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urology > tumors > Flashcards

tumors Flashcards

(39 cards)

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1
Q

RF of renal cell carcinoma

A

smoking
obesity
htn
cystic disease
von hippel lindau disease

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2
Q

presentation of RCC

A

asymptomatic /incidental
triad: hematuria, flank pain, palpable mass
flank ecchymosis
metastasis—> bone pain, anemia, IVC obstruction
paraneoplastic syndrome

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3
Q

types of RCC

A

clear cell, papillary (PCT)
chromophrobe (DCT)
medullary (CD)

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4
Q

diagnosis of RCC

A

-initially US abdomen and labs
-modality of choice CT renal protocol (pre and post contrast):
plain - corticomedullary- neohrogenic- delayed

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5
Q

staging of tumor RCC (TNM )

A

T1- limited to kidney tumor <7cm
T2- limited to kidney >7cm
T3- extend to major veins but not to ipsilateral adrenal gland or fascia gerota
T4- go beyond fascia gerota

N0- no metas to regional LN
N1- metas to regional LN
N2 - no distant metas
N3 - distant metas yes

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6
Q

tx of RCC

A

o Radical nephrectomy (standard of care) [T3 T4]
o Partial nephrectomy possible if small (<4cm) and peripheral [T1 and some T2]
o No role for chemotherapy even in metastasis

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7
Q

what is VHD

A

autosomal dominant usually present with bilateral RCC

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8
Q

paraneoplastic syndrome features

A

o Paraneoplastic syndrome: ↑Ca2+, ectopic hormones (ACTH, ADH), HTN, polycythemia, ↑liver enzymes “Stauffer syndrome”

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9
Q

testicular tumor presentation

A

-painless mass, pain after trauma is commonest presentation
- 10% may have associated hemorrhage, infarction, hydrocele
- Mets–> back pain, abdominal mass

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10
Q

types of testicular tumor

A

germ cell (95%)
stromal (5)
gonadoblastoma

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11
Q

germ cell testicular tumor two types

A

1) seminoma (most common)
2) non-seminoma : yolk sac, choriocarcinoma, teratoma, embryonal carcinoma

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12
Q

RFs of testicular tumor

A

cryptorchidism (orchiopexy doesnt decrease risk of cancer) , gonadal dysgenesis , infertility, HIV

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13
Q

what tumors have AFP markers

A

yolk sac and embryonal tumors

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14
Q

B-HCG markers

A

seminoma , embryonal tumors, choriocarcinoma

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15
Q

patient comes in with disorder of sexual differentiation what is most likely testicular tumor

A

gonadoblastoma

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16
Q

why are seminoma and non epseminoma divided

Study These Flashcards
A

-bcs of tx in seminoma if recurrence happens (radiotherapy and chemo)
-in non seminoma they are radio-resistant ( tx: chemo and surgical )

17
Q

what is Tumor marker LDH used for

Study These Flashcards
A

dectates the burden of the tumor (how severe) but not which tumor type

18
Q

LDH

Study These Flashcards
A

detects burden of tumor (how severe)

19
Q

investigation in testicular tumor

Study These Flashcards
A

-order tumor markers
- ultrasound testes
- metastasis workup (ct w iv contrast ) chest abdo pelvis

20
Q

bladder cancer presents with

Study These Flashcards
A

painless hematuria obstruction w clots
LUTS (irritative)
mets –> bone pain , cough , hemoptysis

21
Q

RF of bladder cancer

Study These Flashcards
A

smoking, chemicals, chemicals, dyes , leather industry, ruber ( ask occupation)

22
Q

investigations

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A

-CBC
-urinalysis
-urine culture and cytology (pap stain: look for malignant cells )
-initial imaging US

23
Q

tx of bladder cancer depend on invasion

Study These Flashcards
A

non- invasive cancer: TURBT + intravesical chemotherapy + immunotherapy(BCG )

invasive cancer: radical cystectomy with urine diversion + LN dissection

24
Q

tumor in renal pelvis vs bladder

Study These Flashcards
A

tumor in renal pelvis – 50% chance of bladder cancer
tumor in bladder– 11% chance of renal pelvis cancer

25
RF of prostate cancer
fam history old age african / black more chance high diet fat BRCA mutation
26
presentaion of prostate cancer
usually asymptomatic commonly detected by DRE elevated PSA incidental finding on TURP LUTS met to the spine
27
DD of high PSA
prostate cancer sexual intercourse BPH prostatitis instrumentation(catheter) inc age
28
management of prostate cancer depends on met or not
o Localized: - Active surveillance - Radical prostatectomy (better if young and wants a family), complications: 5% urinary incontinence, sexual dysfunction - Radiation therapy → 5 days a week for 6 weeks o Mets: - Hormonal (total androgen blockage) Medical castration, chemotherapy if hormone-refractory prostate cancer - GNRH analogues and flutamide - hormone lvls: ↓FSH, ↓LH, ↓testosterone
29
urge incontinence
• Abrupt desire to void that can’t be suppressed • Overactive bladder (muscle) • Causes: Idiopathic, cystitis, tumor, stone, stroke, dementia • Tx: anticholinergics: oxybutin (inhibit contraction of detruser muscle ) o Contraindicated in patients with asthma, glaucoma o Side-effects: dry eyes and mouth, constipation
30
stress incontinence
• With ↑ intra-abdominal pressure (cough sneeze, lift objects, laugh) • Caused by poor pelvic floor support (aging, hormonal, childbirth, surgery), or relaxation of sphincter (pelvic surgery, radiation, trauma, neurogenic) • Most common type in women • Tx: mild: kegel exercises, severe: surgical (TOT/TVT), vaginal sling surgery
31
overflow incontinence
• Non-contractile bladder: hypoactive detrusor secondary to DM, MS, spinal injury, meds (peripheral neuro) • Bladder outlet obstruction: BPH, stricture, cystocele, fecal • Leakage small in volume but continuous, can→rupture. • Over distention & increase post void residual (dull on percussion)
32
tx of urinary incontinence
• Treatment o Obstruction: α blockers or surgery o Neurogenic: indwelling or intermittent catheterization
33
phimosis
• Inability to retract foreskin & expose glans penis, patients have limitation & pain when retracting • Causes: o Congenital (resolve by 3 years old) o Balanitis xerotica obliterans (scarring)→whitish sclerotic preputial tip w/ no pouting o Balanoposthitis/balanitis (inflam of foreskin and head of penis) • Tx: topical steroids, dorsal slit, circumcision.
34
paraphimosis
• Retracted foreskin acts as a constricting ring→edema & inability to reduce foreskin. • Causes: Iatrogenic (post instrumentation, trauma, infections) • Tx: o Early: gentle manual compression w/ anesthesia o Late: dorsal slit, then circumcision
35
upper uti symptoms
Upper UTI: kidney and ureters o Symptoms: fever, chills or rigors, flank pain o Treatment: 3-7 days IV antibiotics
36
lower uti symptoms
o Symptoms: dysuria, frequency, urgency o Treatment: 1-4 days oral antibiotics • Diagnosis of UTI: symptoms + urinalysis + culture
37
causes of UTI
o Ascending infection o Instrumentation o Coitus in females Most common causes: E.coli, proteus, klebsiella, pseudomonas • Risk factors: stones, reflux, diabetes, pregnancy, catheter, stent
38
acute prostatitis
o Tender and soft prostate on DRE o Main causes: E.coli, S.aureus, N.gonorrhea o Treatment with bed rest and antibiotics
39
chronic prostatitis
o Tender and hard prostate on DRE o Culture shows WBCs but no bacterial growth o Treatment with long term antibiotic therapy (ciprofloxacin)

urology (3 decks)

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