Urinary Tumors

Question 1

What is a risk factor for the development of bladder cancer?

Past history of cigarette smoking

Work history in spa maintenance

History of abdominal ultrasonography

Daily consumption of cola drinks

Answer 1

Smoking, industrial exposure in metal work, painting, mining, and increased age are all risk factors for developing bladder cancer.

Question 2

A patient reports right-sided flank pain and hematuria and the primary care provider palpates a renal mass on the affected side. What is the probable treatment for this patient’s condition?

Radiotherapy for palliation of metastatic lesions

Biologic response modifiers, including interleukin

Nephron-sparing nephrectomy and chemotherapy

Ileal conduit urinary diversion surgery

Answer 2

This patient has the classic triad of symptoms for renal cell carcinoma (RCC), which usually do not present until metastasis has occurred, with poor prognosis for survival. Palliative radiotherapy is often used to treat metastatic lesions.

Question 3

Renal Cell Carcinoma

Answer 3

Renal cell carcinoma (RCC) is the most common malignant renal tumor in adults and constitutes more than 90% of all adult renal cancers

Question 4

Wilm’s Tumor

Answer 4

Most common tumor of childhood.

Question 5

Neurogenic Bladder

Answer 5

Bladder dysfunction due to upper motor neuron damage or lower spinal injury. Both result in increased bladder pressure and reflux of urine.

Question 6

Bladder Cancer

Answer 6

develops within the urothelium, the lining of the urinary tract. The urothelium is composed of three to seven layers of transitional cells that cover the muscle layers of the bladder wall. Proliferative changes of the transitional cells may result in cancer, which may remain superficial or progress to invasive or metastatic disease.

Question 7

Obstructive Uropathy

Answer 7

Pain is common, especially flank pain in crescendo - decrescendo pattern
Polyuria and nocturia can occur

Alternating oliguria and polyuria is very suggestive

Question 8

Urinary Tumor Presentation

Answer 8

Hematuria, pain, flank mass are advanced symptoms

Painless hematuria occurring throughout urination is common first sign

Question 9

Diagnostics for Obstruction

Answer 9

Postvoid residual volume
Hematuria workup if needed
Prostate exam (rule out BPH)
Spiral CT scan (KUB if CT not available)
Rule out renal stones and UTI
CBC - rule out infection

Question 10

BPH

Answer 10

Treated if urinary symptoms are significant

5a-Reductase inhbitors are mainstay of treatment

Question 11

Bladder Cancer Treatment

Answer 11

TURP procedure for superficial

More invasive for deep or aggressive cancer

Question 12

Urinary Tumor Referral

Answer 12

Cannot void - catheterization needed
Gross hematuria
Suspected tumor
Suspected cancer
Renal stone >7mm