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Clin Med Final Material- Semester 2 > Urologic Cancers- Brian Miller > Flashcards

Urologic Cancers- Brian Miller Flashcards

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1
Q

Penile Cancer:

accounts for ___% of all cancer in men in the US

A

1%

-More common in less developed countries
Africa, parts of Asia, South America
–Can be 10-20% of male cancer cases in these regions

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2
Q

Penile CA:

-MC demographic?

A

Hispanic, Asian/Pacific Islander men

-Mean age of dx = 60 yo

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3
Q

Penile CA:

-list risk factors

A
  • HPV infection
  • Phimosis
  • uncircumsized men
  • HIV infection
  • smoking
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4
Q

Penile CA:

___% of cases are squamous cell carcinoma (SCC)

A

95%
-Less common: Basal cell carcinoma, Kaposi sarcoma, malignant melanoma, extramammary Paget disease, urethral carcinoma, metastases

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5
Q

Penile CA:

Sx?

A
  • ALMOST ALWAYS 2/2 Pt noticing a lump, mass, or ulceration on penis, MC on glans
  • 30-60% will have inguinal lymphadenopathy on exam
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6
Q

Penile CA:

-If infection is suspected (ie erythema/swelling/drainage) can attempt–> ?

A

trial of antibiotics and/or antifungal meds BUT…

-If there is a palpable mass and LAD–> biopsy is needed

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7
Q

Penile CA:

IF dx is clear on exam, Pt will be taken to _____

A

OR, quickly for excision of lesion if possible

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8
Q

Penile CA: tx for tumors w low risk of recurrence (Tis, Ta lesions of glans and T1a/T1b of glans) =

A
  • consider organ-preserving strategies
  • Partial penectomy –> Goal is 1-2 cm of negative margins
  • Radiation
  • Laser ablation, glans resurfacing (Tis)
  • Mohs micrographic surgery

Topical tx – fluorouracil, imiquimod

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9
Q

Penile CA:

-tx of tumors w/ high risk of recurrence (ie bulky, T2-T4 tumors) ?

A
  • **penectomy

- Interstitial brachytherapy can be considered for those refusing surgery

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10
Q

Bladder CA:

-how common?

A
  • MC malignancy of urinary system
  • Urothelial (transitional cell) carcinoma, MC histologic type
  • -can also be found in the ureter and kidney
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11
Q

Blaader Ca:

-divided into 3 categories (list)

A

Non-muscle invasive
Muscle invasive
Metastatic

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12
Q

Bladder CA:

Sx**

A
  • **painless hematuria
  • with gross hematuria there is higher chance of bladder CA
  • Microscopic hematuria= >3 RBC/hpf
  • **Irritative voiding Sx: frequency, urgency, hesitancy
  • pain
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13
Q

Hematuria present only at beginning of urination=

A

urethral source**

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14
Q

Terminal hematuria=

A

bladder neck source

-often seen in dysfunctional voiding

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15
Q

If hematuria is present throughout voiding–> ?

A

kidney, ureter, and bladder affected

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16
Q

Bladder CA: work-up

A

H&P
Office cystoscopy
Consider cytology –>** +/- transitional cells

  • CT a/p (abdomen/pelvis)
  • Imaging of upper tract collecting system
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17
Q

Bladder CA:

tx?

A

If tumor visualized on office cystoscopy and/or positive cytology…

  • Exam under anesthesia
  • ***TURBT – transurethral resection of bladder tumor

Pathologic evaluation will help differential muscle invasive vs noninvasive

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18
Q

Non-muscle invasive bladder CA tx?

A

After tissue evaluation, patients are risk stratified
Low – 1 dose of intravesical chemotherapy
Intermediate – extended course of intravesical chemo
High – extended course of intravesical chemo, +/- systemic chemo, consider cystectomy

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19
Q

Muscle-invasive bladder CA: tx?

A

Radical cystectomy

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20
Q

Bladder CA w/ mets disease?

A

Platinum based chemotherapy

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21
Q

Prostate Cancer:

-how common?

A
  • VERY common
  • 60% of 80yo will have it on autopsy
  • second only to melanoma and lung CA as a leading cause of CA deaths
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22
Q

Prostate eval:

what is included?

A
  • PSA
  • DRE: normal= symmetric/smooth, abnormal= asymmetric/nodules/masses
  • Sx: usually none
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23
Q

If Pt has abnormal PSA and/or abnormal DRE, what is the next step?

A

prostate biopsy

***TRUS – transrectal ultrasound guided biopsy

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24
Q

Describe TRUS:

-how many cores are typically taken?

A

-12
-Tissue sent for pathologic evaluation
–>If positive= consider tx
–>If negative = observation
-If PSA still high or rising?
18 – 24 core biopsy

Prep:
Enema
–2 days of abx prophylaxis
Why: cuz of Increased UTI/sepsis risk

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25
Prostate CA: | MC mets to ______
BONE - Consider bone scan if symptomatic and/or high grade disease - histologic grade- gleason score - PSA level
26
Gleason score: | -ranges from?
2-5 --combines 2 of most prevalent tissue types from bx (2 scores added together= gleason score) -Ranges from 6-10 (lower numbers are usually not diagnostic for cancer Gleason score and TNM staging are used to guide treatment
27
Prostate CA: | -Localized dz: tx?
-very low risk--> PSA <10, normal DRE, low Gleason <6, < 3 positive cores Active surveillance
28
Prostate CA: | Localized, low risk: tx?
PSA<10, normal DRE, low Gleason <6, ***>3 positive cores | -->Surveillance, radiation, radical prostatectomy
29
Prostate CA: Localized, intermediate risk tx?
PSA >10, Gleason 7, larger and/or in both lobes -RT, radical prostatectomy
30
Prostate CA: | localized high risk? tx
PSA >20, Gleason 8+ -RT, radical prostatectomy
31
Prostate CA: | stage 4 tx?
=Lymph node involvement/distant mets | tx=RT +/- ADT (chemotherapy)
32
After prostate CA tx: | f/u w/?
serial PSA to assess for recurrence -Follow with serial CT scans (depending on risk level)
33
Primary Testicular Tumors : | list the 2 types?**-
- Germ Cell tumors (95%) | - Stromal tumors (5%)
34
Describe serum tumor markers associated w/ Germ cell tumors** (which lab markers?**)
- AFP** - bHCG** KNOW
35
2 types of germ cell tumors
Seminoma – originate from seminiferous tubules Non-Seminoma – originate from sperm/ova cells - -Yolk Sac Tumor - -Embryonal Carcinoma - -Choriocarcinoma - -Teratoma
36
Labs associated w/ stromal tumors
**inhibin
37
Ex's of subtypes of stromal tumors
Leydig Cell Tumors (Testosterone) Sertoli Cell Tumors (Estradiol) Granulosa Cell Tumors Mixed/Undifferentiated
38
Seminoma vs NSGCT (non-seminoma germ cell tumor)
- Seminoma: more likely to be local dz (limited to testicle) - -stage 1 dz, 15% w stage 2 , generally DO NOT have elevated b-hcg and AFP, generally sensitive to radiation tx -NSGCT: MORE likely to present w/ mets, will have elevated b-hcg and AFP, LESS sensitive to radiation tx
39
Testicular CA: | demographic
- younger, 15-35 yo - prognosis= very good - ****Testicular tumors account for 21.4% of all neoplasms in male adolescents and young adults in the U.S. - MC** solid tumor in this age group.
40
Risk factors for testicular tumors
A prior personal history of cryptorchidism A family history of testicular cancer A prior personal history of testicular cancer Intra-tubular Germ Cell Neoplasia (ITGCN)
41
Testicular CA: MOST Pts--70% present with:
an incidentally discovered painless, unilateral mass in the scrotum. -20% of cases the first symptom is scrotal pain.
42
DDx of testicular mass:
- Epididymo-orchitis, Torsion, Hematoma, or Para-testicular tumors. - Other potential etiologies include hernia, hydrocele, varicocele, or spermatocele,
43
testicular tumor: | -First steps of the work-up:
- ** GET A Scrotal US** - **Serum Tumor Markers: bHCG, AFP, LDH - -if those are negative and concern for a stromal tumor: Inhibin, Testosterone, Estradiol - staging imaging: Pre op CXR for orchiectomy to R/O pumonary mets - Recommend sperm banking
44
Testicular tumor: | -Dx?
=*Inguinal surgical approach --In post pubertal male, radical orchiectomy is indicated -If markers are negative, <2cm mass, and suspect benign disease or a stromal tumor: --Testis sparing surgery may be reasonable --Must have pathology available for immediate frozen section analysis --If markers are positive or concern on frozen section= Inguinal radical orchiectomy
45
Testicular tumor: | staging?
- **Serum Markers (based on levels AFTER orchiectomy) | - TNM staging and Group staging 1 2 3
46
**AFP half life =
5-7 days AFP may be elevated in: Yolk Sac Tumor, Embryonal Carcinoma (EC) Physiologic elevation of AFP: Infants, Liver disease
47
bHCG half life =
24-36hrs**
48
bHCG may be elevated in ______
* *Seminoma, Choriocarcinoma, EC | - May see elevation with Marijuana use or elevated LH (hypogonadism)
49
testicular tumor: tx?
-**Orchiectomy Exception: Patient with massive pulmonary metastatic disease with fatal potential -Chemotherapy and RT based on clinical/pathologic staging
50
Renal cell carcinoma: | -MC subtype?
transitional cell carcinoma - Others include: oncocytomas, collecting duct tumors and renal sarcomas - Wilms’ Tumor and nephroblastoma seen in children
51
Renal cell carcinoma: | demographic?
- M>F - 50-70 yo - 3rd MC GU cancer after prostate and bladder cancer - 7th MC cancer over all for men, 9th for women - -Over 50% are discovered incidentally
52
Renal cell carcinoma: | risk factors?
- -Tobacco smoking contributes to 24-30% of RCC cases - -Tobacco results in a 2-fold increased risk Occupational: Leather tanners, shoe workers, asbestos workers. -Obesity, HTN
53
____% of those on long term dialysis develop acquired polycystic kidney disease, out of which 5.8% develop RCC.
33-50%
54
_______ is a key determinant in the pathophysiology of RCC
*Pseudo-hypoxia driving angiogenesis
55
RCCs are the most _______ of all solid tumors
vascularized
56
RCC: presentation?
Presentation - -45% present with localized disease (T1-2) - -25% with locally advanced disease (T3-4) - -30% with metastatic disease (N1 or M1) Distant metastases Lung (75%), soft tissue (36%),
57
RCC: classic triad that occurs in 5-10% of Pts? -other Sx? KNOW!!!
**Flank pain, hematuria, and palpable abdominal mass -*Hematuria present 40% of Pts -Systemic symptoms Fatigue, Weight Loss, Hypercalcemia, Hepatic Dysfunction
58
RCC: workup? | -labs?
-CBC, BMP, LFT's, alkaline phosphatase, urinalysis - CT or MRI of Abd/Pel - *CT Chest once confirmed RCC
59
Localized RCC Treatment
**Surgery is the only curative therapy for stage I-III - 20-30% of patients relapse within 2-3 years - -Metastases to the lung most common 50%
60
RCC: chemo?
RCC has intrinsic resistance to conventional chemotherapy | --so it's rarely used
61
Risk factors for anal CA:
``` HPV HIV Multiple partners Receptive anal intercourse Smoking ```
62
Most common histologic type of anal cancer?
-Squamous cell carcinoma**
63
Anal CA: | -is uncommon, and is NOT related to _____
Hemorrhoids, fissures, fistulas
64
Anal CA: | sx?
**Rectal bleeding – 45% -Bleeding thought to be secondary to hemorrhoids/ fissure often delay diagnosis Anorectal pain – 30% Sensation of mass/fullness – 30% No symptoms – 20%
65
Anal Cancer: work-up?
``` DRE Inguinal lymph node evaluation Biopsy CT chest, abdomen and pelvis Anoscopy HIV testing GYN evaluation ```
66
Anal CA: primary tx?
=Combination therapy of radiation and chemotherapy -May achieve cure w/o surgery Preservation of anal sphincter
67
Anal CA: Following RT and chemo--> tx?
- Restage and proceed with surgical resection if needed - APR (abdominoperineal resection) – less common recently - Removal of anus – colostomy required - Local excision – more common of late If metastatic disease is present Focus will remain on RT and chemo

Clin Med Final Material- Semester 2 (22 decks)

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