Genitourinary Neoplasms

Question 1

What is the peak age of incidence for renal cell carcinoma?

Answer 1

55 y.o. (50-70 years)

Question 2

What are the risk factors of renal cell carcinoma?

Answer 2

Cigarette Smoking**
Obesity
Hypertension
Dialysis related acquired cysts
Several autosomal dominant familial causes

Question 3

What type of cancer is renal cell carcinoma?

Answer 3

Adenocarcinoma

Other less common types: clear cell, papillary, chromophobe

Question 4

Although RCC doesn’t typically metastasis, when it does what is the more common location?

Answer 4

Lungs

Question 5

About 15% of patients with RCC will have this triad of presenting symptoms?

Answer 5

Hematuria
Flank or abdominal pain
Flank or abdominal mass

Question 6

True or False: Any solid renal masses should be considered malignant until proven otherwise

Answer 6

True

*Why biopsies are rare

Question 7

Are biopsies typically done to diagnose RCC?

Answer 7

No not commonly performed in practice although considered to be the gold standard. There are no tumor markers specific for RCC and the risk of seeding is too great

Question 8

What is the standard workup for RCC?

Answer 8

• CT of abdomen/pelvis or MRI
• CXR (unless mets are suspected then do a CT)
• Urinanlysis
• Urine cytology
• Labs: CBC, BMP, LFT’s

Question 9

What is the treatment for localized RCC?

Answer 9

• Radical or partial nephrectomy

Question 10

What is the treatment for metastatic disease?

Answer 10

Surgery and chemo have a limited role in the treatment

Radiation for palliation of bone or brain metastases

Palliative care

Question 11

What are the risk factors for bladder cancer?

Answer 11

• Smoking
• Occupational exposure to chemicals (hairdressers, workers with rubber, dye, leather etc.)
• Arsenic in well water in New England

Question 12

What is the most common presenting symptom with bladder carcinoma?

Answer 12

Gross or microscopic hematuria

Question 13

What is the test of choice for working up bladder carcinoma?

Answer 13

Cystoscopy (+/- biopsy of any tumors seen)

Question 14

Due to the high reoccurrence rate of bladder cancer what is the follow-up cytoscopy schedule after cessation of treatment?

Answer 14

• Every 3 months for one year
• Then every 6 months x1 year
• Then annually thereafter

Question 15

What is the first line treatment for bladder carcinoma in situ and large high grade, recurrent Ta or T1 masses?

Answer 15

Bacille Calmette-Guerin (attenuated strain of mycobacterium bovis) given weekly for 6-12 weeks

Question 16

What are the risk factors for prostate cancer?

Answer 16

• African American
• Age
• Fhx
• • FH of breast, ovarian cancer
• High fat diet
• Perhaps environmental carcinogenic influences

Question 17

Does early prostate cancer typically present with symptoms?

Answer 17

No, usually identified via PSA screening

Question 18

Is BPH a risk factor for prostate cancer?

Answer 18

No, but it does cause elevated PSA levels on screening which then leads to biopsy for cancer

Question 19

With metastasis present in prostate cancer what are some of the presenting symptoms?

Answer 19

• Weight loss
• Anemia
• Bone pain (commonly the lumbosacral area)
• Acute neurologic deficit in the lower limbs
• Urinary retention

Question 20

What is the way to definitively diagnose prostate cancer?

Answer 20

Transrectal ultrasound-guided biopsy

Question 21

What is the treatment of localized prostate cancer?

Answer 21

Radical prostatectomy + radiation therapy

or Surgery open, lap or robotic

Question 22

What is the most common cancer in men age 20 to 35?

Answer 22

Testicular cancer

Question 23

What is the average age of testicular cancer?

Answer 23

33

Question 24

What are the two classifications of testicular cancer?

Answer 24

Seminomas and non-seminomas

Question 25

What are the types of non-seminoma testicular cancer?

Answer 25

- Embryonic cell carcinoma - Teratoma - Choriocarcinoma - Mixed cell type (m/c)

Question 26

What is the most common testicular cancer in kids?

Answer 26

Yolk sac (responds to chemo)

Question 27

What is secreted by seminomas?

Answer 27

HCG

Question 28

Are mets common at presentation with testicular cancer?

Answer 28

Yes, 50% of patients will have metastases when first evaluated

Question 29

What is the most common presenting symptom of testicular cancer?

Answer 29

Painless mass or diffuse enlargement of the testicle

Question 30

What sites are lymphadenopathy common in testicular cancer?

Answer 30

Supraclavicular or inguinal

Question 31

What are some symptoms with advanced testicular cancer?

Answer 31

- Palpable retroperitoneal or supraclavicular nodes, particulary on the left side - Cough, SOB, hemoptysis of lung mets - LE edema from vena caval obstruction - Back pain from retroperitoneal mets

Question 32

What labs should be ordered in working up testicular cancer?

Answer 32

- Alpha-fetoprotein (AFP) - hCG (not normally detectable in men) - Lactate dehydrogenase (LDH)

Question 33

What lab level maybe slightly elevated in those who use mariguana heavily?

Answer 33

hCG

Question 34

What is the imaging modality of choice in working up testicular cancer?

Answer 34

Scrotal ultrasound

Question 35

What is the gold standard treatment of testicular cancer?

Answer 35

Inguinal Orchiectomy

Question 36

Is testicular associated with a high rate of recurrence?

Answer 36

Yes, recurrence in 20-30% of pats on active surveillance (usually w/in first 2 years)

Question 37

What are some risk factors for penile cancer?

Answer 37

- Lack of circumcision - HPV - HIV - Poor hygiene - Number of sexual partners - Smoking - Increased age

Question 38

What are some of the presenting symptoms of penile cancer?

Answer 38

- Lesion - Pain - Discharge - Irritative voiding symptoms - Bleeding - Enlarged, palpable inguinal lymph nodes