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Flashcards in Cancers Deck (40)
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1

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:
sarcomas
SCC
transitional cell carcinoma
neuroendocrine tumors

2

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

3

Clinical presentation of prostate cancer?

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

4

Dx of prostate cancer?

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

5

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%

6

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

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

8

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)

9

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:
orchiectomy
androgen deprivation LHRH (for older pts that can't undergo surgery) - this suppresses testosterone

10

Advantages and disadvantages of external beam radiation therapy? CI?

advantages:
-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
disadvantages:
- 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
CI:
previous pelvic irradiation
active inflammatory disease of rectum
very low bladder capacity
chronic moderate or severe diarrhea from any cause

11

Advantages and disadvantages of brachytherapy? CI?

advantages:
- 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

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

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

12

Advantages and disadvantages of radical prostatectomy? CI?

advantages:
- 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

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

CI: higher medical operative risk, neurogenic bladder

13

Advantages and disadvantages of active survellience? CI?

advantages:
- reduces overtx
- avoids or postpones tx assoc complications

disadvantages:
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

14

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

15

Characteristics of seminomas?

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

16

Characteristics of nonseminomas?

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

17

Causes of testicular cancer?

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

18

Presenation of testicular cancer?

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

19

Dx of testicular cancer?

- scrotal US
- CXR
- CT
- tumor markers:
beta-hCG
AFP
LDH
- if you find mass in testicle: it is cancer until proven otherwise

20

Staging of testicular cancer?

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

21

Tx of testicular cancer?

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

**encourage self-testicular exams

22

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:
HPV
age: older than 50
smegma: poor hygiene
phimosis: uncircumcision

23

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

24

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

25

Tx of penile cancer?

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

26

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

27

Presentation and dx of bladder cancer?

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

dx:
UA
cystoscopy
urine cytology
CT IVP
bx

28

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

29

Tx of bladder cancer?

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

30

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