233/234/235 - Renal and Urothelial Pathology, Cancer Flashcards Preview

Repro/GU by Minnie (she/her) > 233/234/235 - Renal and Urothelial Pathology, Cancer > Flashcards

Flashcards in 233/234/235 - Renal and Urothelial Pathology, Cancer Deck (54)
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1

Which hereditary tumor syndrome is associated with upper tract urothelial cancer?

Lynch 2

 

Mutation in DNA mismatch repair genes

2

Which type of renal cell cancer will have "chicken wire vasculature"?

Clear cell carcinoma

3

List the 3 malignant types of renal cell carcinoma

Clear cell

Papillary

Chromophobe

4

Which type of cancer is most stronly associated with mutations in the VHL gene?

Clear cell RCC

5

Which structures constitute the urothelial system? (4)

  • Kidney
  • Ureter
  • Bladder
  • Proximal urethra

 

6

List 2 risk factors for developing urothelaial cancer

Smoking

Chronic inflammation

 

Inflammation can be due to toxins, cystitis, stones, schistosoma, etc

7

Posterior urethra

  • Blood supply:
  • Lymph drainage:
     

  • Blood supply: Inferior vesical and middle rectal arteries
  • Lymph drainage: Deep pelvic nodes

 

Anterior = internal pudendal artery, inguinal nodes

8

What is the classic symptom triad in patinets with tumors of the renal parenchyma?

Hematuria

Flank pain

Flank mass

 

All 3 present in only 10% of new RCC cases

9

What are 2 common presenting symptoms/signs of bladder tumors?

Gross hematuria

And/or irritative voiding symptoms

 

Ureter/upper collecting system tumor: Flank pain, gross hematuria

Urethral: obstructive voiding symptoms, hematuria, papable mass

10

What is the mainstay of treatment for localized renal cell cancer?

Surgery

Remove all or part of the kidney

 

Legions are basically incurable if metastatic - refractory to chemo and radiation

New immune-modulation therapy is more promising

11

How are kidney cancers staged?

(What is the system)

TNM staging

 

Fuhrman calssification used for clear cell RCC

 

 

*Honestly I am between maybe 5 and infinity years away from the responsibility of staging cancer so cards on this will not be extensive sorryyy*

12

List 4 ways to prevent urothelial cancer

  • Smoking cessation
  • Fruits and veggies
  • Less intake of fat and cholesterol
  • Increase intake of non-chlorinated water

 

Antioxidants *may* be helpful, but not a ton of evidence to support

13

What landmarks help us determine the level of a renal vein/IVC tumor thrombus?

  • Level 1:
  • Level 2: 
  • Level 3:
  • Level 4:

  • Level 1: <2cm from RV ostium
  • Level 2: >2cm, but below hepatic veins
  • Level 3: In the intrahepatic IVC, but below hepatic veins
  • Level 4: Above the hepatic veins 
    • Includes into the right atrium

 

14

What diagnostic studies comprise the gold standard work-up for hematuria? (4)

CT urogram (no contrast)

Cystoscpy

Digital rectal exam

PSA

 

New onset hematuria is concerning for bladder/urothelial cancer

15

Are environmental exposures more likley to contribute to renal cell carcinoma or urothelial cell carcinoma?

Urothelial

16

What is the key difference between a renal papillary adenoma and a papillary renal cell carcinoma?

Size

  • Papillary adenomas are <1.5cm w/low nuclear grade

 

 

 

17

What is the most common type of bladder cancer?

Low-grade papillary urothelial carcinoma

<10% will be invasive, but likely to reccur

18

Which renal tumor has the lowest 5-year survival rate?

Sarcomatoid RCC

19

Anterior urethra

  • Blood supply:
  • Lymph drainage: 

  • Blood supply: Internal pudendal artery
  • Lymph drainage: Inguinal lymph nodes

 

Posterior = inferior vesical and middle rectal arteries, drains into deep pelvic nodes

20

Schistosoma hematobium is a risk factor for what kind of cancer?

Squamous cell carcinoma of the bladder

21

List 2 risk factors for renal cell carcinoma

  • Smoking
  • Family history w/autosomal dominant genotype

 

22

A mutation in which gene is associated wtih hereditary papillary RCC?

MET oncogene on 7q31

23

What is the function of the VHL gene?

Degrades hypoxia-inducible factor alpha

Mutation results in increased angiogenesis

 

Mutation -> Renal cell carcinoma more likely

Why anti-VEGF therapies may be helpful

24

Which type of repro/GU cancer is most strongly associated with paraneoplastic syndromes?

What are the paraneoplastic syndromes?

Renal cell carcinoma

  • Cachexia/weight loss
  • Hepatic dysfunction
  • Anemia
  • Erythrocytosis
  • Hypercalcemia
  • Hypertension

Caused by RCCs that secrete PTHrP, EPO, ACTH, and/or renin​

Thank you @Alba!

25

Which paraneoplastic condition associated with RCC may be caused by increased IL-6 production?

Stauffer's syndrome

26

Is alcohol consumption a risk factor for renal cell carcinoma?

NO

27

What genomic abnormality is typical of most clear cell RCC?

Problem with VHL gene on 3p

Deletion, mutation, or hypermethylation

28

List 4 types of drugs that can be used to treat metastatic renal cancer

  • Anti-VEGF drugs
    • Stop tumor-associated angiogenesis
  • Signal transduction inhibitors
    • Tarket tyrosine kinase and mTOR pathways
  • CTLA-4 inhibitors
  • Checkpoint inhibitors
    • PD-1, PDL-1

 

Metastatic renal disease is refractory to both chemotherapy and radiation

29

Which variant of urothelial carcinoma will show spindle cells?

Sarcomatoid - very aggressive!

 

In general, I think anything that has "sarcoma" in it is pretty bad?

30

In staging renal cell carcinoma:

What feature determines progression from T1 to T2?

What about T2 to T3?

T1 to T2 determined by size

T2 to T3 determined by invasion into adjacent structures/veins