Renal Cancers and Transitional CA

Question 1

What is the most common tumor of childhood?

Answer 1

Wilms tumor (nephroblastoma)

Question 2

Which type of descent has the highest rate of Wilms tumor?

Answer 2

African descent

Question 3

What is a Wilms tumor?

Answer 3

Malignancy derived from the primitive cells of the renal cortex

Question 4

What are some genetic anomalies that may be associated with a patient with a Wilms tumor?

Answer 4

Abesence of iris- aniridia
Enlargement of one side of face
Genitourinary complications

Question 5

What is the most common presentation of a Wilms tumor?

Answer 5

Often asymptomatic - large abdomen

Question 6

What are some clinical manifestations associated with an advanced Wilms tumor?

Answer 6

Pain w/ vomiting
Hematuria
HTN

Question 7

Why should you not biopsy a Wilms tumor?

Answer 7

Risk of spreading it to other tissue, significantly increases staging if ruptured

Question 8

What is the imaging method of choice for a Wilms tumor?

Answer 8

CT scan

Question 9

How do you manage a Wilms tumor?

Answer 9

Surgery
Chemotherapy
Sometimes radiatiom

Question 10

What is the prognosis of a Wilms tumor?

Answer 10

Good if caught early before METs or rupture

90% survival over 5 years if caught before

Question 11

Which type of ancestry is renal cell carcinoma most common in?

Answer 11

Northern European ancestry

Question 12

What are the 3 symptoms associated with renal cell carcinoma?

Answer 12

flank pain, palpable flank mass, and painless hematuria

Question 13

What are some other symptoms associated with renal cell carcinoma?

Answer 13

weight loss, malaise, anemia, hypertension, hypercalcemia, recurrent fevers

Question 14

What age/gender is renal cell carcinoma common in?

Answer 14

50-70 usually male

Question 15

What are the three synthetic substances that can increase the risk for renal cell carcinoma with prolonged exposure?

Answer 15

Asbestos, cadmium, petroleum products

Question 16

What disorders/diseases put a patient at risk for renal cell carcinoma?

Answer 16

Tuberos sclerosis (Genetic benign tumors)
Von Hippel-Lindau disease (CNS, kidneys MC)

Question 17

Long term dialysis puts a patient at risk for ??

Answer 17

Renal cell carcinoma

Question 18

Usually grows shperical , well circumscribed mass in the cortex of the kidney

Answer 18

Renal cell carcinoma

Question 19

Where does renal cell carcinoma arise from?

Answer 19

Epithelial lining of the proximal tubule

Question 20

Where does renal cell carcinoma grow into?

Answer 20

Renal vein
Inferior vena cava
Can occlude R side of the heart

Question 21

What will you find on a UA of a patient with renal cell carcinoma?

Answer 21

Microscopic hemturia - always retest if you are suspicious!

Question 22

What is the best initial diagnosis of renal cell carcinoma?

Answer 22

CT scan (91% accuracy in staging)

Question 23

What is the DEFINITIVE diagnosis of renal cell carcinoma?

Answer 23

Biopsy

Question 24

When should you use an MRI in a patient with renal cell carcinoma?

Answer 24

To look for METS once diagnosed

Question 25

When would you use a CXR or CT of lungs in a patient with renal cell carcinoma?

Answer 25

METS concern once diagnosed

Question 26

When does renal cell carcinoma usually present?

Answer 26

When it is advanced

Question 27

Most common sites of METS with renal cell carcinoma?

Answer 27

Lung, Lymph nodes, Bone, Liver, Brain

Question 28

What is the only cure of renal cell carcinoma?

Answer 28

Surgical eradication (resection, ablation with cryotherapy, embolization of arteries)

Question 29

What type of staging is used in renal cell carcinoma?

Answer 29

TNM and Robson staging

Question 30

Which stages of renal cell carcinoma do you treat with resection and which do you treat with palliative care?

Answer 30

``` I-III = resection IV = palliative care ```

Question 31

What are the two most common types of renal cell cancer?

Answer 31

Clear cell and papillary

Question 32

Papillary renal cell carcinoma looks like ____-____ projections on the tumor

Answer 32

Finger-like

Question 33

Type of kidney cancer that begins in the blood vessels or connective tissue of the kidneys

Answer 33

Renal sarcomas

Question 34

Where does transitional cell cancer typically reside?

Answer 34

Bladder

Question 35

Most common study for bladder, kidney abnormalities

Answer 35

Intravenous pyelogram

Question 36

What is one major risk factor for transitional cell cancer?

Answer 36

SMOKERS! Half of the cases

Question 37

Which chemical exposure puts a patient at a risk for transitional cell cancer?

Answer 37

Aniline dyes (leather woodwork)

Question 38

Symptoms of urothelial carcinoma

Answer 38

PAINLESS hematuria- typical Similar to Renal Cell presentation - may have more back pain If involving the ureters/bladder may have dysuria

Question 39

How do you diagnose urothelial carcinoma?

Answer 39

Cystoscopy and Biopsy

Question 40

Cancer of the mucosal lining of the bladder

Answer 40

Urothelial carcinoma (Renal pelvis, Ureters , Urethra) Urothelial carcinoma = Transition cell cancer

Question 41

What can lead to invasive urothelial carcinoma without warning?

Answer 41

Urothelial Carcinoma in situ (CIS)

Question 42

CIS and low-grade papillary urothelial carcinoma can be treated with?

Answer 42

Bacillus Calmette –Guerin (BCG) This is the TB vaccine!

Question 43

Recurrent CIS or invasive urothelial carcinoma must be treated with?

Answer 43

Resection of all or part of the bladder with/without chemotherapy

Question 44

Monitoring the cytology of a patients urine who has or had urothelial carcinoma frequently gives an almost ____% survival rate

Answer 44

100%

Question 45

Common spots of METS for urothelial cancer?

Answer 45

Lungs, liver, bones

Question 46

Tumor occupying the renal pelvis and into upper and mid pole calyces

Answer 46

Transitional cell CA - renal pelvis

Question 47

Transitional cell carcinoma is most commonly associated with?

Answer 47

The bladder

Question 48

Most common neoplasm arising from the kidney in 9/10 cases?

Answer 48

Renal cell cancer

Question 49

What are the two major groups of malignant tumors int he kidneys?

Answer 49

Wilms tumor and renal cell carcinoma

Question 50

What type of pattern would you describe a renal cell cancer that has proliferation along fibrovascular core?

Answer 50

Papillary

Question 51

What is the first line treatment for RCC?

Answer 51

Resection

Question 52

Does transitional cancer have a high chance of recurrence?

Answer 52

Yes

Question 53

#1 risk factor for bladder cancer??

Answer 53

Smoking!