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Flashcards in GU Cancers Deck (39)
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1

1. What is the most common histological type of prostate cancer?

2. Other types? 4

1. Adenocarcinoma most common type

2. Other types
-Sarcomas
-Small cell carcinomas
-Transitional cell carcinomas
-Neuroendocrine tumors

2

PROSTATE CANCER
Risk factors? 4

1. Age
2. Race
3. Famil hx
4. Genetic
5. Environmental agents

3

Prostate CA risk factors:
Age
1. Rare in men of what age?

Race
2. Higher rates in what race?
3. Lower rates in what races? 2

Famil hx
4. Two fold greater risk with what?

Genetic
5. Mutations especially with what?
6. Men with what syndrome?
7. Environmental causes?

Risk factors
Age
1. Rare in men younger than 40 y/o
-Develops in the 4th decade of life

Race
2. Higher rates in African-American men
3. Lower rate in
-Asian-American/
-Hispanic-Latino men

Family history
4. Two fold greater risk with first-degree relative

Genetic
5. Mutations especially on BRCA2 increase risk in men
6. Men with Lynch syndrome

7. Environmental carcinogens
Agent Orange

4

Clinical presentation of prostate cancer?
6

1. Men with early stage cancer usually have no symptoms
2. Urinary frequency/urgency
3. Nocturia
4. Hesitancy
5. Hematuria/Hematospermia
6. Bone pain

5

Prostate cancer Dx?
4

1. Physical exam/DRE
2. Transrectal Ultrasound (TRUS)/MRI guided
3. MRI
4. Bone scan

6

What are you looking for on the DRE for prostate cancer?
3

1. Nodules
2. Induration
3. Asymmetry

7

1. Pathology: Prostate Cancer?

2. What are the zones of the prostate and state what percentage of cancer is found in each? 3

1. Acinar cells of the prostate will develop into adenocarcinoma

2. Zones of the prostate
-Peripheral zone (Majority of prostate cancer is found) 70%!
-Central zones (2-5% of prostate cancers are found)
-Transition zone (10-20% of prostate cancers are found)

8

PROSTATE CANCER
Describe the Gleason grade and staging?

Grading and Staging

Gleason grade
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

9

Gleason grade
1. Different areas of the prostate have different what?

2. Gleason grade (sum) adds what?
-Which ones?

Example
3. Majority of the cancer is grade what?
4. Less of the majority is grade what?

5. 3 + 4 = Gleason grade __

1. cancer grades

2. two grades together
-Primary tumor and Secondary tumor

3. 3 (primary)

4. 4 (secondary)

5. 7

10

Staging
TMN system
describe the following:
1. Stage T1?

2. Stage T2a and T2b?

3. Stage T3?

4. Stage T4?

5. Stage N+ or M+?

1. cancer is found in the prostate only. Cannot be felt by DRE or seen on imaging test

2. a tumor that is to small to be felt or seen on image test (2a) or a slightly larger tumor that can be felt on DRE (2b)

3. cancer has spread beyond the outer layers of the prostate into nearby tissues, and may have spread to seminal vesicles

4. any tumor that has spread to other parts of the body

5. Spread to lymph nodes or metastasized to other areas of the body

11

Prostate cancer risk classification: 1. Low risk?

2. Intermediate risk?

3. High risk?

1. T1-T2a and gleason score less than or equal to 6 and PSA less than or equal to 10

2. T2b and/or Gleason score 7 and/or PSA 10-20

3. Greater than or equal to 8-10 or PSA greater than 20

12

Prostate CA Treatment?
5

Treatment
1. Active surveillance
2. Open Radical Prostatectomy vs MIRP (Gleason 6 and up)
3. Radiation
4. HIFU (High-Intensity Focused Ultrasound)
5. Hormone therapy

13

Prostate cancer Tx:
1. Active surveillence at what staging level?

2. When would you do Open Radical Prostatectomy vs MIRP?

3. What are the kinds of radiation you could use? 3

4. What kinds of hormone therapy? 2

1. Gleason 6

2. Gleason 6 and up

3.
-External Beam
-High Dose Radiation (HDR)
-Brachytherapy

4.
-Orchiectomy
-Androgen deprivation LHRH (Luteinizing Hormone-Releasing Hormone)

14

Testicular CA:
1. Most common in what ages?
2. Tumor spreads how? 2
3. Prognosis?
4. 90-95% of all primary tumors arise from what?

1. Most common cancer in men between the age of 15-35 y/o

2. Tumor spreads by lymphatics and blood

3. Highly curable if discovered early

4. 90-95% of all primary tumors arise from germ cells

15

Testicular CA
1. Germ cell tumor types? 2

2. Non-germ cell tumors types? 2

1. Germ cell tumors
-Seminomas (50%)
-Nonseminomas (more aggressive)

2. Non-Germ cell tumors (5%)
-Leydig cell
-Sertoli cell

16

TESTICULAR CANCER
1. What is a seminoma?
2. Found in what type of men?
3. Very sensitive to what?

Nonseminoma
1. How is it different than a seminoma?
2. 4 sub-types?

3. Occur in what years?

Seminoma
1. Slow growing tumor
2. Found in men in their 30’s and 40’s
3. Very sensitive to radiation

Nonseminoma
1. More common and quicker growing
2. 4 sub-types
-Embryonal carcinoma
-Yolk sac carcinoma
-Choriocarcinoma
-Teratoma

3. Occur in teen years and early 40’s

17

1. Causes of testicular cancer? 5

2. Presentation? 4

1. Causes
-Cryptorchidism
-Family history
-Klinefelter syndrome
-Previous history of testicular cancer
-Caucasian

2. Presentation
-Painless testicular lump
-Enlarging testicle
-Accumulation around the testicle
-Metastatic disease

18

Testicular cancer: What would suggest metastatic disease? 4

1. Swelling of lower extremities
2. Back pain
3. Cough
4. gynecomastia

19

Testicular CA Dx? 4

Diagnosis
1. Scrotal ultrasound
2. Chest x-ray
3. CT scan
4. Tumor markers

20

What are the tumor markers for testicular cancer? 3

1. Beta-HCG
2. Alpha-fetoprotein (AFP)
3. Lactate dyhydrogenase (LDH)

21

TESTICULAR CANCER
Describe staging I-III?

Staging
1. Stage I
Confined to the testicle

2. Stage II
Metastases to retroperitoneal nodes

3. Stage III
Metastases above the diaphragm or to visceral organs

22

TESTICULAR CANCER
1. Tx?
2. Depending on the stage:
- Seminoma? 2
-Nonseminoma? 2

3. Enourage what?

1. Treatment
Radical orchiectomy

2. Depending on stage:
-Seminoma
Radiation, chemotherapy or both

-Nonseminoma
RPLND or surveillance
Chemotherapy


3. Encourage self-testicular exams!

23

Penile Cancer
1. Occurs mostly in who?
2. Histological type?
3. Risk Factor? 4

Rare type of cancer making up less than 1% of all cancers diagnosed in men

1. Occurs mainly in uncircumcised men

2. Squamous cell carcinoma (95%)

3. Risk Factors
-HPV
-Age (>50 y/o)
-Smegma (Poor hygiene)
-Phimosis

24

PENILE CANCER
1. Presentation? 6
2. Dx? 1

Presentation
1. Growth or sore on the penis
2. Skin thickening on penis
3. Discharge with foul odor from under the foreskin
4. Pain in the penis
5. Swollen lymph nodes in groin
6. Irregular swelling at the end of the penis

Diagnosis
1. biopsy

25

PENILE CANCER
Describe staging 0-IV?

Staging
1. Stage 0
Cancer has not grown below the surface layer of the skin

2. Stage I
Cancer has grown just below the surface layer of the skin

3. Stage II
Invasion into the shaft or corpora; no nodes or metz

4. Stage III
Tumor confined to the penis; operable inguinal nodal metz

5. Stage IV
Tumor involves adjacent structures, inoperable inguinal lymph nodes and/or distant metz

26

PENILE CANCER
Tx?5

Treatment
1. Laser therapy
2. Mohs surgery
3. Partial or total penectomy
4. Lymph node disection
5. Radiation

27

Bladder Cancer
1. Majority of the cancers are what tissue type?
2. More common in what gender?
3. Etiologies? 3

1. One of the most common Urologic malignancy

2. Majority of cases are Transitional Cell Carcinoma (65-75%)

3. 3-4 times more common in women

4. Etiology
-Tobacco exposure
-Industrial exposure (Aniline dyes, textile printing, rubber manufacturing)
-Chemotherapy (Cyclophosphamide and Ifosfamide)

28

BLADDER CANCER
1. Presentation? 4
2. Dx? 5

1. Presentation
-Most common is painless microscopic or gross hematuria (85%)
-Frequency
-Dysuria
-Back or flank pain

2. Diagnosis
-Urinalysis
-Cystoscopy
-Urine cytology
-CT IVP
-Biopsy

29

Bladder Cancer Staging
Describe Stages 0-4?
5

1. Stage 0: papillary lesions relatively benign or carcinoma in situ

2. Stage 1: tumor invades submucosa or lamina propria

3. Stage 2: invasion into muscle

4. Stage 3: extends beyond muscle into the perivesical fat

5. Stage 4: extension into adjacent organs

30

BLADDER CANCER
Tx?
4

1. Biologic therapy
2. Chemotherapy
3. Surgery
4. Radiation