Urologic neoplasms Flashcards
Renal cell carcinoma
the most common type of kidney cancer in adults
RCC epidemiolgy
northern european ancestry and north americans > asian or african descent
RCC pathophysiology
originates proximal renal tubular epithelium. some hereditary syndromes: VHL, HPRC, BHDS, HRC
RCC signs and symptoms
classic triad of flank pain, hematuria, and flank mass (10% pts) weight loss, fever, htn, hypercalcemia, night sweats, malaise, varicocele
RCC diagnosis labs
UA, CBC with diff, electrolytes, renal profile, LFTs, calcium, ESR, PT, aPTT
RCC imaging
ultrasound, CT ab and pelvis, CXR, CT chest and MRI to assess IVC mets
treatment of RCC
radical nephrectomy
- removal of kidney, ipsilateral renal gland and regional lymph nodes
- partial nephrectomy
- laproscopic nephrectomy
- radiofrequency heat ablation or cryoablation
RCC management
SURGERY-remains the only known effective tx for localized RCC radiation therapy chemo hormonal therapy immunotherapy combo therapy palliative therapy in advanced disease
Bladder cancer epidemiology
common urologic ca
highest recurrence rate of any malignancy
most common type is transitional cell carcinoma
Risks for bladder cancer
SMOKING MOST COMMON
male
>65 y.o
signs and symptoms of bladder cancer
painless gross hematuria irritative bladder sxs-dysuria, urgency, frequency pelvic or bony pain lower extremity edema flank pain palpable mass
bladder ca labs
UA with micro UC voided urinary cytology urinary tumor marker testing fluroescence in situ hybridization (FISH) may improve accuracy of cytology
bladder ca imaging/procedures
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
bladder ca diagnostic strategy with negative cystoscopy
negative UC and FISH-routine f/u
negative UC, postive FISH-increased frequency of survey
positive UC and +/- FISH cancer until proven otherwise
bladder ca treatment
surgery-TURBT/cystectomy/cystoprostatectomy
chemo
immunotherapy
testicular ca epidemiology
most common solid malignant tumor in men between the ages 20 and 35 years in the US, then risk reappears at age 65.
Risks for testicular ca
cryptorchidism-risk of germ cell tumor previous history genetics family history infertility environmental exposure
signs and symptoms of localized testicular ca
- painless swelling or nodule of one testicle
- dull ache or heavy sensation in the lower abdomen
signs and symptoms of metastatic testicular ca
- 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
testicular ca diagnosis
- complete h and p
- chemistry profile
- lactate dehydrogenase
- CBC
- serum tumor markers (AFP or B-hCG
testicular ca imaging
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)
treatment of testicular ca
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
prostate ca essential facts
most common noncutaneous cancer in men in the US. currently the majority of prostate ca are identified in pts who are asymptomatic
diagnosis of prostate ca
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
treatments for clinically localized prostate ca
radical prostatectomy
radiation therapy
active surveillance
androgen deprivation therapy (ADT)
signs and sxs of common/early prostate ca
- 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
signs and sxs of advanced prostate ca
- cancer cachexia
- bony tenderness
- lower-extremity lymphedema or DVT
- adenopathy
- overdistended bladder (BOO)
predicting prognosis of prostate cancer
- PSA level
- gleason score
- percentage of bx cores positive for ca
- clinical tumor stage
- age at dx
prostate bx complications
- fever
- pain
- hematospermia
- hematuria
- positive urine cultures
- sepsis (rare)
- psychological trauma
prostate cancer treatment
- watchful waiting
- radical prostatectomy
- radiation therapy
- cryotherapy
- proton beam radiation
- high-intensity focused ultrasound
- hormone therapy
AUA guidelines PSA screeing test
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
AUA greatest benefit of screening
appears to be in men ages 55-69
some men age 70+ who are in excellent health may benefit from screening
nephroblastoma (Wilm’s tumor)
most common childhood abdominal malignancy
nephroblastoma etiology
caused by alterations of genes responsible for normal genitourinary development
complications of wilms tumor
children with this have a minimal risk for impaired renal function primarily related to nephrectomy.
hepatic complications.
h and p for wilms tumor
asymptomatic abdominal mass
exam often reveals a palpable abdominal mass
the abdominal mass should be carefully examined
lab and imaging studies for wilms tumor
CBC chemistry profile UA Renal US CT scanning
treatment of wilms tumor
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
