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RU 1 > Urothelial and Renal Cell Carcinomas > Flashcards

Urothelial and Renal Cell Carcinomas Flashcards

1
Q

Therapeutic plan for urothelial and RCC

A

Surgical problems- cut out

Chemo/rad- not cure
improves success rate for surgery

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2
Q

Urothelium

A

Epithelium to most of UT
Renal papilla to proximal urethra
Includes prostatic urethra in men
UC in any of these places

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3
Q

Structure of urothelium

A

Cells can shape with emptying/filling
Round/heaped up when empty
Flat, stretched out when full

Luminal surface has uroplakins

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4
Q

Uroplakins

Benefits

Harm

A

B- contribute to permeability barrier (keep noxious subst in urine from penetrating bladder)
stabilize cell membrane w repeated stretch/fold of bladder

H- uroplakins contain mannose
T1 pilli of E coli attach to mannose

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5
Q

Symptoms of Bladder carcinoma

A

Painless, visible hematuria (maybe pain)

Acute/inc- bladder pain, pain while voiding, frequent urination, urgency to urinate urge incontinence

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6
Q

Bladder carcinoma RF

A 
Smoking
Exposure to dye/tar/fumes/fert
inc age, male
Radiation
Chronic irritation (stone, catheter)
Cyclophos
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7
Q

Cyclophosphamide

A

Treatment of cancer/AI do

Metabolized to acrolein- leads to hemorrhagic cystitis, inc risk of BC

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8
Q

Symptoms of urothelial carcinoma

Potential symptoms

A

Painless vis hematuria
No sx unless blood clot- dif urinating
Flank pain if acute ureteral obstruction from bc
large, invasive kidney tumor

Weight loss, cachexia, +/- pain from advanced dz

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9
Q

RF for urothelial carcinoma

Unique factor for upper tract location

A

Similar to bladder cancer
Smoking
Exposure to dyes/tars/fume/fert
Rad/chronic irritation

Bladder is more common- carcinogens stay in bladder

HNPCCC

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10
Q

UC PE curable

Advanced dz

A

localized to bladder, ureter, kidney lumen (not palpable)

Cachexia
Mass in pelvis/flank
Lymphad
Bone/brain metastases

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11
Q

Cachexia

Most common

A

Weight loss and tissue wasting bc of underlying dz

Advanced cancer

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12
Q

UC diag tests

A

urine tests
cytoscopy
imaging

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13
Q

UC urine test

UA

UC

Cytology

A

UA- RBC w/wo WBC
suspect cancer- acute/increase bladder sx/rf

UC- no growth

carcinoma cells shed in urine
Diagnostic if +

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14
Q

UC cytoscopy

A

office procedure, look into bladder with scope

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15
Q

UC Imaging

CT urogram

If allergic

A

CT with cntrast- delayed images to show ureters, large bladder tumors

MRI w gado
Cytoscopy w retrograde pyelogram- contrast into ureters from below

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16
Q

RCC

Subtypes

A

most common type of KC

Clear (MC), papillary

17
Q

RCC symptoms

A

Flank pain/hematuria
Sx of metastases- pain/fracture
mental status changes

18
Q

Paraneoplastic Syndroms

HyperCa

HTN

Polycy

Stauffer syndrome

A

HyperCa- tumor makes PTH
Osteolytic bone mets

tumor makes renin/compresses renin vessels

Tumor/hypoxic adjacent tisseu makes EPO

Liver dysfunction from inflam cytokines

19
Q

RCC RF

Familial

A

VHL/tuberous sclerosis

ESRD w dialysis

Smoking
Obesity
HTN

20
Q

RCC PE

Varicocele

A

curable- not palpable
Familial do, advanced dz, paraneop

Inc pressure of spermatic veins- dilation
Healthy youn mang
maybe a retroperitoneal mass

21
Q

Variococele side

A

much more common on left

Left is parallel to gravity, right has gntle slope

22
Q

Variocele and suspected cancer

A

YM with unilateral R varicocele- suspect retroperitoneal tumor of RGV (think testi cancer)

OM with new varicocele
Interim development of tumor
R or L (kidney cancer)

23
Q

RCC Diag tests

Urine

Imaging

A

Hematuria (No cyto)

US can show solid mass vs cyst
CT/MRI w contrast
focal areas of dec RF
Ab/pelvic masses

24
Q

vHL

Normal
Dz

about 90% of sporadic clear cell carcinoma have ___

A

tumor suppressor
for health
AD

Multiple tumors, including cc RCC

VHL mutation

25
Q

vHL function

normal

dysfunctional

A

if tissue is hypoxic, makes HIF
vHL degrades HIF when resolved

HIF not degraded- excess angiogenic/VEGF

26
Q

VEGF function

Relevant to cancer

A

stimulates formation of new BV

Solid tumors expressing VEGF make new BV and grow

must inhibit

27
Q

HIF pathway inhibitors

Drug

A

Treatment for cancer- cc RCC

bevacuzimab- monoclonal ab against VEGF

RU 1 (11 decks)

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