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STEP 2 Cardio + Renal > Renal. Urologic cancers > Flashcards

Renal. Urologic cancers Flashcards

1
Q

FA. Protate.
most common nonskin cancer in male

second cause of death in men

A

.

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2
Q

FA. Protate. 2 risk factors?

A

advanced age and family history

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3
Q

FA. Protate. initial symptoms? 2

A

asymptomatic, may present with obstructive urinary symptoms

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4
Q

FA. Protate. symptoms. additional?

A

Constitutional symptoms
lymphedema (from metastases obstructing lymphatic drainage) and/or black pain (bone mestastases)

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5
Q

FA. Protate. DRE?

A

palpable nodule or an area of induration.
Early carcinoma is usually not detectable

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6
Q

FA. Protate. Diagnosis. 2

A

Clinical findings and/or increased PSA (> 10 ng/ml)

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7
Q

FA. Protate. Diagnosis. most accurate test?

A

transrectal US guided biopsy

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8
Q

FA. Protate. Diagnosis. additional need to do what?

A

Look for metastases with CT of the abdomen/pelvis

and

a bone scan (metastatic lesions shows an osteoblastic or incr. bone density)

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9
Q

FA. key fact. leading causes of cancer death in men? 4

A

lung, protate, colorectal, pancreatic

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10
Q

FA. Protate. incr. in PSA can be caused by what other diseases?4

A

BPH, prostatitis, prostatic trauma, carcinoma

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11
Q

FA. Protate. treatment. older adults with low grade.?

A

watchful waiting, as many cases are slow to progress.

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12
Q

FA. Protate. treatment. radical prostatectomy assoc with what?

A

incr. risk for incontinence and/or erectile dysfunction

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13
Q

FA. Protate. treatment. radiation therapy, assoc with what?

A

incr. risk for radiation proctitis and GI symptoms.
erectile dysfunction posttreatment.

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14
Q

FA. Protate. treatment. PSA for what purpose used?

A

contraversial for screening

used to follow patient post treatment to evaluate for disease recurrence

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15
Q

FA. Protate. treatment. metastatic disease treatment?

A

androgen ablation (gonadotropin-releasing hormone agonists, orchiectomy, bicalutamide)
and
chemotherapy

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16
Q

FA. Protate. treatment. metastatic disease treatment.

Radiation therapy bone?

A

useful to manage bone pain from metastases after androgen ablation

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17
Q

FA. Protate. prevention.

A

screening guidelines contraversial :)))) THE FUCK

Males should discuss pros and cons of anual DRE and/or PSA starting at 50 y/o.

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18
Q

FA. Protate. prevention. in what patients start earlier than 50 yo?

A

black males and in those with first-degree relative with prostate cancer

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19
Q

FA. Bladder.
second most common urologic cancer and the most frequent malignant tumor of urinary tract. THE FUCK

A

.

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20
Q

FA. Bladder. what usually carcinoma?

A

transitional cell carcinoma (now called urothelial carcinoma)

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21
Q

FA. Bladder. in what age?

A

most prevalent in 60-70 decade in males

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22
Q

FA. Bladder. risk factors?

A

smoking, diet rich in meat ant fat, schistosomiasis (squamous cell carcinoma), past treatment of cyclophosphamide, ocupational exposure to anilin dye

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23
Q

FA. Bladder. symtoms.

A

Gross, painless hematuria

Terminal hematuria (end of voiding) suggests bleeding from bladder

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24
Q

FA. Bladder. other symptoms than most common?

A

frequency, urgency, dysuria can also be seen.
Most patients are asymptomatic in the early stages

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25
Q

FA. Bladder. diagnosis.
methods?

A

Sceening - not recommended

UA - hematuria (microscopic or macroscopic)

cystoscopy + biopsy is diagnostic

urine cytology - dysplastic cells

MRI, CT, bone scan - for muscle invasion and metastases

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26
Q

FA. Bladder. diagnosis. which method is diagnostic?

A

cystoscopy + biopsy

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27
Q

FA. Bladder.
diagnosis. when recommended cysto+ biopsy?

A

in adults > 35 yo with unexplained hematuria

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28
Q

FA. Bladder. treatment. depends on what?

A

extent of spread beyond the bladded mucosa

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29
Q

FA. Bladder. treatment. Carcinoma in situ?

A

intravesicular chemotherapy or transuretheral resection.

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30
Q

FA. Bladder. treatment. superficial cancers?

A

Complete transuretheral resection or intravesicular chemotherapy with mitomycin C or BCG (TB vaccine)

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31
Q

FA. Bladder. treatment. Large, high grade recurrent lesions.

A

intravesicular chemotherapy

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32
Q

FA. Bladder. treatment. invasive cancer without metastases.

A

radical cystectomy or radiation therapy for patients who are deemed poor candidates for radical cystectomy and for those with unresectable local disease.
Nonadjuvant systemic therapy and radiosensitization is often considered.

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33
Q

FA. Bladder. treatment. invasive cancer with distant metastases.

A

Chemotherapy, immunotherapy, novel targeted agents are considered.

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34
Q

FA. key fact. key step for diagnosis in an adult with unexplained hematuria is cystoscopy to evaluate for bladder cancer.

A

.

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35
Q

FA. RCC. origin?

A

Adenocarcinoma from tubular epithelial cells

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36
Q

FA. RCC. spread way?

A

spread along the renal vein the the IVC and metastasize to other sites (lungs, bone, brain, liver)

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37
Q

FA. RCC. Risk factors?

A

male, smoking, obesity, acquired cystic kidney disease in ESRD, genetic conditions eg von Hippel Lindau disease.

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38
Q

FA. RCC. symptoms?

A

gross hematuria, flank pain, scrotal varicoceles, palpable flank mass.

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39
Q

FA. RCC. metastatic disease symtoms?

A

weight loss, malaise, symptoms according to metastases site

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40
Q

FA. RCC. paraneoplastic symptoms? gali isskirti EPO

A

anemia, erythropoiesis, thrombocytosis, fever, cachexia, hypercalcemia, polymyalgia rheumatica

41
Q

FA. RCC. best initial test?

A

Diagnosed via CT.
allow to characterize renal mass and stage for lymp nodes/metastases.

42
Q

FA. RCC. how confirmed diagnosis?

A

after CT –> histology on nephrectomy specimen

43
Q

FA. RCC. what about UG?

A

rarely used

44
Q

FA. RCC. treatment. 2

A

surgical resection
OR
thermal ablation
may be curative in localized disease.

45
Q

FA. RCC. treatment. metastases?

A

metastasectomy
may improve survival in metastatic disease.

46
Q

FA. RCC. key fact. triad? same UW

A

hematuria, flank pain, palpable flank mass

these all 3 occur in only 5-10proc. patients.

47
Q

FA. RCC. response to radiation therapy/chemo?

A

15-30 proc. only

48
Q

FA. RCC. newer tyrosine kinase inhibitors (axitinib, lenvatnib, cabozatonib) for treatment?

A

it shows promising results.

it decrease tumor angiogenesis and cell proliferation

49
Q

FA. RCC. key fact. what typical scenario?

A

middle age individual with a history of smoking and left sided varicocele —> CONSIDER RCC.

50
Q

UW. RCC. in what proc. seen hematuria?

A

40 proc.

51
Q

UW. RCC. left varicocele. in what percent and what position?

A

10 proc.

do not empty when patient is recumbent - this failure shows that there is secondary cause of varicocele (eg tumor mass obstructing venous flow)

52
Q

UW. RCC. Constitutional symptoms? 20 proc.

A

fever, night sweats, anorexia, weight loss, easy fatigabilty

53
Q

UW. RCC. diagnosis?

A

CT scan

54
Q

UW. RCC. paraneoplastic symptoms?

A

If ectopic EPO production –> polycytemia
Thrombocytosis
hypercalcemia
cachexia, fever

55
Q

FA. Testicular cancer. origin of 95 proc.?

A

germ cells and virtually all are malignant.

56
Q

FA. Testicular cancer. risk factors?

A

cryptochidism, Kleinfelter syndrome, family history

57
Q

FA. Testicular cancer. in what age?

A

15-34 y/o

58
Q

FA. Testicular cancer. symptoms?

A

painless enlargement of the testes

firm ovoid mass with possible nodules

dull abdominal pain

metastatic symptoms

59
Q

FA. Testicular cancer. what age for seminomas?

A

40-50 y/o

60
Q

FA. Testicular cancer. diagnosis? 2 instrumental

A

testicular UG
xray and CT of abdomen/pelvis for metastases

61
Q

FA. Testicular cancer. whats about screening?

A

tumor markers are useful for diagnosis and in monitoring treatment response

62
Q

FA. Testicular cancer. biopsy?

A

contraindicated due to risk of spillage of cancer

63
Q

FA. Testicular cancer. treatment. 2

A

radical orchiectomy + classification as seminoma or nonseminomatous germ cell turmor

64
Q

FA. Testicular cancer. treatment. Seminoma?

A

chemotherapy or radiation for low stage disease

65
Q

FA. Testicular cancer. treatment. non-seminoma?

A

retroperitoneal lymph node dissection for low-stage disease

66
Q

FA. Testicular cancer. treatment. what chemo for advanced disease?

A

platinum based for advanced disease of either type (seminoma or non-seminoma)

67
Q

FA. Testicular cancer markers.

what are germ cell tumors? 95 proc.

A

Seminoma (most common)
yolk sac
choriocarcinoma
teratoma

68
Q

FA. Testicular cancer markers.

what are non- germ cell tumors? 5 proc.

A

leydig cell, sertoli cells, testicular lymphoma

69
Q

FA. Testicular cancer markers. Seminoma?

A

usually negative;
beta-hCG in some cases

70
Q

FA. Testicular cancer markers. Yolk sac?

A

inc. alfa-fetoprotein (AFP)

71
Q

FA. Testicular cancer markers. Choriocarcinoma?

A

incr. beta-hCG

72
Q

FA. Testicular cancer markers. Teratoma?

A

AFP and/or beta-HCG

73
Q

usually negative;
beta-hCG in some cases?

A

Seminoma

74
Q

inc. alfa-fetoprotein (AFP)?

A

Yolk sac (endodermal sinus tumor)

75
Q

AFP and/or beta-HCG?

A

Teratoma

76
Q

incr. beta-hCG?

A

Choriocarcinoma

77
Q

FA. Testicular cancer markers. leydig cells?

A

incr. testosterone and estrogen (causing dec. LH and FSH)

78
Q

FA. Testicular cancer markers. sertoli?

A

none

79
Q

FA. Testicular cancer markers. testicular lymphoma?

A

none. arises from metastasis to testes

80
Q

incr. testosterone and estrogen (causing dec. LH and FSH)?

A

leydig

81
Q

none marker in what testicular cancer?

A

sertoli

82
Q

testicular markers?

none. arises from metastasis to testes

A

testicular lymphoma

83
Q

UW. Bladder cancer. risk factors. age, family history.

what chronic exposure?3

A

smoking - carcinogens

workplace - aromatic amines or aluminum

well water - arsenic

84
Q

UW. Bladder cancer. why screening is not recommended? 3

A

Current tests have lowe sensitivity/specificity

most of them are detected at an early stage anyway

generally have good prognosis, hence early diagnosis really doesnt help us much

85
Q

UW. RCC. origin of what part shows worst prognosis?

A

collecting duct

86
Q

UW. RCC. spread to 2 most common places?

A

lungs and bones

87
Q

UW. RCC. spread route?

A

hematogenous.

–> DVT or piece of tumor in renal vein

88
Q

UW. RCC. thrombus in liver (hepatic vein), what syndrome?

A

Budd Chiari

89
Q

UW. RCC.
Diagnosis?3

A

CT scan or US

CT thorax and bone scan for stagin

DO NOT BIOPSY

90
Q

UW. RCC. Treatment?

A

Resection –> nephrectomy

91
Q

UW. Bladder cancer. Increased risk in what patients? 2

A

smokers and exposure to industrial carcinogens

92
Q

UW. Bladder cancer.
manifestation?

A

Painless hematuria
Irritative voiding symptoms
Regional pain

93
Q

UW. Bladder cancer.
Diagnosis?2
what gold standard?

A

gold - Flexible cystoscopy with biopsy

Urine cytology

94
Q

UW. Bladder cancer.
staging, what methods?

A

TURBT
Upper urinary tract imaging (IVP, MRI, CT)

95
Q

UW. Bladder cancer. Treatment.
1. no muscle invasion. methods? 2

A

TURBP and itravesical immunotherapy

96
Q

UW. Bladder cancer. Treatment.
2. muscle invasion. methods? 2

A

radical cystectomy and systemic chemotherapy

97
Q

UW. Bladder cancer. Treatment.
3. metastatic? 2

A

Systemic chemotherapy and immunotherapy

98
Q

UW. indications for cystoscopy. 5.

A

Gross hematuria with no evidence of glomerual disease or infection

microscopic hematuria with no evidence of glomerual disease or infection BUT increased risk for malignancy

Recurrent UTI

Obstructive symptoms with suspicion for stricture, stone

Irritative symptoms without UTI

Abnormal bladder imaging or urine cytology

99
Q
A

STEP 2 Cardio + Renal (26 decks)

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