Urinary System Cancers Flashcards
Key role of Kidney =
Filters blood, remove excess water, salt, and waste products.
Makes hormone renin -> helps control BP
Makes Erythropoietin -> stimulates bone marrow to produce RBCs
Most common type of Renal Cell Cancer =
Adenocarcinomas
Various subtypes of kidney RCC adenocarcinomas (4)
Which is most common?
Clear cell RCC (most common 7/10) Papillary RCC (1/10) Chromophobe RCC (5%) Other rare types
Types of Kidney Cancer (4)
Renal Cell Carcinoma
Transitional Cell Carcinoma
Wilms Tumor (Nephroblastoma)
Renal Sarcoma
Transitional Cell Carcinoma
- Where does it start?
- starts in lining of renal pelvis and infiltrates kidney
Wilms Tumor (Nephroblastoma)
- Most always occurs in what age group?
- ___lateral
- 5-15% have ____ tumors in one kidney
- Typically grows quite large before diagnosed ->
- (2) types
- Children
- Uni
- multiple
- higher rates of metastasis
- Favorable (no aplasia) vs Unfavorable (anaplastic)
Anaplasia =
Poor cellular differentiation considered a hallmark of cancer
Rare type of kidney cancer (<1%)
Begins in blood vessels or connective tissue of kidney
Renal Sarcoma
Kidney Cancer
Risk Factors
- Smoking & occupational chemical exposures (cadmium, herbicides, trichlorethylene)
- Obesity, high BP
- Familial hx
- Advanced kidney disease (dialysis)
- Male gender
- African american/indians/alaska natives
- Medications (Phenacetin, diuretics)
- High fat, protein diets low in antioxidants
- Genetic/Hereditary diseases
Genetic and hereditary diseases that are risk factors for Kidney Ca (6)
- Cowden Syndrome
- Von Hippel Lindau disease
- Hereditary papillary or leiomyoma RCC
- Birt-Hogg Dube (BHD) snydrome
- Familial renal CA
- Hereditary renal oncocytoma
Bc there are so many genetic diseases that predispose to renal CA -> _____ ______ is crucial for early identification
Genetic counseling
Kidney Cancer
S/S
- Hematuria
- Back pain (typically on one side)
- Mass on side or lower back
- Fatigue
- Anorexia/ Unintentional weight loss
- Fever with no infection
- Anemia
Kidney Cancer
Screening & Diagnosis (3)
- H&P
- Lab tests (CBC, BMP, urinalysis)
- Imaging (CT abdomen/pelvis > MRI, Renal US, bone scan, biopsy)
RCC
Tx for Stage I, II, III
Surgical resection w partial or radical nephrectomy
RCC
Tx for Stage pT1b
May add sunitinib or clinical trial
RCC
Tx for Stage IV (2)
Nephrectomy w surgical metastasectomy or cytoreductive nephrectomy
Systemic therapy
Systemic therapies for Stage IV RCC (6)
1) Cabozantinib
2) Pazopanib
3) Ipilimumab & Nivolumab
4) Bevacizumab + Interferon alfa 2a
5) Temsirolomus w high dose interleukin II
6) Clinical trial
Kidney Ca
Prognosis
1) __/10 are cured if diagnosis occurs at early stage
2) Chance of cure is lower if tumor has grown into ____ or pain part of kidney, higher grades
1) 9
2) ureter
Most common site of mets for Kidney Ca
Lung
Bladder Ca has decreased somewhat bc of decrease in _____
Smoking
however death rates remain substantial bc of ineffective screening
Bladder CA more common in
1) Men or Women
2) Black or White
3) Young or Old
1) Men
2) White
3) Old
Types of Bladder Ca (5)
Transitional Cell Carcinoma Squamous Cell Carcinoma Adenocarcinoma Small Cell Carcinoma Sarcoma
Which type of Bladder CA?
- > 90% of cases
- starts in inner urothelial layer
- also called urothelial carcinoma
- has several subtypes based on histology
Transitional Cell Carcinoma
Which type of Bladder CA?
- 1-2% of cases
- usually invasive
Squamous Cell Carcinoma
Which type of Bladder Ca?
- < 1% of cases
- often grow quickly
Small Cell Carcinoma
Rarest type of Bladder Ca
- Starts in muscle cells of bladder
Sarcoma
Bladder Ca
Risk Factors
- Smoking*
- Advanced age (~65)
- Workplace chemical exposure (rubber, leather, textiles, dyes, paint)
- Occupation (painters, hairdressers, machinists, printers, truck drivers)
- Caucasians 2x >
- Men
- Chronic bladder infx
- Past hx
- Bladder birth defects
- Past nephrotoxic chemo (Cyclophos)
- Arsenic in drinking water
- Consistent dehydration
- Aristolochic acid dietary supplements
- Genetics (Cowden, Lynch, RB1 mutation)
Bladder Ca
Sx
- Hematuria
- Changes in bladder habits (dysuria, frequency, hesitancy)
- Not being able to urinate
- Low back pain
- Loss of appetite, weight loss
- Swelling in feet
- Bone pain
Bladder Ca
Screening & Diagnosis
- H&P
- Cytoscopy
- Urine testing
- Biopsy
- Imaging (pyelogram)
Bladder Ca
Stage I Tx
Transurethral resection of bladder (TURB) with fulguration +
- Intravesical chemo Gemcitabine or mitomycin
- Postop intravesical chemo
- Intraop, post, maintenance intravesical bacillus Calmette-Guerin
- Observation
Bladder Ca
Stage II & III Tx
Neoadjuvant Cisplatin + radical or partial cystectomy
Chemo + radiation for nonsurgical candidates or transurethral resection + intravesical bacillus Calmette Guerin
Bladder Ca
Stage IV chemo
Systemic chemo +/- radiation
Bladder Ca
Prognosis
1) Recurrence?
> 20 years recurrence in early stage remains high, prognosis is poor, emphasis on palliation of sx
Bladder Ca Post op pts will usually have (2)
1) Ileal conduit stoma
2) Continent urinary diversion (orthoptic neobladder)
Nursing consideration for ileal conduit stoma
- Assessment & care
- patient teaching to care for stoma
Nursing consideration for Continent urinary diversion
- Is the _____ urinary diversion method
- Patient teaching to learn voiding technique
- ____ functioning can be negatively affected following cystectomy
- _____ in men
- Women may experience vaginal _____ and ____ intercourse (bc of partial vaginal removal)
- ______ distress - ongoing assessment and referral is critical
- preferred
- Sexual
- Impotence
- dryness, painful
- Psychological
Most commonly diagnosed solid tumor in men
Prostate Ca
