Genitourinary Neoplasms

Question 1

what is the common groups we see renal cell carcinoma in

Answer 1

M>F
uncommon in patients < 45 yo
peak incidence: 55 yo (50-70)
More common in black and native american people

Question 2

what are risk factors for renal cell carcinoma

Answer 2

cigarette smoking *
obesity
HTN
dialysis related acquired cystic disease of the kidney
severe autosomal dominant familial causes

Question 3

what type of cancer is renal cell carcinoma

Answer 3

adenocarcinoma
other types: clear cell, papillary, chromophobe

Question 4

where do renal cell adenocarcinomas dervice from

Answer 4

proximal renal tubular epithelium

Question 5

What is VEGF

Answer 5

vascular endothelial growth factor

Question 6

What can be targeted as part of systemic treatment for metastatic RCC

Answer 6

VEGF

Question 7

what are common sites of metastasis from RCC

Answer 7

lungs
adjacent renal hilar lymph nodes
ipsilateral adrenal

Question 8

What is the classic triad for RCC presentation

Answer 8

Hematuria
flank/abdominal pain
flank/abdominal mass

fever, weight loss, anemia, varicocele (other presentations)

Question 9

if RCC is associated with paraneoplastic syndromes, what is the presentation

Answer 9

fever
erythrocytosis - results in polycythemia
hypercalcemia
nonmetastatic hepatic dysfunction

Question 10

what is the standard workup for RCC

Answer 10

CT of abdomen/pelvis or MRI
CXR
urinalysis
urine cytology

Question 11

what is the standard lab for for RCC

Answer 11

CBC
BMP
LFTs

Question 12

what other radiology studies are done for RCC

Answer 12

bone scans for large tumors, bone pain
Head CT/MRI

Question 13

what is the definitive diagnostic tests for RCC

Answer 13

Biopsy - risk of seeding the tract, rarely performed in practice

Question 14

what is the treatment of choice for localized RCC

Answer 14

radical or partial nephrectomy

Question 15

what is the treatment of metastatic RCC disease

Answer 15

Palliative nephrectomy for intractable local symptoms
radiation therapy for bone or brain mets
chemo has no role
systemic therapies: anti-angiogenic agents (-nib)
Palliative care

Question 16

What are the risk factors for bladder carcinomas

Answer 16

smoking - dose related, risk decreases with quitting
occupational exposure to chemicals
arsenic in well water in new england, esp. “dug wells”

Question 17

what does exophytic mean for bladder carcinomas

Answer 17

grow outwards from bladder wall aka predunculated, or lie right on wall aka sessile

Question 18

what is the most common presenting symptom with bladder carcinoma

Answer 18

gross or microscopic hematuria
Chronic or intermittent
ANY PAINLESS HEMATURIA IS CANCER UNTIL PROVEN OTHERWISE

Question 19

what labs are done for bladder cell carcinoma

Answer 19

Urinalysis
LFTs
CBC
elevated BUN/creatinine
Urine cytology

Question 20

what diagnostic tests are run for bladder carcinomas

Answer 20

US, MRI or CT

cystoscopy is study of choice

Question 21

how is bladder carcinoma staged and graded?

Answer 21

staged by how deep it invades
grading based on differentiation

Question 22

what is the gold standard treatment of bladder carcinomas

Answer 22

*Bacille Calmette-Guerin (BCG) (not done here)
endoscopic resection and intravesical chemotherapy

Question 23

what can be a curative treatment

Answer 23

resection of superficial and submucosally invasive low-grade tumors

Question 24

What is TURBT

Answer 24

TransUrethral Resection of Bladder Tumor

Question 25

What is MIBC

Answer 25

Muscle invasive bladder cancer

Question 26

what is the surveillance schedule for Bladder cancer

Answer 26

cystoscopy every 3 months for 1 year then every 6 months for 1 year then annually thereafter

Question 27

what are the risk factors for prostate cancer

Answer 27

African american Age + FH (2x) +FH of breast, ovarian CA high fat diet perhaps environmental carcinogenic influences

Question 28

what are protective factors for prostate cancer

Answer 28

not smoking healthy weight physical activity more frequent ejaculation

Question 29

where does a majority of prostate cancers arise from

Answer 29

peripheral zone

Question 30

what is the presentation if a patient has metastasis from prostate cancer

Answer 30

weight loss anemia bone pain (axial skeleton is m/c site of distal mets) acute neurologic deficit in lower limbs urinary retention

Question 31

what are the benefits of PSA screening

Answer 31

better for detecting high-grade tumors than low-grade tumors more predictive when levels are higher

Question 32

what is the definitive diagnosis for prostate cancer

Answer 32

transrectal ultrasound-guided biopsy

Question 33

what is the tumor grading and score used for prostate cancer

Answer 33

Gleason grade and gleason score

Question 34

what is the treatment for localized prostate cancer

Answer 34

radical prostatectomy + radiation

Question 35

what is the treatment for metastatic prostate cancer

Answer 35

palliative care

Question 36

what does prostate cancer respone to

Question 37

what medication therapies can be used for prostate cancer

Answer 37

androgens- use of drugs that block androgen production +/- orchiectomy androgen deprivation therapy Luteinizing hormone-releasing hormone (LHRH) agonists

Question 38

what is the most common cancer in men ages 20-35 years old

Answer 38

testicular cancer

Question 39

What are the risk factors for developing testicular cancer

Answer 39

cryptorchidism personal hx of testicular cancer +FHx; Klinefelter's syndrome HIV infection Carcinoma in situ of testicle race/ethnicity

Question 40

what are the categories of testicular cancer

Answer 40

seminomas vs non-seminomas

Question 41

what are non-seminomas

Answer 41

embryonic cell carcinomas teratoma choriocarcinoma mixed cell type

Question 42

what is the most common type of testicular cancer

Answer 42

germ cell tumors

Question 43

what are the types of germ cell tumors

Answer 43

seminomas - slower growing, less spreading; secrete only HCG non-seminomatous (4 main subtypes)

Question 44

what are the 4 subtypes of non-seminomatous germ cell tumors

Answer 44

Embryonal carcinoma - aggressive, secretes HCG and AFP choriocarcinoma - aggressive, secreted HCG Teratoma - mixed - resistant to chemo and rads yolk sack carcinoma - m/c TC in kids, secrete AFP. response to chemo

Question 45

what is the less common testicular cancer

Answer 45

stromal tumors - have excellent prognosis: Leydig cell tumors Sertoli cell tumors

Question 46

which testicle is more commonly affected by cancer

Answer 46

Right Vs. Left reflective of increased incidence of Right cryptochidism

Question 47

what is the most common symptom of testicular cancer

Answer 47

painless mass or diffuse enlargement of testicle -sensation of heaviness, acute testicular pain from intratesticular hemorrhage, development of hydrocele)

Question 48

What is the presentation of advanced testicular cancer

Answer 48

palpable retroperitoneal or supraclavicular nodes (left side) cough, SOB, hemoptysis of lung mets LE edema from vena cava obstruction back pain from retroperitoneal mets

Question 49

what tumor markers may be elevated with testicular cancer

Answer 49

Alpha-fetoprotein (AFP) hCG Lactate dehydrogenase (LDH)

Question 50

what is the imaging of choice for testicular cancer

Answer 50

scrotal ultrasound may also do abdominal and pelvic CT and chest XR/CT scan

Question 51

how is testicular cancer definitively diagnosed

Answer 51

histology

Question 52

what is the gold standard treatment of testicular cancer

Answer 52

inguinal orchiectomy -includes removal of testicle and spermatic cord to level of internal inguinal ring

Question 53

what is the treatment of testicular cancer if positive retroperitoneal nodes or mets

Answer 53

combination chemotherapy resection of residual masses after normalization of tumor markers +/- retroperitoneal lymphadenectomy

Question 54

what is the follow up schedule for testicular cancer

Answer 54

every 2-6 months x 2 years then every 4-6 months in year 3 includes tumor markers, CXR, and CT for non-seminomas CT for seminomas; tumor markers and CXR as needed

Question 55

when is penile cancer most common

Answer 55

age groups 50-70 years old primarily uncircumcised males

Question 56

what are the risk factors for penile cancer

Answer 56

lack of circumcision HPV HIV Poor genital hygiene phimosis Smegma number of sexual partners smoking increased age hx of precancerous lesions (leukoplakia, condyloma accuminata)

Question 57

what is the primary type of penile cancer

Answer 57

squamous cell carcinoma

Question 58

where does penile cancer typically begin

Answer 58

on the foreskin or on the glans

Question 59

what is the presentation of penile cancer

Answer 59

most common complaint is the lesion itself pain discharge irritative voiding symptoms bleeding enlarged, palpable inguinal lymph nodes

Question 60

what is mandatory for the diagnosis of penile cancer

Answer 60

biopsy of the primary lesion

Question 61

what is the treatment for penile cancer

Answer 61

goal: organ-sparing procedure if at all possible small, noninfiltrating lesions: 5FU cream, radiation, MOHS surgery, laser ablation

Question 62

when is total penectomy with formation of perineal urethrostomy necessary

Answer 62

deeply infiltrating and proximal lesions for penile cancer