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Flashcards in Cancers Deck (40)
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How common is prostate cancer? What helps dx prostate cancer? MC type?

- 2nd most common cancer in men in America - 2nd greatest cause of mortality in men
- PSA helps dx in 1/6 men w/ prostate cancer
- clinical incidence doesn't match prevalence at autopsy - over 40% of men over 50 are found to have cancer
- MC type: adenocarcinoma
- other types:
transitional cell carcinoma
neuroendocrine tumors


RFs for prostate cancer?

- age: rare in men younger than 40, develops in 40s
- race: higher rates in African American men (higher PSAs), lower rate in Asian-American/Hispanic latino men
- family hx:
2 fold greater risk w/ 1st degree relative
- genetic:
mutations especially on BRCA 2 increase risk in men, men w/ lynch syndrome (HNPCC)
- enviro carcinogens: agent orange


Clinical presentation of prostate cancer?

- men w/ early stage cancer usually have no sxs:
urinary frequency/urgency
- hematuria/hematospermia
- bone pain (pathological fracture)


Dx of prostate cancer?

-DRE: nodules, induration, asymmetry
- TRUS: MRI guided
- bone scan


Pathology of prostate CA? MC zones of prostate that are affected?

- acinar cells of prostate will develp into adenocarcinoma
- zones:
peripheral zone - majority (70%)
central: 2-5%
transition: 10-20%


Gleason grading scale?

- scoring system using numbers 1-5
- grade 1: cancerous tissue looks like normal prostate tissue
- grade 5: cancer cells and growth patterns look very abnormal
- diff areas of prostate ahve diff cancer grades - gleason grade (sum) adds 2 grades together:
primary tumor
secondary tumor (minority of the tumor)
- ex:
majority: 3 (primary)
less: 4 (secondary) - total gleason grade = 7


TMN staging system?

- stage T1: cancer is found in prostate only, can't be felt by DRE or seen on imaging
- T2a and T2b: tumor that is too small to be felt or seen on image (2a) or slightly larger tumor that can be felt on DRE (2b)
- stage T3: cancer has spread beyond outer layers of prostate into nearby tissues, and may have spread to seminal vesicles
- stage T4: any tumor that has spread to other parts of the body
- stage N+ or M+: spread to lymph nodes or met to other areas of body


Risk classificaiton of prostate cancer stages?

guidelines from ESMO
- low risk: T1-T2a and gleason score 6 or less and PSA 10 or less
- intermediate risk: T2b and/or Gleason score 7 and/or PSA 10-20 (usually go on to tx: prostatectomy)
- high risk:
T2c and greater or Gleason score 8-10 or PSA greater than 20 (get mets workup)


Diff tx options for prostate cancer?

- active surveillance: Gleason 6 (slow growing)
- open radical prostatectomy vs MIRP (gleason 6 and up)
- radiation:
external beam, high dose radiation (HDR), brachytherapy
- HIFU (High intensity focused US)
- hormone therapy:
androgen deprivation LHRH (for older pts that can't undergo surgery) - this suppresses testosterone


Advantages and disadvantages of external beam radiation therapy? CI?

-effective long-term cancer control w/ high-dose txs, very low risk of urinary incontinence, available for cure of pts over wide range of ages and in those w/ significant comorbidity
- sig risk of impotence, lack of lymph node removed, late rectal sxs more common than w/ brachytherapy or radical prostatectomy, up to half of pts have some temp. bowel and bladder sxs during tx
**Usually tx of choice if want to preserve continence and erection
previous pelvic irradiation
active inflammatory disease of rectum
very low bladder capacity
chronic moderate or severe diarrhea from any cause


Advantages and disadvantages of brachytherapy? CI?

- cancer control rates appear equal to surgery and EBRT for organ confined tumors
- quicker than EBRT (single tx)
- available for cure over wide range of ages and in those w/ some comorbidity

- sig risk of impotence
- lack of lymph node removed
- up to half may have some temp. bladder or bowel sxs with tx

- previous pelvic irradiation
- large volume gland
- marked voiding sxs
- large or high grade tumors
- chronic moderate or severe diarrhea
- active inflammatory disease of rectum


Advantages and disadvantages of radical prostatectomy? CI?

- effective long term cancer control
- predictions of prognosis can be more precise based on pathologic features in specimen
- pelvic lymph node dissection is possible through same incision, PSA failure is easy to detect

-sig risk of impotence
-risk of operative morbidity
- low risk of long term incontinence

CI: higher medical operative risk, neurogenic bladder


Advantages and disadvantages of active survellience? CI?

- reduces overtx
- avoids or postpones tx assoc complications

tumor may progress past possibilty of cure
- later tx may result in more SEs
- living w/ untx cancer may cause anxiety

CI: high grade tumors (higher than gleason 6), not stage T1c
- prolonged expected survival


What pop group is testicular cancer most common?
Curable or not? MC types of cancers?

- MC cancer in men b/t 15-35
- accounts for 1% of all tumors in males
- tumor spreads by lymphatics and blood
- highly curable if discovered early
- 90-95% of all primary tumors arise from germ cells
- germ cell tumors:
seminomas (50%)
nonseminomas (more aggressive
- non germ cell tumors (5%):
leydig cell
sertoli cell


Characteristics of seminomas?

- germ cell tumor
- slow growing
- found in men in 30s and 40s
- very sensitive to radiation


Characteristics of nonseminomas?

- germ cell tumor
- more common and quicker growing
- 4 subtypes:
embryonal carcinoma
yolk sac carcinoma
- occur in teen yrs and early 40s
- more sensitive to chemo


Causes of testicular cancer?

- cyrptorchidism
- family hx
- klinefelter syndrome
- previous hx of testicular cancer
- caucasian


Presenation of testicular cancer?

- painless testicular lump**
- enlarging testicle
- accum around testicle
- accumulation around testicle (hydrocele)
- mets:
swelling of lower extremities
back pain


Dx of testicular cancer?

- scrotal US
- CT
- tumor markers:
- if you find mass in testicle: it is cancer until proven otherwise


Staging of testicular cancer?

- stage 1: confined to testicle
- stage 2: mets to retroperitoneal nodes
- stage 3: mets above diaphragm or to visceral organs


Tx of testicular cancer?

- radical orchiectomy
- depending on stage:
seminoma: radiation, chemo or both
nonseminoma: RPLND or survellience, chemo

**encourage self-testicular exams


How common is penile cancer? RFs?

rare type of cancer making up less than 1% of all cancers dx in men
- occurs mainly in uncircumcised men
- SCC (95%)
- RFs:
age: older than 50
smegma: poor hygiene
phimosis: uncircumcision


Presentation and dx of penile cancer?

- growth or sore on penis
- skin thickening on penis
- d/c w/ foul odor from under the foreskin
- pain in penis
- swollen lymph nodes in groin
- irregular swelling at end of penis

-dx: bx


Staging of penile cancer?

- O: cancer hasn't grown below surface of layer of the skin
- 1: cancer has grown just below the surface layer of the skin
- 2: invasion into the shaft or corpora: no nodes or mets
- 3: tumor confined to penis, operable inguinal nodes mets
- 4: tumor involves adjacent structures, inoperable inguinal lymph nodes and distant mets


Tx of penile cancer?

- laser therapy
- mohs surgery
- partial or total penectomy
- lymph node disection
- radiation


How common is bladder cancer? Etiology?

- one of MC urologic malignancy
- majority of cases are transitional cell carcinoma (65-75%)
- 60,000 new cases yearly w/ 13,000 deaths
- 3-4x more common in women
- etiology:
tobacco exposure (even 2nd smoke)
industrial exposure: aniline dyes, textile printing, rubber manufacturing
chemo: cyclophosphamide and ifosfamide


Presentation and dx of bladder cancer?

- MC in painless microscopic or gross hematuria (85%)
- frequency
- dysuria
- back or flank pain

urine cytology


Staging of bladder cancer?

- stage 0: papillary lesions relatively benign or carcinoma in situ
- stage 1: tumor invades submucosa or lamina propria
- stage 2: invasion into muscle (need to have bladder removed)
- stage 3: extends beyond muscel into perivesical fat
- stage 4: extension into adjacent organs


Tx of bladder cancer?

- biologic therapy:
uses pts immune system to fight cancer, BCG
- chemo
- surgery:
radical cystectomy w/ urinary diversion
partial cystectomy
- radiation


Types of renal cancer? How common?

- renal cell carcinoma: 85%
- transitional cell: 10-15%
- sarcoma
- wilm's tumor
- 62,000 adults dx with renal cancer, w/ 14,000 deaths
- 7th MC cancer, 10th MC cause of cancer death
- 72% 5 yr survival rate