RENAL/GU-M Neoplams Flashcards
Prostate Cancer: Risk Factors, Epic Presentation
MC tumor in M-US 2nd MC cause of cancer death American- 18% risk ,3% risk of death 10-year survival rates local = 75% regional = 55% distant metastases = 15%
>45 y AA Obesity High testosterone level Genetic- BRCA1/2 ,Chromosome 1 abn Chronic Infection High animal fat Inc. calcium / Vitamin D deficiency Low vegetable intake and omega-3-fatty acids Selenium, Soy, Zinc / Vitamin E protect, chemoprotective
Clinical Presentation
MC asymptomatic
urgency, frequency, hesitancy, and nocturia
acute erectile dysfunction
Hematuria or hematospermia-older
Rare - s/s metastatic disease (bone pain, spinal cord compression)
Prostate Cancer Screening: Risks vs. Benefits
PSA glycoprotein produced by the prostate epithelial cells, liquefies seminal fluid
Elevations precede clinical disease- 5-10
CA l/t prostate gland lumen and capillary are disrupted → increased serum PSA
Anxiety/psychological distress
False -+
Rare, complications of biopsy
Overdiagnosis, clinically significant
Risks of treatment
screening and aggressive treatment have not been proven
further invasive evaluation as a result of high PSA
Aggressive therapy
SE- chronic sexual and urinary problems, early death m
Early detection may save lives, avert future cancer-related illness
Prostate Cancer:Digital Rectal Examination, Positive Screening Results
Good for Nodules, asymmetry, or induration
Combination PSA + DRE- Minimal improvement
Transrectal US- guide prostate biopsy- suspicious lesions
Too expensive, complicated Abnormal DRE (if performed)
Refer to Urology
PSA 4-7: Repeat in a few weeks to confirm
Repeat PSA >4, refer to Urology
PSA >7: Refer to Urology for TRUS-guided biopsy
PSA increasing >0.75 ng/mL/year, refer to Urology
Prostate Cancer: Prostate Biopsy
Gold standard for diagnosis of prostate cancer
At least 6 core samples from base, midzone, and apical areas of right and left lobes
Lateral samples
Clinical stage
DRE and/or TRUS results
Pathological stage
Based on Gleason Score
TNM staging and Gleason grade scores used
to determine therapy
Increasing # correlates with increasing tumor aggressiveness
Radionuclide bone scan-indicates disease outside the gland
MRI or CT scan of abdomen/pelvis
PSA >10 ng/mL, or Gleason score >6 (increased likelihood of lymphatic metastases)
Prostate Cancer: Detection
(Early Detection) Watchful waiting Radical prostatectomy Radiation therapy External beam radiation Interstitial implantation (brachytherapy) Androgen deprivation therapy Definitive therapy or as adjunct
(Advanced)
Androgen deprivation therapy
LHRH Agonist (Lupron, Zoladex), (Flutamide, Casadex)
Palliative care for metastatic bone disease
not curative-radition, etc.
Testicular Cancer
MC in males ages 15-35 yrs
95% germ cell
5-year survival rate >95%
Risk Factors Cryptorchidism Cancer of contralateral testicle HIV Carcinoma in situ or testicular intraepithelial neoplasia FH Extragonadal germ cell Klinefelter and Down syndromes Race (rare in AA) Marijuana
Clinical Presentation
Painless mass-enlargement-pain, Aching in the scrotum or lower abdomen
firm, no transilluminate;
gynecomastia
20% metatisis: back pain, abdominal mass, pulmonary symptoms
Testicular Cancer: Diagnostic Evaluation
US
follow with CT scan of abdomen/pelvis
CXR
Serum tumor markers: Pre/Post- orchiectomy
AFP, β-hCG, LDH elevated above 10,000 ng/mL
Retroperitoneal lymph node dissection-Gold standard for staging
Testicular Cancer: Prognosis and Treatment
based on histologic type of cancer
Surgical treatment
Radical inguinal orchiectomy- TX and DX
Radiation
Chemotherapy
Testicular Cancer: Semen cryopreservation should be prior to starting therapy
Renal Cell Carcinoma
tumor of the kidney 2.6% -6th decade M, AA Cigarette smoking 4% genitics
> 50% detected incidentally on US or CT
Hematuria
“Too Late Triad:” flank pain, hematuria, palpable mass
20-30% metastatic sx (cough, bone pain)
Paraneoplastic syndrome-Anorexia
malaise, night sweats
Renal Cell Carcinoma:Findings
Hematuria 60% Anemia Hypercalcemia 10% Gonadotropin excess Erythrocytosis, thrombocytosis, coagulopathy Fever 55% inc. ESR 14% inc. LFT’s without metatsis 13% inc. SrCA-CAncer
Imaging Studies CT scan-Look at contralateral kidney CXR to r/o pulmonary metastases Bone scan for elevated serum alkphos MRI, Doppler US -R/o renal vein or vena cava thrombosis
Diagnosis
Solid mass on imaging -cancer until proven otherwise
Rare d/t bleeding, unreliable–Biopsy of mass for definitive diagnosis and staging
Renal Cell Carcinoma: Treatment
Partial or radical nephrectomy
Radiofrequency or cryosurgical ablation- studied
No effective chemotherapy
90-100% in T1-T2 renal capsule
50-60% in T3-T4 beyond
0-15% in node positive tumors
Bladder Cancer
2nd urologic M 65 years Cigarette smoking 60% industrial 15%
transitional cell carcinomas
Hematuria
Irritative voids -frequency and urgency
Palpable masses present late, suprapubic region-rare
Pelvic nodes-HSM, supraclavicular LAD, lymphedema
Bladder Cancer:Laboratory Findings
pyuria Painless hematuria is bladder cancer until proven otherwise Azotemia -inc. BUN obstruction present Anemia - dec blood Urine cytology- positive
US/CT- IVP, MRI-Filling defects within the bladder
Staging
Confirmed by cystoscopy and biopsy by TURS
bladder and prostate biopsies also for staging
50-80%- superficial at presentation
81% surival
50% low grade recurrences
Bladder Cancer Treatment:
T2-T3 cancers
Transurethral resection as initial treatment in all patients; 70% are noninvasive superficial tumors
Partial cystectomy
Radical cystectomy with pelvic node
Radiotherapy -External beam radiation 6-8 week period
recurrence occurs in 30-70%
combination
Intravesical Chemotherapy- delivered into the bladder by catheter
