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GU CANCERS Flashcards

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1
Q

2nd most common cancer in men in america

A

prostate cancer

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2
Q

most common type of prostate cancer

A

adenocarcinoma

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3
Q

most aggressive type of prostate cancer

A

small cell carcinoma

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4
Q

RISK FACTORS FOR PROSTATE CANCER

A

⦁ Age: rare in men < 40; develops in 4th decade of life

⦁ Race: higher rates in African-American men, lower in asian-american / hispanic-latino men

⦁ Family Hx: 2x greater risk with 1st degree relative

⦁ Genetics: Mutations especially on BRCA2 & men with Lynch syndrome

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5
Q

prostate cancer associated with what environmental carcinogen used in military

A

Agent Orange

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6
Q

men with early stage prostate cancer symptoms

A

usually don’t have symptoms!

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7
Q

symptoms of prostate cancer

A 
⦁	urgency / frequency
⦁	nocturia
⦁	hesitancy
⦁	hematuria / hematospermia
⦁	bone pain (mets)
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8
Q

diagnosis of prostate cancer

A
  • DRE (nodules, induration, asymmetry)
  • TRUS
  • MRI
  • Bone scan
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9
Q

pathology of prostate cancer = looking for _____ cells

A

ACINAR CELLS

will develop into Adenocarcinoma

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10
Q

what are the 3 zones of the prostate, and which zone is where the majority of prostate cancers are found

A

1) peripheral = where majority of prostate cancer is found
2) central (least amount found here)
3) transition

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11
Q

which prostate zone is where the majority of prostate cancers are found

A

peripheral

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12
Q

what grade system is used to grade prostate cancer

A

Gleason grading scale (grade 1-5)

⦁ grade 1 = where the cancerous tissue looks like normal prostate tissue

⦁ grade 5 = cancer cells & growth patterns look very abnormal

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13
Q

gleason grading scale

A

⦁ grade 1 = where the cancerous tissue looks like normal prostate tissue
⦁ grade 5 = cancer cells & growth patterns look very abnormal

  • different areas of the prostate can have different cancer grades = so add the grades together
    ex: if primary tumor (where majority of cancer cells are located) = grade 3, and if secondary tumor = grade 4, then have a Gleason grade 7

Need to biopsy the prostate to get a gleason grade; if take multiple biopsies from the primary tumor and they have different gleason grades, then take the higher score

a gleason score of 6 or less = usually more favorable & more slow growing

a gleason score of 8-10 = looking at more small cell cancer that is aggressive/fast growing

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14
Q

a gleason score of _________ = usually more favorable & more slow growing

A

6 or less!

a gleason score of 8-10 = looking at more small cell cancer that is aggressive/fast growing

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15
Q

PROSTATE CANCER TNM STAGING

A

-tumor / mets / nodes

⦁ Stage T1 = cancer only in prostate; can’t be felt by DRE or seen on imaging test

⦁ Stage T2a = tumor that is too small to be felt or seen on image test

⦁ Stage T2b = slightly larger tumor that can be felt on DRE

⦁ Stage T3 = cancer has spread beyond outer layers of prostate into nearby tissues, and may have spread to seminal vesicles

⦁ Stage T4 = any tumor that has spread to other parts of the body

Stage N+ or M+ = has spread to lymph nodes or has metastasized to other areas of the body

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16
Q

at which stage has prostate cancer spread beyond prostate into nearby tissues

A

stage 3

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17
Q

RISK CLASSIFICATION OF PROSTATE CANCER

A

⦁ Low risk = T1-T2A & Gleason score ≤ 6 and PSA ≤ 10

⦁ Intermediate Risk = T2b and/or Gleason score 7 and/or PSA 10-20

⦁ High Risk = ≥ T2c or Gleason score 8-10 or PSA > 20

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18
Q

low risk for prostate cancer

A

T1-T2A & Gleason score ≤ 6 and PSA ≤ 10

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19
Q

intermediate risk for prostate cancer

A

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

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20
Q

high risk for prostate cancer

A

≥ T2c or Gleason score 8-10 or PSA > 20

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21
Q

SE of prostatectomy-

A
  • urinary incontinence
  • impotence / ED
  • surgical risks - bleeding
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22
Q

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

A

TESTICULAR CANCER

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23
Q

testicular cancer spreads by

A

lymphatics & blood

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24
Q

90-95% of all primary testicular cancer tumors arise from

A

germ cells

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25
germ cell vs non-germ cell tumors of testicular cancer
90-95% of all primary tumors arise from germ cells Germ cell tumors (more common than non-germ cell tumors) ⦁ Seminomas ⦁ Nonseminomas (more aggressive/ more common) Non-Germ cell tumors ⦁ Leydig Cells ⦁ Sertoli Cells
26
germ cell tumors
seminoma | non-seminoma = more aggressive & more common
27
SEMINOMA GERM CELL TUMOR (testicular cancer)
- slow growing tumor - found in men in 30-40s - very sensitive to radiation
28
NON-SEMINOMA GERM CELL TUMOR (testicular cancer)
- more common - quicker growing ``` - 4 types ⦁ Embryonal carcinoma ⦁ yolk sac carcinoma ⦁ choriocarcinoma ⦁ teratoma ``` - occur in teen years & early 40s - most often get a mixed non-seminoma germ cell cancer = mixture of subtypes
29
CAUSES OF TESTICULAR CANCER
``` Cryptorchidism Family history Klinefelter syndrome Previous history of testicular cancer Caucasian ```
30
PRESENTATION OF TESTICULAR CANCER
``` ⦁ Painless testicular lump ⦁ Enlarging testicle ⦁ Accumulation around the testicle ⦁ Metastatic disease - Swelling of lower extremities - Back pain - Cough - Gynecomastia ```
31
DIAGNOSIS OF TESTICULAR CANCER - IMAGING OF CHOICE
SCROTAL ULTRASOUND
32
TUMOR MARKERS FOR TESTICULAR CANCER
- AFP - BETA-HCG - LDH - AFP = not elevated with seminomas & choriocarcinoma - they do not produce AFP - beta-HCG = elevated with seminomas, choriocarcinoma and embryonal LDH = any tumor type
33
which testicular cancers don't produce AFP
seminomas & choriocarcinomas if AFP present = could be any nonseminomatous but chorio (embryonal, yolk sac or teratoma)
34
80% of seminomas are in what stage
stage I (slow growing!)
35
men with Non-seminomatous germ cell tumors | are in what stage
stage III
36
chemo combo (BEP)
bleomycin, etoposide, and cisplatin
37
treatment with testicular cancer
low grade (stage I) nonseminoma = orchiectomy with retroperitoneal lymph node dissection low grade seminoma = orchiectomy & radiation high grade seminoma = chemo, orchiectomy & XRT
38
penile cancer occurs mainly in
uncircumcised men > 60
39
most common type of penile cancer
squamous cell
40
risk factors for penile cancer
⦁ HPV**** ⦁ Age (> 50) ⦁ Smegma (poor hygiene) ⦁ Phimosis
41
greatest risk factor for penile cancer
HPV
42
PRESENTATION OF PENILE CANCER
⦁ growth or sore on penis ⦁ skin thickening on penis ⦁ discharge with foul odor from under foreskin ⦁ innguinal adenopathy present 30-60% of cases ⦁ distant mets = uncommon
43
DIAGNOSIS OF PENILE CANCER
BIOPSY
44
PENILE CANCER STAGINNG
⦁ Stage 0 = Cancer has not grown below the surface layer of the skin ⦁ Stage I = Cancer has grown just below the surface layer of the skin ⦁ Stage II = Invasion into the shaft or corpora; no nodes or metz ⦁ Stage III = Tumor confined to the penis; operable inguinal nodal metz ⦁ Stage IV = Tumor involves adjacent structures, inoperable inguinal lymph nodes and/or distant metz
45
penile cancer treatment
``` Laser therapy Mohs surgery Partial or total penectomy Lymph node dissection Radiation ```
46
most cases of bladder cancer are
transitional cell carcinoma - Urothelial
47
most common risk factor for bladder cancer
smoking*** (tobacco) other causes == chemical exposure & chemo
48
bladder cancer is more common in
women
49
presentation of bladder cancer
⦁ **Most common = painless microscopic or gross hematuria ⦁ frequency ⦁ dysuria ⦁ back or flank pain - advanced / mets
50
most common symptom of bladder cancer
painless hematuria
51
diagnosis of bladder cancer
- Urinalysis - urine cytology - GOLD STANDARD = CYSTOSCOPY**
52
localizing the source
o hematuria only at beginning of urination = urethral source o blood only with discharge between voidings or stain on undergarments and urine is clear = urethral meatus or anterior urethra o terminal hematuria - blood appears towards end of voiding = originates from bladder neck or prostatic urethra o hematuria throughout voiding = anywhere in urinary tract, including bladder, ureters or kidneys
53
bladder cancer likes to spread to the
lungs liver bone
54
TREATMENT FOR BLADDER CANCER
⦁ BCG - uses pt's immune system to fight cancer ⦁ chemo ⦁ surgery = TURBT (bladder resection) or if advanced = radical cystectomy or partial cystectomy ⦁ radiation - if no detrusor muscle involved = TURBT & either BCG or chemo
55
most common type of renal cancer
RENAL CELL CARCINOMA
56
risk factors for renal cancer
⦁ smoking ⦁ male ⦁ obesity ⦁ family hx
57
presentation of renal cancer
⦁ hematuria ⦁ pain/pressure in flank ⦁ fatigue
58
diagnosis of renal cancer
- UA - biopsy - CT IVP - Cystoscopy / Nephro-ureteroscopy
59
staging of renal cancer
⦁ Stage 1: tumor is 7cm or less within the kidney (T1,N0,M0) ⦁ Stage 2: tumor is larger than 7cm within the kidney (T2,N0,M0) ⦁ Stage 3: tumor of any size with spread into regional lymph nodes, or tumor grown into major veins or perinephric tissue (T1,T2,N1,M0) or (T3, N+,M0) ⦁ Stage 4: tumor has spread beyond Gerota’s fascia into the adrenal gland (same side) with lymph nodes but not to other body parts, or spread to other body parts (T4,N+,M0) or (T4,N+,M1) ****7cm = magic number; < 7cm = stage 1, >7cm = stage 2
60
renal cancer does NOT respond well to
chemo = have to do surgery +/- radiation
61
treatment for renal cancer
- RFA - radiofrequency ablation - Surgery - partial or radical nephrectomy - radiation * doesn't respond well to chemo
62
risk factors for wilm's tumor
``` Mutated, damaged, missing gene WAGR syndrome Beckwith-Wiedemann syndrome Boys with Deny-Drash syndrome Family history ```
63
presentation of wilm's tumor
``` Parent may notice a large lump or mass in child's abdomen*** Hematuria HTN Anemia Fatigue Fever that doesn’t go away ```
64
diagnosis of wilm's tumor
- UA - abdominal ultrasound***** = best initial test - CT scan = (with contrast) = more accurate - surgical biopsy - chromosome test

UROLOGY (12 decks)

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