Neoplastic disease of GU & PCKD

Question 1

bladder cancer is the ___ most common cancer in men and ___ most common in women

Answer 1

4th MC in men

13th MC in women

Question 2

what is the mean age of Dx for bladder cancer

Answer 2

73yo

Question 3

who is bladder cancer more common in for race?

Answer 3

whites

Question 4

what are causes of bladder cancer?

Answer 4

smoking contributies 50-60% of dx
high risk continues 10 yrs after smoking
dyes and solvent exposure
Schistosoma haematobium parasite 
catheter use

Question 5

bladder cancer originated from what cell line?

Answer 5

98% are epithelial malignancies

Question 6

what are S/S of bladder cancer

Answer 6

hematuria presenting symptoms in 85-90% of pts with bladder cancer
Irritative voiding
may be asymptomatic
palpable tumors, organomegaly and lyphadenopathy

Question 7

Diagnostic testing for bladder cancer

Answer 7

U/A shows hematuria
US,CT,MRI may show masses in bladder
Dx confirmed by cystoscopy with Bx

Question 8

what is the Tx for bladder cancer?

Answer 8

depends on stage dz
superificial cancers-lesions and intravesical chemo
radio-therapy with chemo

Question 9

renal cell carcinoma causes

Answer 9

smoking only identifiable RF

2:1 male:female

Question 10

renal cell carcinoma s/s

Answer 10

gross or microscopic hematuria
flank pain
abdominal mass

Question 11

renal cell carcinoma dx testing

Answer 11

U/A hematuria, anemia

CT,MRI,US incidental findings

Question 12

renal cell CA Tx

Answer 12

partial nephrectomy-small tumor

radical nephrectomy-large tumor

Question 13

renal cell 5 yr prognosis

Answer 13

90-100% for tumor confined to renal capsule
50-60% for tumors beyond renal capsule
0-15% for node positive

Question 14

Wilms tumor

Answer 14

rare kidney cancer that affects children also called nephroblastoma
MC in kids 3-4 yrs old
occurs in 1 kidney

Question 15

wilms tumor s/s

Answer 15

abdominal swelling/pain/mass
fever
hematuria

Question 16

wilms tumor testing

Answer 16

CBC,LFT, Renal funx, UA, CT/MRI

PET scan, Bx resection

Question 17

wilms tumor tx

Answer 17

nephrectomy, chemo, radiation, lymphnode bx

Question 18

wilms tumor prognosis for 5 yrs

Answer 18

> 90%

Question 19

prostate cancer in men is the MC what type of cancer?

Answer 19

non cutaneous cancer

Question 20

what increases risk for prostate cancer?

Answer 20

50yo american male 40% chance of developing latent CA

Blacks, FHx, high fat diet

Question 21

what type of cancer is prostate cancer

Answer 21

95% are adenocarcinomas

Question 22

prostate cancer s/s

Answer 22

may find on DRE or PSA
obstructive or voiding symptoms
hematuria or hematospermia(blood in sperm)
lymph node involvement may cause LE edema
METs are common to bone>back pain and pathologic fx

Question 23

Prostate cancer dx findings

Answer 23

Increased PSA but can be falsely elevated in BPH and prostatitis
Controversial test, 4.0 ng/ml considered “normal” PSA level

Question 24

what is the Tx of prostate cancer

Answer 24

based on tumor stage and age/ health of pt
Prostatectomy-incontinence and ED
Brachytherapy
cryosurgery
chemo
Androgen deprivation dz because prostate cancer is hormone sensitive

Question 25

what are S/E of androgen deprivation

Answer 25

decreased libido, impotence, weight gain, fatigue, anemia, hot flashes,

Question 26

prostate cancer screening

Answer 26

Discussion should start at 50yo with avg risk, 45 yo with high risk, 40yo with highest risk screening should be PSA and DRE screening yearly to every 2 yrs

Question 27

testicular cancer incidence

Answer 27

MC in men 20-35yrs old MC in right testicle MC in cryptorchidism

Question 28

testicular caner s/s

Answer 28

MC is painless enlargement of testes sensation of heaviness discrete mass or diffuse testicular enlargement

Question 29

testicular cancer testing

Answer 29

HCG, alpha fetoprotein, LDH LFT, CBC Scrotal U/S Orchiectomy is needed for Bx

Question 30

testicular CA tx

Answer 30

orchiectomy retroperitoneal radiation chemo lymph node bx

Question 31

testicular surveillance

Answer 31

pt followed monthly for 2 yrs then bimonthly in 3rd yr | tumor marker q visits, CXR and CT q 3months

Question 32

what are identifiable genes for PCKD?

Answer 32

ADPKD1 on chromosome 16 (85-90% of pts) | ADPKD2 on chromosome 4 (10-15% of pts)

Question 33

PCKD affects how many americans?

Answer 33

500,000

Question 34

of cysts in PCKD depends on what

Answer 34

age

Question 35

PCKD s/s

Answer 35

``` abdominal/flank pain microscopic or gross hematuria hx of UTI and kidney stones common FHx in 75% of cases Large kidneys on exam HTN+abdominal mass suggest dz ```

Question 36

PCKD diagnostic testing

Answer 36

``` CBC, U/A U/S confirms Dx 2+ cysts <30yo 2+ cysts in each kidney 30-59yo 4+ cysts in each kidney at 60+ ```

Question 37

PCKD tx

Answer 37

``` aimed to control complications BP monitoring goal <125/75 Tx HTN w/ ACE or ARB Tx for UTI and stones avoid contact sports renal transplant Pts at risk for cerebral aneurysm MRA screen ```

Question 38

PCKD prognosis

Answer 38

50% will have ESRD by 60yo | Accounts for 10% of pts on dialysis