and cancers Flashcards
prostate cancer?
gnerally slow -growing, malignant neoplams of the adenomatous cells
what can Pr. CA lead to?
urinary obstruction and metastatic disase
where do th)e majority of pr Ca originate?
in the peripheral zone (outer portion that is palpable on rectal exam)
then the transition zone (portion that surrounds the urethra)
then the central zone (ejaculatory ducts)
epidemiology of pr cancer
most common non-skin cancer in men
what are some risk factors for Pr, Can?
genetic predisposition, hormonal influence, dietary and environmental factors, infectious agents
*** old age
what can be used for Pr cancer screening?
PSA, DRE
what are the clinical features of Pr. Ca?
+many asx
+ urinary obstruction or irritative voiding if tumor invaded into the urethra, bladder neck, or trigone of the bladder
+enlarged, nodular, asymmetric prostate
where may Pr Ca metastasize?
bone! may lead to possilbe spinal cord impingement if the vertebral bodies are involved
what dx studies can be done for Pr ca?
+PSA usually elevated
+patholgical exam
+ transrectal US
+biopsy
+may see incrased LFTs (alk phos)
what would apathologic exam of tissue reveal in Pr. Ca?
obstructive prostatic hyperplasia shows that 10% have malignancy
what would a US show for Pr ca?
hypoechoic lesions in prostate
what confirms the dx of prostate cancer?
biopsy; and allows histolgical grading
what grading system is used for prostate cancer?
the Gleason: adds together the pimary and secondary grades of the tumor; final score btw 2-10
*higher score, worse prognosis
tx of pro. c?
depends on staging
what dx tools/imaging is used to stage pros cancern?
abdominal/pelvic CT or MRI, pelvic lymphandencetomy, bone scan
low grade prs tumors
may not need tx
stages A and B pr cancer tx?
tumore confined to prostate
tx with Radical retropubic* prostatectomy (RRP), brachytheraphy, or external beam radiation therapy
stage C Pr. cancer tx?
tumor w/ local invasion; tx the same as stage A and B
stage D pr cancer tx?
hormonal manipulation using orchiectomy, antiandrogens, LH agonists, estrogens
palliative care
what is brachytheraphy?
are radiated and implanted in prostate They remain in prostate even after radiation has degraded about 60 days.
This treatment is best for localized, contained cancer.
bladder cancer general features?
uroepithelial tumors
+most are transitional cell carcinomas
what pt population is more likely to get bladder cancer?
men, pts 40-70
what are some causal risk factors for bladder cancer?
exposure to tobacco, occupational carcinogens from rubber, dye, printing, and chemical industries, schistosmiasis,
exposure to cyclophosphamide, and chronic infection
what is schistomiasis?
also known as bilharzia, is a disease caused by parasitic worms.
what are the clinical features of bladder cancer?
painless hematuria is the most common
also, bladder irritability and infection
what dx studies can be done for bladder cancer?
CBC and blood chemistry: infx, renal funx
what is the definitive dx of bladder cancer?
cystoscopy, and bx confirms the pathologic diagnosis
what other radiologic procedures can be used for staging and to find tumors?
IV urogram, Pelvic/abdominal CT, chest sr, bone scan, retrograe pyelography fro renal pelvic for uretral tumors
how is bladder cancer trx?
depends on stage
how are superficial bladder cancer lestions tx?
with endoscopic resection and fulguration followed by cystoscopy every 3 mtns
how are recurrent or multiple lesion tx in bladder cancer?
intravesical instillation of thiotepa, mitomycin-C, or bacillus calmette- guerin (BCG)
what can BCG also be used for?
prevent TB
what can be used for recurrent bladder cancer? or diffuse TCC in situ, or for tumors tha have invaded the muscle
radical cystectomy,
what is reserved for pts taht are not surgical candiddates due to significant comorbid medical conditions?
external beam irradiation therapy
what is renal cell carcinoma?
aka hypernephroma or renal adneocarcinoma
+most common type of renal malignancy
what population is most likely to get RCC?
men older than 55
american indian, alsakan native
what risk factor has been linked with RCC?
cigarette smoking
what are the other forms of RCC?
hereditary: von Hipple Lindau dz, herediatry papillary renal carcinoma
what are the clinical features of RCC?
wide range of s/sx
“internists’ tumor” bc commonly discovered as an incidental finding on abdominal imagins
what ist he most common sx of RCC?
gross or microscopic hematuria, followed by pain or an abdominal mass
+this triad is not commonly seen
what other paraneoplastic syndromes is RCC associated with?
erythrocytosis, hypercalcemia, htn, hepatic dysfuction
what dx should be done for RCC?
pts w/ hematuria should under go an US to r/o stone
what is the primary technique for diagnosis RCC?
CT scanning w and w/o contrast
others: MRI w/ contrast or arteriography
how is RCC graded?
using Fuhrman grade (1-4) and TNM of tumor
how is localized RCC dz tx?
radical nephrectomy
where may RCC dessiminate to?
brain, bone, lungs
*treat with radiation theraphy
what meds have been shown to have some sucess in reduction grown of RCC?
interferon-A and interleukin
testicular cancer general characteristics?
young men!
hx of cryptorchidism or previous hx of testicular cancer
what are the clinical features of testicular cancer?
painless, solid testicular swelling
-may also complain of a heaviness
what lymph nodes may be involved in testicular cancer?
para-aortic; may present as a ureteral obstrctions
what part of the body may also be involved int testicuar cancer?
lungs- pulmonary metastases shown on chest xray
what ist he most common type of testicular cancer?
nonseminomatous (embryonal carcinoma, teratoma, mixed cell type, and choriocarcinoma)
then seminomatous
what is dx for nonseminomatous germ cell tumors?
elevated alpha-fetoprotein or Beta human chorionic gonadotrioub
