Genitourinary Malignancies Flashcards Preview

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Flashcards in Genitourinary Malignancies Deck (16):
1

What is the epidemiology of bladder cancer?

  • Estimated new cases in 2015: 74,000 (M:F ratio – 3:1)
  • Estimated deaths in 2014: 16,000
  • Few clinical advances over the past 20 years
  • Standard of care unchanged
  • No targeted agents approved for bladder cancer
     

2

What are some risk factors of bladder carcinoma?

  • Transitional cell epithelium
  • Tumor primary sites: 90% bladder, 8% renal pelvis, 2% ureter and urethra 
  • Risk factors
    • Smoking (2-4x higher risk in smokers)
    • Aniline dyes
    • Drugs:
      • phenacetin
      • chlornaphazine
      • cyclophosphamide
    • Schistosoma haematobium  
       

3

What are the pathological calssifications of bladder carcinoma?

  • Transitional cell (95%)
  • Squamous carcinoma (3%)
  • Adenocarcinoma (2%)
  • Small cell tumors (<1%)
  • Others: melanoma, lymphoma
     

4

What are the signs and symptoms of bladder carcinoma?

  • Hematuria (>80%)
  • Irritative urinary symptoms: 
    • frequency, nocturia, urgency, precipitancy
  • Flank pain
  • Symptoms related to metastatic disease

5

What is the epidemiology of prostate cancer?

  • Estimated new cases in 2015: 220,800
  • Estimated deaths in 2015: 27,540
  • Trend in cancer incidence: -2% /yr
  • Positive trend in 5-year survival rates:
    • 1975-77: 68%
    • 1987-89: 83%
    • 2004-10: >99%
       

6

How is PSA used in screening for prostate cancer?

  • American Cancer Society:
    • PSA at 50 yo
    • PSA < 2.5ng/ml: every 2 yrs testing
    • PSA > 2.5ng/ml: annual
    • Screening discussions 40-45 yo for high risk patients: African Americans and family history of 1st degree relative with prostate ca <65yo
    • Biopsy if PSA > 4ng/ml
  • United State Preventive Services Task Force:
    • Men should not be screened for prostate cancer
  • American Urological Association:
    • PSA screening 55-69 yo
    • Individualize decision for high risk patients (40-54 yo)
    • Do not screen:
      • >70 yo
      • Life expectancy < 10-15 yrs
  • American College of Physicians:
    • Discuss with patients 50-69 yo
    • Do not screen:
      • <50 or >69 yo
      • Life expectancy < 10-15 yrs

7

Ehat are the signs and symptoms of prostate cancer?

  • Urinary symptoms: urgency, nocturia, hesitancy
  • Hematuria
  • Back pain

8

What are the different pathological classifications of prostate cancer, and how are they graded/staged?

  • Evaluation and staging
    • TRUS-guided needle biopsy
  • Pathology:
    • Adenocarcinomas
    • Squamous or transitional cell carcinoma
    • Carcinosarcomas
    • Metastatic tumors
  • Gleason score

9

Ehat are the types of androgen depreivation therapy (ADT)?

  • Surgery (orchiectomy)
  • Injectable LHRH agonists (luprolide, goserelin)
  • LHRH antagonists (degarelix)  
  • Antiandrogens (bicalutamide, flutamide, enzalutamide)
  • Estrogens
     

10

What is the epidemiology of testicular cancer?

  • Estimated new cases in 2015: 8,430
  • Estimated deaths in 2015: 380

11

What are the types of testicular cancers and what are some risk factors?

  • Primary germ cell tumors
  • Patients 20-40 yrs old
  • Nonseminoma
    • Embryonal carcinoma (AFP and/or hCG)
    • Teratoma
    • Choriocarcinoma (hCG)
    • Endodermal sinus (yolk sac) (AFP)
  • Seminoma
  • Other sites of primary germ cell tumors:
    • mediastinum
    • retroperitoneum
    • pineal gland
  • Risk factors:
    • Cryptorchidism
    • Klinefelter’s syndrome

12

What are the signs and symptoms as well as diagnosis of testicular cancer?

  • Signs and symptoms
    • Painless testicular mass
    • Back pain
    • Dyspnea
    • Gynecomastia (hCG producing tumors)
  • Evaluation and staging
    • Scrotal US
    • Radical inguinal orchiectomy
    • Alfa fetoprotein, hCG, LDH
    • CT scan chest/abdomen/pelvis

13

What is the epidemiology of renal cell carcinoma?

  • Estimated new cases in 2015: 61,560 (M:F ratio – 2:1)
  • Estimated deaths in 2015: 14,080
  • Positive trend in 5-year survival rates:
    • 1975-77: 50%
    • 1987-89: 57%
    • 2004-10: 74% (to to increased imaging)
       

14

What are the risk factors of renal carcinoma?

  • Smoking
  • Acquired cystic disease associated end-stage kidney disease
  • Tuberous sclerosis
  • Genetic syndromes
     

15

What are the types of sporadic renal cell carcinoma?

  • Clear cell - proximal tubule cell origin, most common
  • Papillary - proximal tubule cell origin, bilateral and multifocal
  • Chromophobic - cortical collecting duct cell origin, indolent
  • Collecting duct - medullary collecting duct, aggressive and least common

16

What are the signs and symptoms of renal cell carcinoma?

  • Hematuria, abdominal pain, flank mass (10-20% pts)
  • Fever
  • Anemia
  • Weight loss
  • Paraneoplastic syndromes:
    • Erythrocytosis
    • Hypercalcemia
    • Nonmetastatic hepatic dysfunction (Stauffer syndrome)
    • Dysfibrinogenemia