Urologic neoplasms Flashcards

1
Q

Renal cell carcinoma

A

the most common type of kidney cancer in adults

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2
Q

RCC epidemiolgy

A

northern european ancestry and north americans > asian or african descent

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3
Q

RCC pathophysiology

A

originates proximal renal tubular epithelium. some hereditary syndromes: VHL, HPRC, BHDS, HRC

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4
Q

RCC signs and symptoms

A

classic triad of flank pain, hematuria, and flank mass (10% pts) weight loss, fever, htn, hypercalcemia, night sweats, malaise, varicocele

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5
Q

RCC diagnosis labs

A

UA, CBC with diff, electrolytes, renal profile, LFTs, calcium, ESR, PT, aPTT

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6
Q

RCC imaging

A

ultrasound, CT ab and pelvis, CXR, CT chest and MRI to assess IVC mets

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7
Q

treatment of RCC

A

radical nephrectomy

  • removal of kidney, ipsilateral renal gland and regional lymph nodes
  • partial nephrectomy
  • laproscopic nephrectomy
  • radiofrequency heat ablation or cryoablation
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8
Q

RCC management

A
SURGERY-remains the only known effective tx for localized RCC
radiation therapy
chemo
hormonal therapy
immunotherapy
combo therapy
palliative therapy in advanced disease
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9
Q

Bladder cancer epidemiology

A

common urologic ca
highest recurrence rate of any malignancy
most common type is transitional cell carcinoma

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10
Q

Risks for bladder cancer

A

SMOKING MOST COMMON
male
>65 y.o

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11
Q

signs and symptoms of bladder cancer

A
painless gross hematuria
irritative bladder sxs-dysuria, urgency, frequency
pelvic or bony pain
lower extremity edema
flank pain 
palpable mass
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12
Q

bladder ca labs

A
UA with micro
UC
voided urinary cytology
urinary tumor marker testing
fluroescence in situ hybridization (FISH) may improve accuracy of cytology
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13
Q

bladder ca imaging/procedures

A

cystoscopy-primary modality for dx of bladder carcinoma permits biopsy and resection of papillary tumors.
upper urinary tract imaging
hematuria workup
CT pelvis and abdomen

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14
Q

bladder ca diagnostic strategy with negative cystoscopy

A

negative UC and FISH-routine f/u
negative UC, postive FISH-increased frequency of survey
positive UC and +/- FISH cancer until proven otherwise

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15
Q

bladder ca treatment

A

surgery-TURBT/cystectomy/cystoprostatectomy
chemo
immunotherapy

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16
Q

testicular ca epidemiology

A

most common solid malignant tumor in men between the ages 20 and 35 years in the US, then risk reappears at age 65.

17
Q

Risks for testicular ca

A
cryptorchidism-risk of germ cell tumor
previous history
genetics
family history
infertility 
environmental exposure
18
Q

signs and symptoms of localized testicular ca

A
  • painless swelling or nodule of one testicle

- dull ache or heavy sensation in the lower abdomen

19
Q

signs and symptoms of metastatic testicular ca

A
  • neck mass in supraclavicular lymph node metastatic disease
  • anorexia
  • n/v/d
  • back pain
  • cough
  • chest pain
  • hemoptysis/dyspnea
  • CNS (rare)
  • bone pain (rare)
  • gynecosmastia
20
Q

testicular ca diagnosis

A
  • complete h and p
  • chemistry profile
  • lactate dehydrogenase
  • CBC
  • serum tumor markers (AFP or B-hCG
21
Q

testicular ca imaging

A

testicular US
high resolution CT scan of the ab and pelvis
chest xray
chest CT (if chest xray is abnormal or suspicious of metastatic ds in the throax)

22
Q

treatment of testicular ca

A

radical inguinal orchiectomy and retroperitoneal lymph node dissection
-retroperitoneal lymph node dissection is the gold standard reliable method to identify nodal micrometastases and provide accurate pathologic staging of the retroperitoneal disease

23
Q

prostate ca essential facts

A

most common noncutaneous cancer in men in the US. currently the majority of prostate ca are identified in pts who are asymptomatic

24
Q

diagnosis of prostate ca

A

elevated PSA level
the risk of the disease increases as the PSA increases level
abnormal DRE findings
biopsy-false negatives often occur so multiple bxs needed before prostate ca is detected

25
Q

treatments for clinically localized prostate ca

A

radical prostatectomy
radiation therapy
active surveillance
androgen deprivation therapy (ADT)

26
Q

signs and sxs of common/early prostate ca

A
  • urinary complaints or retention
  • back pain
  • hematuria
  • sxs are often from ds other than prostate ca
  • physical exam alone cannot reliably differentiate BPH from cancer
27
Q

signs and sxs of advanced prostate ca

A
  • cancer cachexia
  • bony tenderness
  • lower-extremity lymphedema or DVT
  • adenopathy
  • overdistended bladder (BOO)
28
Q

predicting prognosis of prostate cancer

A
  • PSA level
  • gleason score
  • percentage of bx cores positive for ca
  • clinical tumor stage
  • age at dx
29
Q

prostate bx complications

A
  • fever
  • pain
  • hematospermia
  • hematuria
  • positive urine cultures
  • sepsis (rare)
  • psychological trauma
30
Q

prostate cancer treatment

A
  • watchful waiting
  • radical prostatectomy
  • radiation therapy
  • cryotherapy
  • proton beam radiation
  • high-intensity focused ultrasound
  • hormone therapy
31
Q

AUA guidelines PSA screeing test

A

recommendations against screening:

  • 70 years
  • <55 years at high risk
  • 55-69 years to reduce harms of screening a routine interval of 2 years or more
  • intervals for rescreening can be indivualized by a baseline PSA
32
Q

AUA greatest benefit of screening

A

appears to be in men ages 55-69

some men age 70+ who are in excellent health may benefit from screening

33
Q

nephroblastoma (Wilm’s tumor)

A

most common childhood abdominal malignancy

34
Q

nephroblastoma etiology

A

caused by alterations of genes responsible for normal genitourinary development

35
Q

complications of wilms tumor

A

children with this have a minimal risk for impaired renal function primarily related to nephrectomy.
hepatic complications.

36
Q

h and p for wilms tumor

A

asymptomatic abdominal mass
exam often reveals a palpable abdominal mass
the abdominal mass should be carefully examined

37
Q

lab and imaging studies for wilms tumor

A
CBC
chemistry profile
UA
Renal US
CT scanning
38
Q

treatment of wilms tumor

A

histopathologic confirmation of wilm’s tumor is essential.
undergo nephrectomy
-contralateral kidney is explored (ensure unilateral)
-lymph node biopsy staging
-immediate nephrectomy is not performed in patients with bilateral disease