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5th year blocks > Urology > Flashcards

Urology Flashcards

1
Q

General about renal tumors

A
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2
Q

Mechanism of renal tumors

A
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3
Q

Symptoms of renal tumor

A
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4
Q

Tretamen to renal tumors

A
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5
Q

Name risk factors of renal tumors

A

smoking
obesity
asbestos
HT
Phenacetin (analgetic)
Anatomy: PKD and horseshoes kidneys

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6
Q

genetic background of renal tumors?

A

VHL gene mutation of chromosome 3 (tumor suppressor gene)

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7
Q

Epidemiologi of renal tumors

A

1.5x in men
age 60-70
3% of all cancers

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8
Q

Wha structure does renal tumor form

A

normally a cyst

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9
Q

metastasis of renal tumors?

A

Lung
Liver
Bone
Brain

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10
Q

Grading used in renal tumor?

A

Fuhrmann classification (MOST COMMON)
TNM
Robson’s

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11
Q

Histological classification of renal cell tumor?

A

Benign
- Angiomyolipoma
- Adenoma
- Oncocytoma

Malignant
- Adenocarcinoma (82%)
- Sarcoma
- Lymphoma

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12
Q

Treatment if renal cell carcinoma

A

NOT SENSITIVE TO CHEMO OR RADIATION
Surgery!!!

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13
Q

what was renal cell carcinoma also called before and why?

A

Hypernephroma since they thought it came from the adrenals or clear cell carcinoma due to the cells appearance

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14
Q

is renal cell carcinoma increasing?

A

2% per year in europe except for Sweden and danmark

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15
Q

what is the Fuhrnmann classification of renal cell carcinoma based on?

A

Grade 1-4 determined based on:
Nucleus size and shape
Nucleoli

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16
Q

Renal tumor effect on testicle?

A

Varicocele due to obstruction of the testicular vein if tumor is in the LEFT renal vein

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17
Q

when to think that a cyst is malignant in the kidney?

A

Solitary intracystic elements
Irregular calcified wall

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18
Q

Immune therapy and targeted therapy in renal cell carcinoma?

A

Immune: Interferon Alpha 2 and IL-2
Targeted: VEGEF Ab

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19
Q

What groups to mention on topic 1 antineoplastic drugs

A

Kidney tumor
Tumor of pyelon and ureter
Bladder cancer
Prostate cancer
Testicular cancer
Penile cancer

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20
Q

treatment tumor of pyelon and ureter drugs

A

Gemzar-cisplatin
M-VAC (methotrexate, vinblastine, adriamycin, cisplatin

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21
Q

treatment of bladder cancer drugs

A

Superficial: Mitromycin C, Epirubicin, Doxorubicin
Invasive: M-VAC or Gemzar-cisplatin
Immune after TURB: BCG

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22
Q

Treatment in penile cancer drugs

A

Chemotherapy: Vincristine, MTX, Bleomycin, 5-FU, cisplatin

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23
Q

treatment testicular cancer drugs

A

BEC: bleomycin, etoposide, cisplatin
PVB: Cisplatin, Vinblastin, Bleomycin

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24
Q

renal pelvic and ureter tumor incidence?

A

10% of renal tumors
5% of urothelial tumors

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25
Q

what is regularly ass with upper ureter tumors?

A

Seen in Balkan country: interstitial nephropathy

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26
Q

normal location of ureter tumor?

A

Lower is most common

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27
Q

symptoms of renal pelvis cancer

A

colic pain
hematuria
flank pain
abdominal mass

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28
Q

Diagnosis of pelvic and ureter cancer

A

Retrograde urography first then urethral catheter for urine cytology
Ureteroscopy with biopsy
Nephroscopy through a pyelotomy

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29
Q

treatment of pelvic and urethral cancers?

A

Total nephro-uretherectomy in high risk
in low risk: localized non-metastatic: kidney-spearing surgery

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30
Q

what hereditary syndrom is ass with pelvic and ureter cancer?

A

Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC)

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31
Q

what is the second most common cancer in urology?

A

Bladder cancer

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32
Q

male vs female bladder cancer epidemiology

A

2.5 x more in men

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33
Q

risk factors of bladder cancer

A

smoking (increase by x3)
aromatic amines
printing
iron or alumni processing
gas and tar manufacturing
industrial painting

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34
Q

hallmark symptom of bladder cancer

A

PAINLESS hematuria

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35
Q

T staging in bladder cancer

A

Non-muscle invasive
pTa/pT1/CIS

Muscle-invasive
pT2-4

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36
Q

N staging in bladder cancer

A

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

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37
Q

histological classification of bladder cancer

A
  1. Transitional carcinoma (90%)
  2. Adenocarcinoma
  3. Squamous cell carcinoma
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38
Q

diagnosis of bladder cancer

A

History
Physical exam
Labs
US
CT
Cystoscopy
MRI
Urine cytology

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39
Q

treatment of bladder cancer

A

TURB + intravesical chemo to decrease recurrence or BCG

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40
Q

what is dangerous about CIS in bladder cancer?

A

has a direct relationship with muscle invasive tumor

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41
Q

what is the indication for total cystectomy?

A

Bladder cancer at stage T2-4 (muscle invasive)
High risk superficial tumor

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42
Q

what is removed in cystectomy?

A

Bladder
prostate
seminal vesicles
uterus + lower vagina
Regional LN

43
Q

what are the 4 treatment options after blader removal?

A

Ileal conduct (brickers bladder)
ureterocutaneostomy
Orthotopic bladder

44
Q

mortality of prostate cancer?

A

Mortality: in 2020, second leading cause of cancer deaths in men in the US (after lung cancer)

45
Q

Prostate cancer risk factors

A

Advanced age (> 50 years)
Family history
African-American descent
Genetic disposition (e.g., BRCA2, Lynch syndrome)

46
Q

Prostate cancer grading

A

Gleasons 1-3: well diff
Gleasons 4-7 moderate diff
Gleason 8-10 non diff

47
Q

how do you decide staging of prostate cancer?

A

DRE
PSA
Gleasons score
Imaging

48
Q

when do you get symptoms in prostate cancer?

A

Locally advanced stage (T3-T4)

49
Q

Normal PSA leven?

A

4ng/ml

50
Q

if the prostate cancer is located anteriorly what should be done in diagnosis?

A

transrectal US

51
Q

size of prostate?

A

walnut

52
Q

prostate structures for out to in?

A
  1. Hard capsule of SM
  2. Peripheral zone (biggest)
  3. Central zone (Ejaculatory ducts)
  4. Transitional zone (urethra)
53
Q

what part of prostate undergoes hyperplasia?

A

transitional zone

54
Q

what is prostate adenocarcinoma

A

cancer of glandular tissue of prostate

55
Q

Gene mutation in prostate cancer

A

BRCA1 and BRCA 2

56
Q

Risk factor for prostate cancer?

A

Old age
Obesity
Low fiber diet

57
Q

Growth rate of prostate cancer ?

A

Very slow so no symptoms

58
Q

other forms of prostate cancer?

A

Neuroendocrine - small cell prostate cancer
Transitional cell carcinoma

59
Q

most common location of prostate cancer?

A

posterior, so far away from urethra, therefore no symptoms in early stages

60
Q

symptoms of prostate cancer

A

Urinary retention
Hematuria
Incontinence
Flank pain (due to hydronephrosis)

61
Q

medication hiding an increased PSA

A

5-alpha reductase inhibitors suppress PSA production. This should be taken into consideration in patients on long-term 5-ARIs for BPH

62
Q

define Localized prostate cancer

A

T1-T2 stage and only local

63
Q

imaging in prostate cancer?

A

MRI (gold standard)
Transrectal US + biopsy

64
Q

what to talk about n topic 2.7 localized prostate cancer

A

the treatment methods!!

65
Q

treatment of choice for advanced prostate cancer

A

Hormonal therapy
1. Antiandrogens PO 1/day to reduce flare-up phenomenon
2. LHRH after a few days, Depot injection every 3 month

66
Q

What is the androgen blockage phase in prostate cancer treatment

A

when Antiandrogens PO and LHRH agonists depot injections are given at the same time.

67
Q

how long can you give hormonal therapy in prostate cancer?

A

after 3-5 years it will become resistant - chemo must begin

68
Q

first and second line chemo in porstat cancer

A
  1. Docetaxel
  2. Cabazitaxel
69
Q

what to do in bone metastasis of prostate cancer?

A

Bisphosphonates and palliative irradiation

70
Q

Penile cancer epidemiology

A
  1. very rare
  2. low in circumcised countries
  3. high in south Africa
  4. mostly elderly
71
Q

Risk factors

A

Poor hygiene
STD
Long term phimosis
Viral infections like HPV
Chronic inflammation

72
Q

what is Phimosis

A

A congenital or acquired constriction of the foreskin (prepuce) causing inability to retract it

73
Q

symptoms of penile cancer

A

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

74
Q

types of penile tumor?

A

95% are SCC
5% are Sarcoma, Kaposi, BCC, melanoma

75
Q

Location of penile cancer

A

48% glans
21% prepuce (foreskin)
9% glans and prepuce

76
Q

Precancerous skin lesions on penis

A

Bowen disease
Leukoplakia

77
Q

important DDx in penile cancer

A

Benign tumors or lesions:
- Condylomata acuminata
- Buschke-Löwenstein tumor
- Sexually transmitted infections

78
Q

staging of penile cancer

A
79
Q

penile cancer lymph node metastasis

A
80
Q

testicular lymph node metastasis

A
81
Q

prostate LM metastasis

A
82
Q

Penile cancer treatment

A

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

83
Q

systemic chemo in penile cancer

A

MTX
5-FU
Cisplatin
Bleomycin

84
Q

Epidemiology of testicular tumors

A

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

85
Q

risk factors of testicular cancer

A

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

86
Q

classification of testicular tumor

A
87
Q

marker to look for in testicular cancer?

A

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.

88
Q

symptoms of testicular cancer

A

Painless testicular nodule or swelling
Negative transillumination test
Dull lower abdominal or scrotal discomfort
Gynecomastia
In Leydig cell tumors: androgen excess features

89
Q

Normal levels of AFP and B-HCG

A

AFP < 40ng/ml
B-HCG < 5mlU/ml

90
Q

what staging is used in testicular cancer

A

American Joint Committee on Cancer (AJCC) groups, which combines TNM stage and serum tumor marker levels.

91
Q

testicular cancer stages?

A

I. lesion confined to testis
II. Retroperitoneal node involvement
III. supradiaphragmatic nodal involvement or visceral metastasis

92
Q

Diagnosis of testicular cancer?

A

Laboratory markers
US
CT
Histopathological confirmation: following orchiectomy

93
Q

treatment of testicular cancer

A

Surgery - prior to surgery: sperm cryopreservation
Radical inguinal orchiectomy

94
Q

are testicular cancers radiosensitive?

A

Only seminomas

95
Q

Chemo in testicular cancer?

A

yes, always needed

96
Q

should you do a biopsy in testicular cancer?

A

The testis should be REMOVED and sent to pathology.
Trans scrotal biopsy should not be conducted because of the risk of tumor seeding!

97
Q

Hematuria classified acc to appearance

A

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

98
Q

Hematuria classified acc to timing when voiding

A

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

99
Q

etiology of non-glomeruli hematuria

A

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

100
Q

Glomeruli causes of hematuria

A

Nephritic syndrome: characteristic of glomerulonephritis
(Hematuria with proteinuria)

101
Q

urinalysis in hematuria?

A

Dipstick
Urin culture
Urine sediment and microscopic analysis
Cystoscopy may be done

102
Q

how much blood is needed to say it is hematuria

A

> 1+

103
Q

what is the correlation in % between hematuria and cancer

A

20% of gross hematuria is due to malignancy

5th year blocks (14 decks)

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