Urologic Cancers - AO

Question 1

What must be ruled out first in a patient with hematuria?

Answer 1

• Cancer

- Assume cancer until proven otherwise

Question 2

What is the imaging procedure of choice for viewing the urinary tract?

Answer 2

• CT urography in adults

- Ultrasonography of kidneys in children

Question 3

Most is the most common type of kidney cancer?

Answer 3

90% of renal malignancies are renal cell carcinomas

Question 4

Where do RCC most commonly originate from?

Answer 4

Renal cortex (PCT cells MC → very metabolically active cells = more prone to dysplasia)

Question 5

What type of RCC is the most common?

Answer 5

Clear cell carcinomas (75-85% of tumors)

Question 6

What disease is Clear Cell carcinoma associated with and what are its characteristics?

Answer 6

Clear cell carcinomas associated with von Hippel-Lindau Dz.

• Inherited
• Benign and malignant tumors

Question 7

What are the characteristics of Papillary carcinomas?

Answer 7

• Multifocal, bilateral
• Small, early stage tumors
• Originate from proximal tubule (as well as Clear Cell)
• Genetic predisposition
• Associated with painful cutaneous leiomyomas and uterine leiomyomas

Question 8

What are the characteristics of Chromophobe carcinomas?

Answer 8

-Uncommon
-Originate in collecting system
-Lower risk of disease progression and death compared to clear cell
-Hereditary
→Birt-Hogg-Dubé syndrome characterized by fibrofolliculomas, pulmonary cysts, pneumothorax, and bilateral renal tumors

Question 9

What are the characteristics of Oncocytomas?

Answer 9

• Uncommon
• Originate in collecting ducts
• Usually unilateral, single, and benign
• Usually slow growing, well capsulated
• Found most often incidentally

Question 10

What are the S/S of RCCs? What is the Classic traid?

Answer 10

Classic Triad: 1) Hematuria 2) flank/abdominal pain 3) palpable mass
-Also: weight loss, L-sided varicocele, HTN, hypercalcemia common

Question 11

What is the first test conducted for the Dx of RCC?

Answer 11

CT scan or MRI of entire abdomen

GOLD standard is pathology after resection of mass

Question 12

What is the Tx/management of RCCs?

Answer 12

• Radical nephrectomy (if > 4 cm or Stage I-III)
• Partial nephrectomy if < 4 cm
• Active Surveillance if < 1 cm or if elderly

Also: immunotherapy, molecular targeted therapy

Question 13

What is the most common renal malignancy in children?

Answer 13

Wilm’s Tumor (Nephroblastoma)

Question 14

What are the clinical manifestations of a Nephroblastoma?

Answer 14

• Painless, palpable abdominal mass
• Hematuria
• May or may not have HTN
• Anemia
• May or may not have abdominal pain, fever

Question 15

What is the Tx for nephroblastoma?

Answer 15

-Nephrectomy followed by chemotherapy

Question 16

What is the most common type of bladder cancer?

Answer 16

Urothelial carcinoma (transitional cell) 90%

Question 17

What is the clinical presentation of Bladder cancer?

Answer 17

• Painless gross or microscopic hematuria
• ↓ voiding capacity, dysuria, urgency, frequency
• fatigue, weight loss, anorexia

Question 18

What is the Dx work-up for a suspected bladder cancer?

Answer 18

• Urinalysis → hematuria
• Cytoscopy with biopsy (GOLD standard for initial Dx)
• TURBT if localized
• Radical Cystectomy if invasive
• BCG vaccine intravesicular if recurrent Bladder cancer