Urology Flashcards
General about renal tumors
Mechanism of renal tumors
Symptoms of renal tumor
Tretamen to renal tumors
Name risk factors of renal tumors
smoking
obesity
asbestos
HT
Phenacetin (analgetic)
Anatomy: PKD and horseshoes kidneys
genetic background of renal tumors?
VHL gene mutation of chromosome 3 (tumor suppressor gene)
Epidemiologi of renal tumors
1.5x in men
age 60-70
3% of all cancers
Wha structure does renal tumor form
normally a cyst
metastasis of renal tumors?
Lung
Liver
Bone
Brain
Grading used in renal tumor?
Fuhrmann classification (MOST COMMON)
TNM
Robson’s
Histological classification of renal cell tumor?
Benign
- Angiomyolipoma
- Adenoma
- Oncocytoma
Malignant
- Adenocarcinoma (82%)
- Sarcoma
- Lymphoma
Treatment if renal cell carcinoma
NOT SENSITIVE TO CHEMO OR RADIATION
Surgery!!!
what was renal cell carcinoma also called before and why?
Hypernephroma since they thought it came from the adrenals or clear cell carcinoma due to the cells appearance
is renal cell carcinoma increasing?
2% per year in europe except for Sweden and danmark
what is the Fuhrnmann classification of renal cell carcinoma based on?
Grade 1-4 determined based on:
Nucleus size and shape
Nucleoli
Renal tumor effect on testicle?
Varicocele due to obstruction of the testicular vein if tumor is in the LEFT renal vein
when to think that a cyst is malignant in the kidney?
Solitary intracystic elements
Irregular calcified wall
Immune therapy and targeted therapy in renal cell carcinoma?
Immune: Interferon Alpha 2 and IL-2
Targeted: VEGEF Ab
What groups to mention on topic 1 antineoplastic drugs
Kidney tumor
Tumor of pyelon and ureter
Bladder cancer
Prostate cancer
Testicular cancer
Penile cancer
treatment tumor of pyelon and ureter drugs
Gemzar-cisplatin
M-VAC (methotrexate, vinblastine, adriamycin, cisplatin
treatment of bladder cancer drugs
Superficial: Mitromycin C, Epirubicin, Doxorubicin
Invasive: M-VAC or Gemzar-cisplatin
Immune after TURB: BCG
Treatment in penile cancer drugs
Chemotherapy: Vincristine, MTX, Bleomycin, 5-FU, cisplatin
treatment testicular cancer drugs
BEC: bleomycin, etoposide, cisplatin
PVB: Cisplatin, Vinblastin, Bleomycin
renal pelvic and ureter tumor incidence?
10% of renal tumors
5% of urothelial tumors
what is regularly ass with upper ureter tumors?
Seen in Balkan country: interstitial nephropathy
normal location of ureter tumor?
Lower is most common
symptoms of renal pelvis cancer
colic pain
hematuria
flank pain
abdominal mass
Diagnosis of pelvic and ureter cancer
Retrograde urography first then urethral catheter for urine cytology
Ureteroscopy with biopsy
Nephroscopy through a pyelotomy
treatment of pelvic and urethral cancers?
Total nephro-uretherectomy in high risk
in low risk: localized non-metastatic: kidney-spearing surgery
what hereditary syndrom is ass with pelvic and ureter cancer?
Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC)
what is the second most common cancer in urology?
Bladder cancer
male vs female bladder cancer epidemiology
2.5 x more in men
risk factors of bladder cancer
smoking (increase by x3)
aromatic amines
printing
iron or alumni processing
gas and tar manufacturing
industrial painting
hallmark symptom of bladder cancer
PAINLESS hematuria
T staging in bladder cancer
Non-muscle invasive
pTa/pT1/CIS
Muscle-invasive
pT2-4
N staging in bladder cancer
NX: cannot be assessed
N0: no nodes involved
N1: one single LN <2cm
N2: one or more LN <2-5cm
N3: one or more LN > 5cm
histological classification of bladder cancer
- Transitional carcinoma (90%)
- Adenocarcinoma
- Squamous cell carcinoma
diagnosis of bladder cancer
History
Physical exam
Labs
US
CT
Cystoscopy
MRI
Urine cytology
treatment of bladder cancer
TURB + intravesical chemo to decrease recurrence or BCG
what is dangerous about CIS in bladder cancer?
has a direct relationship with muscle invasive tumor
what is the indication for total cystectomy?
Bladder cancer at stage T2-4 (muscle invasive)
High risk superficial tumor
what is removed in cystectomy?
Bladder
prostate
seminal vesicles
uterus + lower vagina
Regional LN
what are the 4 treatment options after blader removal?
Ileal conduct (brickers bladder)
ureterocutaneostomy
Orthotopic bladder
mortality of prostate cancer?
Mortality: in 2020, second leading cause of cancer deaths in men in the US (after lung cancer)
Prostate cancer risk factors
Advanced age (> 50 years)
Family history
African-American descent
Genetic disposition (e.g., BRCA2, Lynch syndrome)
Prostate cancer grading
Gleasons 1-3: well diff
Gleasons 4-7 moderate diff
Gleason 8-10 non diff
how do you decide staging of prostate cancer?
DRE
PSA
Gleasons score
Imaging
when do you get symptoms in prostate cancer?
Locally advanced stage (T3-T4)
Normal PSA leven?
4ng/ml
if the prostate cancer is located anteriorly what should be done in diagnosis?
transrectal US
size of prostate?
walnut
prostate structures for out to in?
- Hard capsule of SM
- Peripheral zone (biggest)
- Central zone (Ejaculatory ducts)
- Transitional zone (urethra)
what part of prostate undergoes hyperplasia?
transitional zone
what is prostate adenocarcinoma
cancer of glandular tissue of prostate
Gene mutation in prostate cancer
BRCA1 and BRCA 2
Risk factor for prostate cancer?
Old age
Obesity
Low fiber diet
Growth rate of prostate cancer ?
Very slow so no symptoms
other forms of prostate cancer?
Neuroendocrine - small cell prostate cancer
Transitional cell carcinoma
most common location of prostate cancer?
posterior, so far away from urethra, therefore no symptoms in early stages
symptoms of prostate cancer
Urinary retention
Hematuria
Incontinence
Flank pain (due to hydronephrosis)
medication hiding an increased PSA
5-alpha reductase inhibitors suppress PSA production. This should be taken into consideration in patients on long-term 5-ARIs for BPH
define Localized prostate cancer
T1-T2 stage and only local
imaging in prostate cancer?
MRI (gold standard)
Transrectal US + biopsy
what to talk about n topic 2.7 localized prostate cancer
the treatment methods!!
treatment of choice for advanced prostate cancer
Hormonal therapy
1. Antiandrogens PO 1/day to reduce flare-up phenomenon
2. LHRH after a few days, Depot injection every 3 month
What is the androgen blockage phase in prostate cancer treatment
when Antiandrogens PO and LHRH agonists depot injections are given at the same time.
how long can you give hormonal therapy in prostate cancer?
after 3-5 years it will become resistant - chemo must begin
first and second line chemo in porstat cancer
- Docetaxel
- Cabazitaxel
what to do in bone metastasis of prostate cancer?
Bisphosphonates and palliative irradiation
Penile cancer epidemiology
- very rare
- low in circumcised countries
- high in south Africa
- mostly elderly
Risk factors
Poor hygiene
STD
Long term phimosis
Viral infections like HPV
Chronic inflammation
what is Phimosis
A congenital or acquired constriction of the foreskin (prepuce) causing inability to retract it
symptoms of penile cancer
Painless lump/ ulceration (glans and the foreskin the most common)
A concurrent phimosis may conceal the lesion
Chronic penile rash or subtle burning sensation
Voiding and sexual function typically remain unimpaired
Swollen inguinal lymph nodes
types of penile tumor?
95% are SCC
5% are Sarcoma, Kaposi, BCC, melanoma
Location of penile cancer
48% glans
21% prepuce (foreskin)
9% glans and prepuce
Precancerous skin lesions on penis
Bowen disease
Leukoplakia
important DDx in penile cancer
Benign tumors or lesions:
- Condylomata acuminata
- Buschke-Löwenstein tumor
- Sexually transmitted infections
staging of penile cancer
penile cancer lymph node metastasis
testicular lymph node metastasis
prostate LM metastasis
Penile cancer treatment
Small (< 3cm) primary tumors:
- Local excision with or without circumcision
- Laser ablation
- Radiation therapy
Invasive or bulky primary tumors
- Partial penectomy: if penile length is adequate
- Total penectomy and perineal urethrostomy
Regional ipsilateral lymph node dissection
Recurrent or metastatic disease: penectomy or palliative chemo
systemic chemo in penile cancer
MTX
5-FU
Cisplatin
Bleomycin
Epidemiology of testicular tumors
Most common solid malignant tumor in young men
Peak incidence: 20–35 years
Non-seminomas peak in 3 decade of life
Seminomas in the 4 decade of life
risk factors of testicular cancer
Cryptorchidism (increased risk for germ cell tumors)
Contralateral testicular cancer
Germ cell neoplasia in situ (GCNIS)
Family history of testicular cancer
Klinefelter syndrome, trisomy 21
classification of testicular tumor
marker to look for in testicular cancer?
HCG is always elevated in choriocarcinoma and sometimes seminoma. AFP is always elevated in yolk sac tumors.
Both AFP and HCG may be elevated in mixed germ cell tumors.
symptoms of testicular cancer
Painless testicular nodule or swelling
Negative transillumination test
Dull lower abdominal or scrotal discomfort
Gynecomastia
In Leydig cell tumors: androgen excess features
Normal levels of AFP and B-HCG
AFP < 40ng/ml
B-HCG < 5mlU/ml
what staging is used in testicular cancer
American Joint Committee on Cancer (AJCC) groups, which combines TNM stage and serum tumor marker levels.
testicular cancer stages?
I. lesion confined to testis
II. Retroperitoneal node involvement
III. supradiaphragmatic nodal involvement or visceral metastasis
Diagnosis of testicular cancer?
Laboratory markers
US
CT
Histopathological confirmation: following orchiectomy
treatment of testicular cancer
Surgery - prior to surgery: sperm cryopreservation
Radical inguinal orchiectomy
are testicular cancers radiosensitive?
Only seminomas
Chemo in testicular cancer?
yes, always needed
should you do a biopsy in testicular cancer?
The testis should be REMOVED and sent to pathology.
Trans scrotal biopsy should not be conducted because of the risk of tumor seeding!
Hematuria classified acc to appearance
Macroscopic hematuria (gross hematuria)
- Suggests damage to the kidneys, upper/lower urinary tract
Microscopic hematuria
- RBCs are present in the urine sediment but no urine discoloration
- Can indicate damage to the glomeruli
Hematuria classified acc to timing when voiding
Initial hematuria: at beginning of micturition and clears by the end
- Suggests urethral damage
Terminal hematuria: blood or clots during the last part of micturition
- Suggests damage to the bladder neck, prostate, or trigonal area
Total hematuria: throughout the entire micturition
- Suggests damage to the bladder, ureters or kidneys
Painless hematuria (asymptomatic hematuria)
- Suggests malignancy
etiology of non-glomeruli hematuria
Urolithiasis
Infection
- Cystitis
- Urethritis
- Prostatitis
Malignancy: especially if otherwise asymptomatic
- Urothelial cancer
- Renal cell carcinoma
- Prostate cancer
Coagulation disorders
- Platelet dysfunction
- Hemophilia
Urinary tract obstruction
- Benign prostatic hyperplasia
- Congenital anomalies
Polycystic kidney disease
Trauma (e.g., urethral, bladder, ureteral, or renal injury)
Drugs
- Cyclophosphamide, sulfonamides
- Warfarin, heparin
Glomeruli causes of hematuria
Nephritic syndrome: characteristic of glomerulonephritis
(Hematuria with proteinuria)
urinalysis in hematuria?
Dipstick
Urin culture
Urine sediment and microscopic analysis
Cystoscopy may be done
how much blood is needed to say it is hematuria
> 1+
what is the correlation in % between hematuria and cancer
20% of gross hematuria is due to malignancy
