Renal & Bladder Cancer

Question 1

Wilms tumor (renal cancer) one of most common neoplasm of _______

Answer 1

Wilms tumor is one of most common neoplasm of young children (usually presents between 2-5 yrs)
most common malignant abdominal tumor in children

Question 2

what is Wilms tumor histologically comprised of?

Answer 2

comprised of tissues that resemble normal fetal tissue

ex) blastemic, stromal or epithelial

Question 3

Wilms tumor is associated with other _____________

Answer 3

congenital abnormalities such as; anividia (absence of the iris), hemihypertrophy (enlargment of one side of face or body) & others usually of gentiourinary system

Question 4

several chromosomal abnormalities have been associated with wilms tumors, most significantly

Answer 4

WT1 on chr 11, encodes for transcription factor that is critical for kidney development 20% of wilms tumors will have this mutation

Question 5

what are the presentations of WIlms tumor

Answer 5

• common presenting signs; large asymptomatic abdominal mass & hypertension
• some children present with abdominal pain & vomiting or both
• microscopic and gross hematuria is present in 17% -25%

Question 6

what is the treatment of wilms tumor

Answer 6

• surgery, chemotherapy & sometimes radiation

- long term survival rates have increased to more than 60% for all stages and to 88%-98% for stages 1 through 4

Question 7

what are the two major groups of renal cancer

Answer 7

• Wilms tumor

- Renal cell carcinoma

Question 8

renal cell carcinoma is the _______ leading malignancy among men & ______ among women

Answer 8

6th

11th

Question 9

Peak incidence of renal cell carcinoma

Answer 9

ages 55-84

Question 10

what is the etiology of renal cell carcinoma

Answer 10

• unknown, correlations between heavy smoking & obesity particularly in women
• additional risk factors: occupational exposure to petroleum products, heavy metals & asbestos

Question 11

what is the presentation of renal cell carcinoma

Answer 11

• silent in early stages

- symptoms usually indicate advanced disease ie) flank pain, hematuria, palpable flank mass

Question 12

diagnosing renal cell carcinoma

Answer 12

ultrasound, CT, MRI

Question 13

treatment of renal cell carcinoma

Answer 13

• surgery (radical nephrectomy with lymph node dissection-treatment of choice for all resectable tumors
• chemo limited success
• immunotherapy some success
• nephron sparing surgery may be done both kidneys invaded
• 5 year survival rate is 90% if tumor has not extended beyond the renal capsule, but drops to 30% if metastasis has increased

Question 14

classification of renal cell carcinoma

Answer 14

1. Clear cell carcinoma (60%)
   - clear cytoplasm
   - usually show chr 3 deletion
2. papillary tumors 5-10%
3. chromophobic tumors 5-10%
4. Oncocytomas 5-10%
5. collecting duct tumors less than 1%

Question 15

_______ cancer is most common cause of urinary tract cancer in Canada

Answer 15

bladder cancer

Question 16

greater occurrence in _____

Answer 16

greater occurrence in men 4th in men, 8th women

Question 17

90% of bladder cancers are derived from _________ cells that line the bladder

Answer 17

transitonal (urothelium)

Question 18

tumors of the bladder fall into 2 categories

Answer 18

1. low grade non-invasive

2. High grade invasive tumors that are associated with mestatasis & worse prognosis

Question 19

Etiology of bladder cancer

Answer 19

• uknown
• carcinogens that are excreted in urine & stored in the bladder, include breakdown products of aromatic amines in dye industry, products of rubber, textiles, paints
• 30-50% associated with cigarette smoking
• chronic bladder infections & bladder stones also increase risk for bladder cacher
• bladder cancer more frequent among persons harbouring parasite schistosoma haematobium in their bladder (endemic in eygpt & sudan)

Question 20

manifestations of bladder cancer

Answer 20

• painless hematuria happens in 75% of people
• frequency, urgency & dysuria occasionally accompany
• periodic urine cytology is recommended for people who are at risk for developing

Question 21

diagnosing bladder cancer

Answer 21

• cytology studies
• excretory urogray (radiographic examination of urinary tract)
• cystoscopy & biopsy
• ultrasonography
• CT & MRI

Question 22

treatment of bladder cancer

Answer 22

• depends on extent of lesion & health of pt
• endoscopic resection for superficial lesions
• external beam radiation
• chemotherapy-certain types can be instilled directly into bladder avoiding gross systemic effects