05b: Urinary tract/Kidney

Question 1

Most common presenting feature of genitourinary tract cancer

Answer 1

Hematuria

Question 2

The vast majority of renal tumors in adults prove to be (X), (benign/malignant) tumors.

Answer 2

X = clear cell renal tumors (80%)

Malignant

Question 3

T/F: Autosomal dominant polycystic kidney disease (ADPKD) does not increase risk of renal cancer.

Answer 3

True

Question 4

T/F: Renal cancer accounts for under 3% of all malignancies in adults.

Answer 4

True (2.6%)

Question 5

T/F: Cancer of renal pelvis arises from renal epithelium and accounts for 40% of renal cancers.

Answer 5

False - considered urothelial (transitional cell) cancer and accounts for 5% of renal cancers

Question 6

Genetic disorders that increase irsk of CCRC carcinoma:

Answer 6

1. von Hippel-Lindau disease
2. Familial chromosome 3 translocations
3. Tuberous sclerosis

Question 7

Non-genetic diseases/factors that increase irsk of CCRC carcinoma:

Answer 7

1. ESRD (acquired cystic kidney disease)
2. Smoking (2-4x risk)
3. Heavy metal exposure (2-4x risk)

Question 8

CCRC carcinoma: cells of origin?

Answer 8

Prob proximal tubule

Question 9

CCRC carcinoma: cells are filled with (X) and express high levels of (Y) growth factor.

Answer 9

X = lipid (high glycogen content)
Y = VEGF (highly vascular)

Question 10

Classic triad of CCRC:

Answer 10

1. Flank pain
2. Hematuria
3. Abdominal mass

**found in less than 10% of cases! So many various Sx presentation

Question 11

The “internist’s tumor”

Answer 11

CCRC (due to wide breadth of paraneoplastic features/Sx)

Question 12

CCRC carcinoma: most effective therapy

Answer 12

Nephrectomy

Question 13

CCRC carcinoma: 5y survival if disease confined in renal capsule is (X)%.

Answer 13

X = 90

Question 14

CCRC carcinoma: 5y survival if disease invades renal capsule but has not spread past (X) is (Y)%.

Answer 14

X = Gerota's fascia
Y = 60

Stage III

Question 15

CCRC carcinoma: 5y survival if disease spreads beyond Gerota’s fascia is (X)%

Answer 15

X = 10%

Locally invasive - Stage IV

Question 16

(X) renal cell cancers may undergo spontaneous remission. Which characteristic of this cancer may account for this?

Answer 16

X = CCRC carcinoma

This carcinoma may be relatively responsive to chances in host immunity

Question 17

T/F: Renal cancer responds poorly to conventional cytotoxic chemotherapy and radiation therapy.

Answer 17

True

Question 18

T/F: Renal cancer that responds to chemo “completely” implies the patient has been cured.

Answer 18

False! Indicates disappearance of radiographic evidence of tumor, but relapses may occur

Question 19

CCRC carcinoma: 5y survival if disease spread to renal vein is (Y)%.

Answer 19

Y = 60%

Stage IIIA

Question 20

CCRC carcinoma: 5y survival if disease spread to one lymph node is (Y)%.

Answer 20

X = 20%

Stage IIIB

Question 21

Von Hippel-Lindau (VHL) disease: most common cause of death

Answer 21

CCRC carcinoma

Question 22

Major renal cancer cell gene in adults:

Answer 22

VHL (tumor suppressor)

Question 23

Von Hippel-Lindau (VHL) disease: inheritance pattern

Answer 23

AD

Question 24

VHL protein function

Answer 24

Down-regulates hypoxia-induced genes by targeting HIF-alpha (TF) for destruction

Question 25

Renal cancer: VHL loss results in overexpression of which key factors?

Answer 25

1. VEGF 2. PDGF-beta 3. TGF-beta Angiogenic factors!

Question 26

Renal cancer: VHL loss allows cancer cell to form cooperative relationship with (X)

Answer 26

X = neighboring endothelial cell (gives it oxygen, nutrients via neovascularization)

Question 27

T/F: loss of second VHL allele results in renal cancer

Answer 27

False -forms cyst that (with additional mutations)can become cancer

Question 28

(X) renal tumors are small (<5mm), present in (cortex/medulla) as pale yellow nodule with papillary growth pattern. If larger than (Y) size, they're re-classified as...

Answer 28

X = renal papillary adenoma Cortex Y = 3 cm RCC (due to malignant potential)

Question 29

List some tyrosine kinase inhibitor targets for RCC

Answer 29

VEGF-R | PDGF-R

Question 30

List the urothelial tumor cell types and star the most common

Answer 30

1. Transitional cell* (95%) 2. Squamous Cell 3. Adenocarcinoma

Question 31

Bladder cancer: (X) is the major risk factor and is responsible for (Y)% of cases

Answer 31

``` X = smoking (4x risk) Y = 50 ```

Question 32

Chronic inflammation, such as in (X) conditions, increases risk of which urothelial cancers?

Answer 32

X = catheter or schistosomiasis Squamous and transitional cell carcinomas of bladder

Question 33

Which drug causes 9x increased risk of bladder cancer?

Answer 33

Cyclophosphamide

Question 34

Bladder cancer: T1 involves (X) layer. T2 involves (Y) layer. T3 involves (Z) layer.

Answer 34

``` X = mucosa Y = mucosa and muscularis Z = mucosa, muscularis, and fat ```

Question 35

Bladder cancer: Rx and prognosis for stage T1

Answer 35

TUR (Transurethral resection) | Good prognosis, but can recur

Question 36

Bladder cancer: Rx and prognosis for stage T2

Answer 36

Cystectomy | 60% 5y survival

Question 37

Bladder cancer: prognosis for stage T3

Answer 37

10% 5y survival

Question 38

Bladder cancer can be identified early with thorough work-up of (X) patients that present with (Y)

Answer 38

``` x = >40 years old Y = hematuria (evaluate by cytoscopy) ```

Question 39

Bladder cancer: Deletion of (X) is an early event. Deletion of (Y) happens later and has been linked to poorer prognosis.

Answer 39

``` X = chromosome 9q Y = Rb and p53 ```

Question 40

List the two main benign tumors of the kidney

Answer 40

1. Renal papillary adenoma | 2. Oncocytoma

Question 41

(X) renal tumors are small (<5mm), present in (cortex/medulla) as pale yellow nodule with papillary growth pattern. If larger than (Y) size, they're re-classified as...

Answer 41

X = renal papillary adenoma Cortex Y = 3 cm RCC (due to malignant potential)

Question 42

Oncocytoma: composed of (small/large) (eosinophilic/basophilic) cells thought to arise from the (X) cells.

Answer 42

Large; eosinophilic | X = interacalated cells of collecting duct

Question 43

Oncocytoma: (X) color and can grow up to (Y).

Answer 43

``` X = mahogany-brown Y = 12 cm ```

Question 44

Pt has renal mass resected that shows numerous mitochondria on EM. Which type of tumor is this a characteristic of?

Answer 44

Oncocytoma

Question 45

Aside from the most common malignant renal tumor, (X), which other malignant tumors can arise in kidney? Star the one with the best prognosis.

Answer 45

X = CCRC carcinoma (80%) 1. Papillary carcinoma 2. Chromophobe renal carcinoma*

Question 46

Characteristic chromosomal abnormalities of CCRC largely involve chromosome (X).

Answer 46

X = 3 | loss of the short arm of chromosome 3 or translocations involving chromosome 3