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Urology > GU Cancer > Flashcards

GU Cancer Flashcards

(65 cards)

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1
Q

Types of GU Cancers

A 
Prostate
Testicular
Penile
Bladder
Renal
Wilms tumor
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2
Q

Epidemiology of Prostate Cancer

A

2nd most common cancer in men

Clinical incidence doesn’t match prevalence at autopsy

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3
Q

Types of Prostate Cancer

A 
Adenocarcinoma (most common)
Sarcomas
Small cell carcinomas
Transitional cell carcinomas
Neuroendocrine tumors
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4
Q

Risk Factors for Prostate Cancer

A 
Age: 40+ years
Race: higher in African-American men
Family history: two fold greater risk with 1st-degree relative
Genetic: BRCA2
Environmental carcinogens: agent orange
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5
Q

Clinical Presentation of Prostate Cancer

A

Early stage cancer: asymptomatic
Symptoms may include: urinary frequency/urgency, nocturne, hesitancy
Hematuria/hematospermia
Bone pain

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6
Q

Diagnosis of Prostate Cancer

A

DRE: nodules, induration, asymmetry
Transrectal ultrasound (TRUS)
MRI
Bone scan

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7
Q

Pathology of Prostate Cancer

A

Acinar cells develop into adenocarcinoma

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8
Q

Zones of the Prostate

A

Peripheral zone
Central zones
Transition zone

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9
Q

Which zone of the prostate are a majority of prostate cancers found?

A

Peripheral zone

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10
Q

Grading of Prostate Cancer

A

Gleason grade: well-differentiated (grade 1) to poorly differentiated (grade 5)
Gleason score = primary tumor grade + secondary tumor grade

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11
Q

Staging of Prostate Cancer

A

Stage 1: found in prostate only
Stage 2: tumor that is too small to be felt or seen on image test (2a) or larger tumor that can be felt on DRE (2b)
Stage 3: cancer has spread beyond the outer layers of the prostate into nearby tissues & maybe seminal vesicles
Stage 4: any tumor that has spread to other parts of the body

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12
Q

Risk Classification of Prostate Cancer

A

Low risk: T1-T2a & Gleason score T2c or Gleason score 8-10 or PSA >20

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13
Q

Define Gleason Score

A

Describes how aggressive the cancer is and how quickly it can spread

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14
Q

Treatment of Prostate Cancer

A 
Active surveillance
Open radical prostatectomy vs. minimally invasive radical prostatectomy (MIRP)
Radiation
High-intensity focused ultrasound (HIFU)
Hormone therapy
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15
Q

When can you use active surveillance in the treatment of prostate cancer?

A

Gleason score

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16
Q

When would you use an open radical prostatectomy or MIRP?

A

Gleason score 6+

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17
Q

Types of Radiation for Treatment of Prostate Cancer

A

External beam
High dose radiation (HDR)
Brachytherapy

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18
Q

When can you use hormone therapy for prostate cancer?

A

Diagnosed in their 70s & 80s & don’t want other treatment
Orchiectomy
Androgen deprivation LHRH

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19
Q

Advantages of External Beam Radiation Therapy

A

Effective long-term cancer control with high-dose treatment
Low risk of urinary incontinence
Available for cure of patients over a wide range of ages & in those with significant comorbidity

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20
Q

Advantages of Brachytherapy

A

Cancer control rates appear equal to surgery & EBRT for organ-confined tumors
Quicker than EBRT
Available for cure of patient over a wide range of ages & in those with some comorbidity

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21
Q

Advantages of Radical Prostatectomy

A

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 the same incision
PSA failure is easy to detect

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22
Q

Advantages of Active Surveillance

A

Reduces over treatment
Avoids or postpones treatment-associated complications
Has no effect on work or social activities

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23
Q

Disadvantages of External Beam Radiation Therapy

A

Significant risk of impotence
Lack of lymph node removed
Knowledge of possible metastasis to lymph nodes not available
Up to half of patients have some temporary bladder or bowel symptoms during treatment

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24
Q

Disadvantages of Brachytherapy

A

Significant risk of impotence
Lack of lymph node removal
Up to half of patients have some temporary bladder or bowel symptoms with treatment

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25
Disadvantages of Radical Prostatectomy
Significant risk of impotence Risk of operative morbidity Low risk of long-term incontinence
26
Disadvantages of Active Surveillance
Tumor may progress beyond possibility for cure Later treatment may result in more SE Living with untreated cancer may cause anxiety
27
Relative Contraindications to External Beam Radiation Therapy
Previous pelvic irradiation Active inflammatory disease of the rectum Very low bladder capacity Chronic moderate or severe diarrhea from any cause
28
Relative Contraindications to Brachytherapy
``` Previous pelvic irradiation Large-volume gland Marked voiding symptoms Large or high-grade tumor burdens Chronic moderate or severe diarrhea Active inflammatory disease of the rectum ```
29
Relative Contraindications for Radical prostatectomy
Higher medical operative risk | Neurogenic bladder
30
Relative Contraindications for Active Surveillance
Patients with high prostate cancer anxiety High-grade tumors (>6 Gleason score) Prolonged expected survival
31
Epidemiology of Testicular Cancer
Most common cancer between 15-35 years old Spread by lymphatic & blood Curable if discovered early
32
Testicular Cancer Germ Cell Tumors
Seminomas | Non-seminomas (more aggressive)
33
Testicular Cancer Non-Germ Cell Tumors
Lydia cell | Sertoli cell
34
Seminoma Testicular Cancer
Slow growing tumor Men 30s & 40s Sensitive to radiation
35
Non-seminoma Testicular Cancer
More common Quicker growing 4 sub-types: embyonal, yolk sac, choriocarcinoma, teratoma Occur in teen years & early 40s
36
Causes of Testicular Cancer
``` Cryptochidism Family history Klinefelter syndrome Previous history of testicular cancer Caucasian ```
37
Presentation of Testicular Cancer
Painless testicular lump Enlarging testicle Accumulation around the testicle (hydrocele) Metastatic disease
38
Symptoms of Metastatic Disease
Swelling of lower extremities Back pain Cough Gynecomastia
39
Diagnosis of Testicular Cancer
Scrotal ultrasound Chest x-ray CT scan Tumor markers: beta-hCG, alpha-fetoprotein (AFP), lactate dyhydrogenase (LDH)
40
Staging of Testicular Cancer
Stage I: confined to testicle Stage II: metastases to retroperitoneal nodes Stage III: metastases above the diaphragm or to visceral organs
41
Treatment of Testicular Cancer
Radical orchiectomy Depending on stage: seminoma (radiation, chemo, or both), non-seminoma (retroperitoneal lymph node dissection, surveillance, chemo)
42
Most Common Type of Penile Cancer
Squamous cell carcinoma
43
Risk Factors of Penile Cancer
HPV Age: 50+ Smegma Phimosis
44
Presentation of Penile Cancer
Growth or sore on the penis Skin thickening on penis Discharge with foul odor from under the foreskin Pain in the penis Swollen lymph nodes in groin Irregular swelling at the end of the penis
45
Diagnosis of Penile Cancer
Biopsy
46
Staging of Penile Cancer
Stage 0: not grown below the surface layer of the skin Stage 1: grown just below the surface layer of the skin Stage 2: invasion into the shaft or corpora; no nodes or mets Stage 3: tumor confined to penis; operable inguinal nodal mets Stage 4: tumor involves adjacent structures; inoperable inguinal lymph nodes and/or distant mets
47
Treatment of Penile Cancer
``` Laser therapy Mohs surgery Partial or total penectomy Lymph node dissection Radiation ```
48
Epidemiology of Bladder Cancer
Most common urologic malignancy Majority transitional cell carcinoma Women > men: 3-4:1
49
Etiology of bladder Cancer
Tobacco exposure Industrial exposure Chemotherapy
50
Presentation of Bladder Cancer
Painless microscopic or gross hematuria Frequency Dysuria Back/flank pain
51
Diagnosis of Bladder Cancer
``` Urinalysis Cystoscopy Urine cytology CT IVP Biopsy ```
52
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 Stage 3: extends beyond muscle into the peri-vesical fat Stage 4: extension into adjacent organs
53
Treatment of Bladder Cancer
Biologic therapy Chemotherapy Surgery: TURBT, radical cystectomy with urinary diversion, partial cystectomy Radiation
54
Types of Renal Cancer
Renal cell carcinoma Transitional cell carcinoma Sarcoma Wilms tumor
55
Risk Factors for Renal Cancer
``` Smoking Male > Female (2-3:1) Obesity HTN Family history ```
56
Presentation of Renal Cancer
Hematuria Pain/pressure in flank Fatigue
57
Diagnosis of Renal Cancer
UA Biopsy CT IVP Cystoscopy/Nephro-ureteroscopy
58
Staging of Renal Cancer
Stage 1: tumor
59
Treatment of Renal Cancer
Radio frequency ablation (RFA) Surgery: radical or partial nephrectomy Radiation
60
Wilms Tumor
Kidney cancer in children Most frequently between ages 3-4 Female slightly greater than males
61
Risk Factors of Wilms Tumor
``` Mutated, damaged, missing gene WAGR syndrome Beckwith-Wiedemann syndrome Boys with Deny-Drash syndrome Family history ```
62
Presentation of Wilms Tumor
``` Parent may notice large lump or mass in child's abdomen Hematuria HTN Anemia Fatigue Fever that won't go away ```
63
Diagnosis of Wilms Tumor
``` UA Ultrasound CT scan Surgical biopsy Chromosome test ```
64
Staging of Wilms Tumor
Stage 1: tumor in one kidney & can be completely removed with surgery Stage 2: cancer in kidney, fat, soft tissues, or blood vessels near kidney; tumor removed with surgery Stage 3: cancer found in areas near kidney & can't be removed with surgery; not spread outside of abdomen Stage 4: cancer spread to distant organs Stage 5: cancer in both kidneys
65
Treatment of Wilms Tumor
Surgery: radical or partial nephrectomy Chemotherapy Radiation: stages 3 & 4 Clinical trials

Urology (12 decks)

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