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Clin Med Final Material- Semester 2 > Urologic Cancers- Brian Miller > Flashcards

Urologic Cancers- Brian Miller Flashcards

1
Q

Penile Cancer:

accounts for ___% of all cancer in men in the US

A

1%

-More common in less developed countries
Africa, parts of Asia, South America
–Can be 10-20% of male cancer cases in these regions

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2
Q

Penile CA:

-MC demographic?

A

Hispanic, Asian/Pacific Islander men

-Mean age of dx = 60 yo

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3
Q

Penile CA:

-list risk factors

A
  • HPV infection
  • Phimosis
  • uncircumsized men
  • HIV infection
  • smoking
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4
Q

Penile CA:

___% of cases are squamous cell carcinoma (SCC)

A

95%
-Less common: Basal cell carcinoma, Kaposi sarcoma, malignant melanoma, extramammary Paget disease, urethral carcinoma, metastases

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5
Q

Penile CA:

Sx?

A
  • ALMOST ALWAYS 2/2 Pt noticing a lump, mass, or ulceration on penis, MC on glans
  • 30-60% will have inguinal lymphadenopathy on exam
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6
Q

Penile CA:

-If infection is suspected (ie erythema/swelling/drainage) can attempt–> ?

A

trial of antibiotics and/or antifungal meds BUT…

-If there is a palpable mass and LAD–> biopsy is needed

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7
Q

Penile CA:

IF dx is clear on exam, Pt will be taken to _____

A

OR, quickly for excision of lesion if possible

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8
Q

Penile CA: tx for tumors w low risk of recurrence (Tis, Ta lesions of glans and T1a/T1b of glans) =

A
  • consider organ-preserving strategies
  • Partial penectomy –> Goal is 1-2 cm of negative margins
  • Radiation
  • Laser ablation, glans resurfacing (Tis)
  • Mohs micrographic surgery

Topical tx – fluorouracil, imiquimod

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9
Q

Penile CA:

-tx of tumors w/ high risk of recurrence (ie bulky, T2-T4 tumors) ?

A
  • **penectomy

- Interstitial brachytherapy can be considered for those refusing surgery

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10
Q

Bladder CA:

-how common?

A
  • MC malignancy of urinary system
  • Urothelial (transitional cell) carcinoma, MC histologic type
  • -can also be found in the ureter and kidney
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11
Q

Blaader Ca:

-divided into 3 categories (list)

A

Non-muscle invasive
Muscle invasive
Metastatic

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12
Q

Bladder CA:

Sx**

A
  • **painless hematuria
  • with gross hematuria there is higher chance of bladder CA
  • Microscopic hematuria= >3 RBC/hpf
  • **Irritative voiding Sx: frequency, urgency, hesitancy
  • pain
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13
Q

Hematuria present only at beginning of urination=

A

urethral source**

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14
Q

Terminal hematuria=

A

bladder neck source

-often seen in dysfunctional voiding

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15
Q

If hematuria is present throughout voiding–> ?

A

kidney, ureter, and bladder affected

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16
Q

Bladder CA: work-up

A

H&P
Office cystoscopy
Consider cytology –>** +/- transitional cells

  • CT a/p (abdomen/pelvis)
  • Imaging of upper tract collecting system
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17
Q

Bladder CA:

tx?

A

If tumor visualized on office cystoscopy and/or positive cytology…

  • Exam under anesthesia
  • ***TURBT – transurethral resection of bladder tumor

Pathologic evaluation will help differential muscle invasive vs noninvasive

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18
Q

Non-muscle invasive bladder CA tx?

A

After tissue evaluation, patients are risk stratified
Low – 1 dose of intravesical chemotherapy
Intermediate – extended course of intravesical chemo
High – extended course of intravesical chemo, +/- systemic chemo, consider cystectomy

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19
Q

Muscle-invasive bladder CA: tx?

A

Radical cystectomy

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20
Q

Bladder CA w/ mets disease?

A

Platinum based chemotherapy

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21
Q

Prostate Cancer:

-how common?

A
  • VERY common
  • 60% of 80yo will have it on autopsy
  • second only to melanoma and lung CA as a leading cause of CA deaths
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22
Q

Prostate eval:

what is included?

A
  • PSA
  • DRE: normal= symmetric/smooth, abnormal= asymmetric/nodules/masses
  • Sx: usually none
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23
Q

If Pt has abnormal PSA and/or abnormal DRE, what is the next step?

A

prostate biopsy

***TRUS – transrectal ultrasound guided biopsy

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24
Q

Describe TRUS:

-how many cores are typically taken?

A

-12
-Tissue sent for pathologic evaluation
–>If positive= consider tx
–>If negative = observation
-If PSA still high or rising?
18 – 24 core biopsy

Prep:
Enema
–2 days of abx prophylaxis
Why: cuz of Increased UTI/sepsis risk

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25
Q

Prostate CA:

MC mets to ______

A

BONE

  • Consider bone scan if symptomatic and/or high grade disease
  • histologic grade- gleason score
  • PSA level
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26
Q

Gleason score:

-ranges from?

A

2-5
–combines 2 of most prevalent tissue types from bx
(2 scores added together= gleason score)

-Ranges from 6-10 (lower numbers are usually not diagnostic for cancer
Gleason score and TNM staging are used to guide treatment

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27
Q

Prostate CA:

-Localized dz: tx?

A

-very low risk–> PSA <10, normal DRE, low Gleason <6, < 3 positive cores
Active surveillance

28
Q

Prostate CA:

Localized, low risk: tx?

A

PSA<10, normal DRE, low Gleason <6, ***>3 positive cores

–>Surveillance, radiation, radical prostatectomy

29
Q

Prostate CA:
Localized, intermediate risk
tx?

A

PSA >10, Gleason 7, larger and/or in both lobes

-RT, radical prostatectomy

30
Q

Prostate CA:

localized high risk? tx

A

PSA >20, Gleason 8+

-RT, radical prostatectomy

31
Q

Prostate CA:

stage 4 tx?

A

=Lymph node involvement/distant mets

tx=RT +/- ADT (chemotherapy)

32
Q

After prostate CA tx:

f/u w/?

A

serial PSA to assess for recurrence

-Follow with serial CT scans (depending on risk level)

33
Q

Primary Testicular Tumors :

list the 2 types?**-

A
  • Germ Cell tumors (95%)

- Stromal tumors (5%)

34
Q

Describe serum tumor markers associated w/ Germ cell tumors** (which lab markers?**)

A
  • AFP**
  • bHCG**

KNOW

35
Q

2 types of germ cell tumors

A

Seminoma – originate from seminiferous tubules

Non-Seminoma – originate from sperm/ova cells

  • -Yolk Sac Tumor
  • -Embryonal Carcinoma
  • -Choriocarcinoma
  • -Teratoma
36
Q

Labs associated w/ stromal tumors

A

**inhibin

37
Q

Ex’s of subtypes of stromal tumors

A

Leydig Cell Tumors (Testosterone)
Sertoli Cell Tumors (Estradiol)
Granulosa Cell Tumors
Mixed/Undifferentiated

38
Q

Seminoma vs NSGCT (non-seminoma germ cell tumor)

A
  • Seminoma: more likely to be local dz (limited to testicle)
  • -stage 1 dz, 15% w stage 2 , generally DO NOT have elevated b-hcg and AFP, generally sensitive to radiation tx

-NSGCT: MORE likely to present w/ mets, will have elevated b-hcg and AFP, LESS sensitive to radiation tx

39
Q

Testicular CA:

demographic

A
  • younger, 15-35 yo
  • prognosis= very good
  • **Testicular tumors account for 21.4% of all neoplasms in male adolescents and young adults in the U.S.
  • MC** solid tumor in this age group.
40
Q

Risk factors for testicular tumors

A

A prior personal history of cryptorchidism
A family history of testicular cancer
A prior personal history of testicular cancer
Intra-tubular Germ Cell Neoplasia (ITGCN)

41
Q

Testicular CA: MOST Pts–70% present with:

A

an incidentally discovered painless, unilateral mass in the scrotum.
-20% of cases the first symptom is scrotal pain.

42
Q

DDx of testicular mass:

A
  • Epididymo-orchitis, Torsion, Hematoma, or Para-testicular tumors.
  • Other potential etiologies include hernia, hydrocele, varicocele, or spermatocele,
43
Q

testicular tumor:

-First steps of the work-up:

A
  • ** GET A Scrotal US**
  • **Serum Tumor Markers: bHCG, AFP, LDH
  • -if those are negative and concern for a stromal tumor: Inhibin, Testosterone, Estradiol
  • staging imaging: Pre op CXR for orchiectomy to R/O pumonary mets
  • Recommend sperm banking
44
Q

Testicular tumor:

-Dx?

A

=*Inguinal surgical approach

–In post pubertal male, radical orchiectomy is indicated

-If markers are negative, <2cm mass, and suspect benign disease or a stromal tumor:
–Testis sparing surgery may be reasonable
–Must have pathology available for immediate frozen section analysis
–If markers are positive or concern on frozen section=
Inguinal radical orchiectomy

45
Q

Testicular tumor:

staging?

A
  • **Serum Markers (based on levels AFTER orchiectomy)

- TNM staging and Group staging 1 2 3

46
Q

**AFP half life =

A

5-7 days

AFP may be elevated in: Yolk Sac Tumor, Embryonal Carcinoma (EC)

Physiologic elevation of AFP: Infants, Liver disease

47
Q

bHCG half life =

A

24-36hrs**

48
Q

bHCG may be elevated in ______

A
  • *Seminoma, Choriocarcinoma, EC

- May see elevation with Marijuana use or elevated LH (hypogonadism)

49
Q

testicular tumor: tx?

A

-**Orchiectomy
Exception:
Patient with massive pulmonary metastatic disease with fatal potential

-Chemotherapy and RT based on clinical/pathologic staging

50
Q

Renal cell carcinoma:

-MC subtype?

A

transitional cell carcinoma

  • Others include: oncocytomas, collecting duct tumors and renal sarcomas
  • Wilms’ Tumor and nephroblastoma seen in children
51
Q

Renal cell carcinoma:

demographic?

A
  • M>F
  • 50-70 yo
  • 3rd MC GU cancer after prostate and bladder cancer
  • 7th MC cancer over all for men, 9th for women
  • -Over 50% are discovered incidentally
52
Q

Renal cell carcinoma:

risk factors?

A
  • -Tobacco smoking contributes to 24-30% of RCC cases
  • -Tobacco results in a 2-fold increased risk

Occupational:
Leather tanners, shoe workers, asbestos workers.

-Obesity, HTN

53
Q

____% of those on long term dialysis develop acquired polycystic kidney disease, out of which 5.8% develop RCC.

A

33-50%

54
Q

_______ is a key determinant in the pathophysiology of RCC

A

*Pseudo-hypoxia driving angiogenesis

55
Q

RCCs are the most _______ of all solid tumors

A

vascularized

56
Q

RCC: presentation?

A

Presentation

  • -45% present with localized disease (T1-2)
  • -25% with locally advanced disease (T3-4)
  • -30% with metastatic disease (N1 or M1)

Distant metastases
Lung (75%), soft tissue (36%),

57
Q

RCC: classic triad that occurs in 5-10% of Pts?

-other Sx?

KNOW!!!

A

**Flank pain, hematuria, and palpable abdominal mass

-*Hematuria present 40% of Pts

-Systemic symptoms
Fatigue, Weight Loss, Hypercalcemia, Hepatic Dysfunction

58
Q

RCC: workup?

-labs?

A

-CBC, BMP, LFT’s, alkaline phosphatase, urinalysis

  • CT or MRI of Abd/Pel
  • *CT Chest once confirmed RCC
59
Q

Localized RCC Treatment

A

**Surgery is the only curative therapy for stage I-III

  • 20-30% of patients relapse within 2-3 years
  • -Metastases to the lung most common 50%
60
Q

RCC: chemo?

A

RCC has intrinsic resistance to conventional chemotherapy

–so it’s rarely used

61
Q

Risk factors for anal CA:

A 
HPV
HIV
Multiple partners 
Receptive anal intercourse
Smoking
62
Q

Most common histologic type of anal cancer?

A

-Squamous cell carcinoma**

63
Q

Anal CA:

-is uncommon, and is NOT related to _____

A

Hemorrhoids, fissures, fistulas

64
Q

Anal CA:

sx?

A

**Rectal bleeding – 45%
-Bleeding thought to be secondary to hemorrhoids/ fissure often delay diagnosis
Anorectal pain – 30%
Sensation of mass/fullness – 30%
No symptoms – 20%

65
Q

Anal Cancer: work-up?

A 
DRE
Inguinal lymph node evaluation
Biopsy 
CT chest, abdomen and pelvis 
Anoscopy 
HIV testing
GYN evaluation
66
Q

Anal CA: primary tx?

A

=Combination therapy of radiation and chemotherapy
-May achieve cure w/o surgery
Preservation of anal sphincter

67
Q

Anal CA: Following RT and chemo–> tx?

A
  • Restage and proceed with surgical resection if needed
  • APR (abdominoperineal resection) – less common recently
  • Removal of anus – colostomy required
  • Local excision – more common of late

If metastatic disease is present
Focus will remain on RT and chemo

Clin Med Final Material- Semester 2 (22 decks)

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