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14 Onco > Surgery Uro > Flashcards

Surgery Uro Flashcards

1
Q

t/f adrenal gland incidentalomas are found by chance

A

true

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2
Q

t/f adrenal adenomas and incidentalomas are larger than adrenal cancers

A

false, cancers are larger.

larger than 5 cm = cancer

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3
Q

management for adrenal cancer

A
  • open adrenalectomy: incision almost half the abdomen

- laparoscopic adrenalectomy: keyhole incisions

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4
Q

most common type of pediatric renal cancer

A

wilm’s tumor or nephroblastoma

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5
Q

management for pediatric renal ca

A

transverse laparotomy, nephrectomy

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6
Q

most common type of kidney ca in adults

A

renal cell ca

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7
Q

triad of renal cell ca

A

flank pain, renal mass, hematuria

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8
Q

staging of renal cell ca

A

1: originates and is in renal parenchyma, <7 cm
2: >7 cm
3: tumor extended within kidney (parenchyma, blood vessels, ln)
4: tumor extended beyond kidney

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9
Q

management of renal cell ca

A
  • partial nephrectomy =4 cm

- radical nephrectomy (kidney, fatty tissues, ureter) +/- adrenal gland +/- ln resection

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10
Q

squaca of the kidney associated with long standing nephrolithiasis (staghorn calculus)

A

renal squamous cell ca

chronic irritation, inflammation, infection -> squamous metaplasia

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11
Q

in transitional cell ca of renal pelvis and collecting system, tumor starts in ___

A

ureter and/or calyces of renal pelvis

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12
Q

management of transitional cell ca

A
  • radical nephroureterectomy with bladder cuff excision
  • must remove all continuous transitional cell lining
  • minoter with cytoscopy
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13
Q

t/f ureteral ca is common

A

false

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14
Q

diagnostics for ureter malignancy

A
  • initial: ct scan (urogram, iv urogram, stonogram)
  • retrograde pyelography for confirmation
  • ureteroscopy
  • biopsy
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15
Q

management of ureter malignancy

A
  • ensure that there is no renal pelvis tumor (antegrade seeding or extension)
  • check for bladder ca (retrograde extension)
  • no other pathologies = excise/ resect affected segment
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16
Q

if ureter tumor is too short, ___ can be done

A

ureteroneocystostomy

  • psoas hitch
  • boari flap

transuretero-ureterostomy

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17
Q

types of bladder ca

A
  • transitional cell ca !!!
  • adenoca
  • squaca of the bladder
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18
Q

diagnosis of bladder ca

A
  • cystoscopy for identification

- transurethral resection of bladder tumor + biopsy

19
Q

staging for bladder ca

A

1 no deep muscle involvement
2 muscle involvement
3 through muscle wall, fatty layer of tissue around bladder, or prostate, regional ln
4 spread into pelvic wall, abdominal wall, ln outside pelvis, other parts of body

20
Q

management for transitional cell ca

A

1 turbt + adjuvant intravesical chemo (bgc, mitomycin, thiotepa)
2, 3, 4 radical cystectomy
- men: + prostate and seminal vesicles
- women: uterus, ovaries, and part of vagina

21
Q

most common method to create a new bladder

A

radical cystectomy with ileal conduit

22
Q

what happens in radical cystectomy with ileal conduit

A
  • ureters are attached to proximal ileal conduit

- distal end will become urostomy (incintinent urinery diversion)

23
Q

what happens in radical cystectomy with continent urinary diversion

A
  • cut out distal ileum until ascending colon
  • ascending colon = new bladder
  • ileum is sown to anterior abdominal wall
  • patient has to put catheter through ileum to pee
24
Q

what happens in radical cystectomy without urinary diversion

A
  • bladder is reconstructed form colon and anastomosed to urethra
  • ureters attach to new bladder
  • intermittent catheterization needed (every 4-6 h)
25
Q

for stage 2-4 transitional cell ca, ____; for adenoca for the bladder ___

A

tcc = radical cystectomy required

adenoca = partial ca as long as there is adequate bladder left (must verify by turbt)

26
Q

what happens in partial cystectomy

A
  • remove part of bladder +/- ln dissection

- can be with urachal remnant

27
Q

diagnostic tests for prostate ca

A
  • prostate specific antigen
  • digital rectal examination
  • prostate biopsy
  • mri-us fusion prostate biopsy
28
Q

pr-rads classification

A 
I most probably benign
II probably benign
III intermediate
IV probably malignant
V most probably malignant
29
Q

management for prostate ca

A

surgery: radiacl prostatectomy
radio: ebrt (igrt and imrt), brachy
hormonal: androgen deprivation therapy, complete androgen blockade

30
Q

types of prostatectomy

A
  • radical: + seminal vesicles and ln
  • open surgical: via abdomen or perineum
  • laparoscopic: via keyhold incisions
  • robot assisted laparoscopic
31
Q

types of radiotherapy for prostate ca

A
  • external beam radiation therapy (intensity modulated radiation therapy or image guided radiation therapy)
  • internal radiotherapy (brachy): high dose brachy (needles) or low dose (seeds)
32
Q

types of hormonal therapy for prostate ca

A
  • medical castration: androgen deprivation therapy
  • lhrh agonist induces t production -> negative feedback -> decreases t (leuprolide, goserelin, triptorelin)
  • lhrh antagonist blocks lh (degarelix)
  • complete androgen blockage blocks the effects of testosterone in end organ (bicalutamide and flutamide)
  • orchiectomy
33
Q

t/f testosterone feeds the growth of prostate ca

A

true, drugs that block the action of t can treat men with advanced prostate ca

34
Q

most common type of penile ca

A

squaca or epidermoid ca

others: basal cell ca, melanoma, sarcoma

35
Q

risk factors for penile ca

A

hpv, uncircumcised, phimosis, smegma

36
Q

management for penile ca

A
  • partial penectomy if small
  • total penectomy if big
  • lymphadenectomy improves survival
37
Q

more than 90% of testicular cancer are ___

main types of germ cell tumors ___

A

90% are germ cells

main types: seminomas and non-seminomas (embryonal ca, yolk sac, chorioca, teratoma)

38
Q

general rule for testicular ca

A

extra testicular (epididymis, vas deferens, spermatic cord) = benign

intra vesicular (testes) = malignant

39
Q

serum markers for testicular ca

A

afp, ldh, hcg

40
Q

staging of testicular ca

A

read

41
Q

surgical management for testicular ca

A
  • radical inguinal orchiectomy (inguinal incision, testicle + spermatic cord)
  • simple orchiectomy (scrotal incision)
42
Q

radiotherapy for testicular ca

A
  • seminomatous: radical orchiectomy + adjuvant radiotherapy

- does not work for non-seminomatous

43
Q

treatment for nonseminomatous testicular ca

A

radical orchiectomy and/or chemo and/or radio and/or retroperitoneal ln dissection (until aorta and vena cava)

14 Onco (27 decks)

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