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Repro / GU > SM_235b: Urothelial Cancer > Flashcards

SM_235b: Urothelial Cancer Flashcards

1
Q

Largest risk factor for urothelial carcinoma is ___

A

Largest risk factor for urothelial carcinoma is smoking

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2
Q

Describe molecular pathology of bladder cancer

A

Molecular pathology of bladder cancer

  • Differences in detoxification pathways may influence bladder cancer risk
  • Efficient elimination of toxins is protective
  • N-acetyltransferase 2 (slow acetylators)
  • Glutathione S-transferase M1 homozygous deletions
  • Cytochrome P450 1A2 induction
  • Papillary tumors: 9q, p15/16, p27
  • CIS: p53, pRb, p14ARF, p21
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3
Q

____ pathway involving ____ has been implicated in low grade urothelial cancer

A

Proliferative pathway involving loss of 9q has been implicated in low grade urothelial cancer

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4
Q

____ pathway involving ____ has been implicated in high grade urothelial cancer

A

Dysplastic pathway involving p53 mutation has been implicated in high grade urothelial cancer

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5
Q

Describe molecular model of urothelial cancer progression

A

Urothelial cancer progression

  1. Normal urothelium (9p-/9p-)
    • Hyperplasia -> superficial papillary low grade (FGFR3)
    • Dysplasia (G1 > G2) -> carcinoma in situ
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6
Q

Describe signs and symptoms of urothelial carcinomas

A

Signs and symptoms of urothelial carcinomas

  • Hematuria: 80%
  • Irritative voiding symptoms: 20%
  • Flank pain
  • Palpable mass
  • Mucosuria: adenocarcinoma
  • Symptoms due to metastatic disease
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7
Q

Urothelial carcinoma involves ____

A

Urothelial carcinoma involves cystoscopy

  • Trans-urethral resection of bladder tumor
  • Urinary tract imaging
  • Enhanced blue light cystoscopy
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8
Q

___ is by far the most common type of urothelial carcinoma

A

Transitional cell carcinoma is by far the most common type of urothelial carcinoma

  • Bladder >> upper tracts > urethra
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9
Q

Prognosis of urothelial carcinoma ____ with increasing stage

A

Prognosis of urothelial carcinoma worsens with increasing stage

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10
Q

Most bladder cancer is ___ at diagnosis

A

Most bladder cancer is low stage at diagnosis

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11
Q

Recurrence risk for superficial bladder cancer increases with ____, ____, ____, and ____

A

Recurrence risk for superficial bladder cancer increases with stage, grade, multiplicity of tumors, and tumor size

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12
Q

Describe treatment of superficial bladder cancer

A

Superficial bladder cancer treatment

  • Transurethral resection of bladder tumor (TURBT)
  • Close surveillance
  • Intravesical BCG
  • Intravesical chemotherapy standard: MMC, thiotepa, doxorubicin, valrubicin
  • Intravesical chenotherapy novel: gemcitabine, taxanes, and mitoxantrone
  • Smoking cessation, greater intake of fruits and vegetables, decreased intake of fat and cholesterol, increased intake of non-chlorinated water
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13
Q

Describe natural history of T1 tumors

A

T1 tumors

  • 25-30% progress to muscle invasion
  • Frequently under-staged
  • Often requires a second look transurethral resection of bladder tumor
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14
Q

Describe natural history of muscle-invasive bladder cancer

A

Muscle-invasive bladder cancer

  • T2 and T3 tumors are endowed with the invasive phenotype de nova
  • Radical cystectomy is treatment of choice
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15
Q

___ is treatment of choice for invasive bladder cancers

A

Radical cystectomy is treatment of choice for invasive bladder cancers

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16
Q

Neoadjuvant ___ is often used for invasive bladder cancer

A

Neoadjuvant chemotherapy is often used for invasive bladder cancer

  • Improves survival
17
Q

Invasive bladder cancer necessitates ____

A

Invasive bladder cancer necessitates retroperitoneal lymph node dissection

  • Minimum dissection: bilateral external iliac, hypogastric, and obturator
  • Extended dissection: pre-sacral and common iliac nodes
  • Lymph node density is # of positive nodes divided by # nodes of removed
18
Q

____ diversion is necessary after radical cystectomy for invasive bladder cancer

A

Urine diversion is necessary after radical cystectomy for invasive bladder cancer

  • Non-continent: ileal conduit
  • Continent diversion: neo-bladder, continent cutaneous diversion
19
Q

Describe upper urinary tract urothelial carcinoma

A

Upper urinary tract urothelial carcinoma

  • 50% develop bladder urothelial carcinoma
  • 5% of bladder urothelial carcinomas develop upper urinary tract urothelial carcinoma
  • Carcinoma in situ in bladder can recur in upper tracts
  • Lynch syndrome: defect in DNA mismatch repair genes (MLH1, MSH2)
20
Q

____ is a syndrome associated with urothelial carcinoma

A

Lynch syndrome is a syndrome associated with urothelial carcinoma

  • Defect in DNA mismatch repair genes (MLH1, MSH2)
21
Q

Upper tract urothelial carcinomas are treated with ____, ____, or ____

A

Upper tract urothelial carcinomas are treated with radical nephroureterectomy, segmental ureteral resection, and distal ureterectomy and reimplantation

22
Q

Ureteral tumor may present as a ____

A

Ureteral tumor may present as a filling defect

23
Q

Distal ureteral tumor is treated with ____

A

Distal ureteral tumor is treated with psoas-hitch ureteral reimplantation

24
Q

Treatment of metastatic urothelial carcinoma is ____, ____, or ____

A

Treatment of metastatic urothelial carcinoma is

  • MVAC: methotrexate, vinblastine, adriamycin, and cisplatin
  • Gemcitabine + cisplatin
  • PD-1 or PDL_1 inhibition
25
Q

Describe segments of urethra

A

Urethra

26
Q

Describe presentation of urethral cancer

A

Urethra cancer presentation

  • Males: obstruction, hematuria, discharge, mass, fistula
  • Females: bleeding, mass, obstruction
27
Q

Most urethral cancer is ____ in males but is ____ in females

A

Most urethral cancer is proximal in males but is distal in females

  • Urothelial is predominant histology for both
28
Q

Describe anterior urethra cancer

A

Anterior urethra cancer

  • Perform inguinal node dissection only if groin mass present
  • Palpable nodes usually indicate metastatic disease
  • Inguinal disease has been cured with node dissection
  • Prophylactic node dissection has no proven clinical benefit
  • Positive pelvic nodes is lethal disease
29
Q

Posterior urethra cancer is managed with ____, ____, ____, and ____

A

Posterior urethra cancer is managed with radical cystectomy, prostatectomy, total urethrectomy, and penectomy

30
Q

Anterior urethra cancer can invade ___ lymph nodes

A

Anterior urethra cancer can invade inguinal lymph nodes

31
Q

Posterior urethra cancer can invade ___ lymph nodes

A

Posterior urethra cancer can invade pelvic lymph nodes

32
Q

Anterior urethral cancer is ____, ____, ____, and ____ compared to posterior

A

Anterior urethral cancer is discovered earlier, lower stage at diagnosis, requires less radical resections, and has better overall prognosis compared to posterior

33
Q

Stage T1 urothelial cancer involves ____ of bladder wall

A

Stage T1 urothelial cancer involves lamina propria of bladder wall

34
Q

____ is associated with an increased risk of upper tract urothelial cancer

A

Lynch II syndrome is associated with an increased risk of upper tract urothelial cancer

35
Q

Tumors involving the distal urethra are most likely to invade ____

A

Tumors involving the distal urethra are most likely to invade inguinal lymph nodes

Repro / GU (46 decks)

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