Urology Flashcards
(103 cards)
1
Q
General about renal tumors
A
2
Q
Mechanism of renal tumors
A
3
Q
Symptoms of renal tumor
A
4
Q
Tretamen to renal tumors
A
5
Q
Name risk factors of renal tumors
A
smoking
obesity
asbestos
HT
Phenacetin (analgetic)
Anatomy: PKD and horseshoes kidneys
6
Q
genetic background of renal tumors?
A
VHL gene mutation of chromosome 3 (tumor suppressor gene)
7
Q
Epidemiologi of renal tumors
A
1.5x in men
age 60-70
3% of all cancers
8
Q
Wha structure does renal tumor form
A
normally a cyst
9
Q
metastasis of renal tumors?
A
Lung
Liver
Bone
Brain
10
Q
Grading used in renal tumor?
A
Fuhrmann classification (MOST COMMON)
TNM
Robson’s
11
Q
Histological classification of renal cell tumor?
A
Benign
- Angiomyolipoma
- Adenoma
- Oncocytoma
Malignant
- Adenocarcinoma (82%)
- Sarcoma
- Lymphoma
12
Q
Treatment if renal cell carcinoma
A
NOT SENSITIVE TO CHEMO OR RADIATION
Surgery!!!
13
Q
what was renal cell carcinoma also called before and why?
A
Hypernephroma since they thought it came from the adrenals or clear cell carcinoma due to the cells appearance
14
Q
is renal cell carcinoma increasing?
A
2% per year in europe except for Sweden and danmark
15
Q
what is the Fuhrnmann classification of renal cell carcinoma based on?
A
Grade 1-4 determined based on:
Nucleus size and shape
Nucleoli
16
Q
Renal tumor effect on testicle?
A
Varicocele due to obstruction of the testicular vein if tumor is in the LEFT renal vein
17
Q
when to think that a cyst is malignant in the kidney?
A
Solitary intracystic elements
Irregular calcified wall
18
Q
Immune therapy and targeted therapy in renal cell carcinoma?
A
Immune: Interferon Alpha 2 and IL-2
Targeted: VEGEF Ab
19
Q
What groups to mention on topic 1 antineoplastic drugs
A
Kidney tumor
Tumor of pyelon and ureter
Bladder cancer
Prostate cancer
Testicular cancer
Penile cancer
20
Q
treatment tumor of pyelon and ureter drugs
A
Gemzar-cisplatin
M-VAC (methotrexate, vinblastine, adriamycin, cisplatin
21
Q
treatment of bladder cancer drugs
A
Superficial: Mitromycin C, Epirubicin, Doxorubicin
Invasive: M-VAC or Gemzar-cisplatin
Immune after TURB: BCG
22
Q
Treatment in penile cancer drugs
A
Chemotherapy: Vincristine, MTX, Bleomycin, 5-FU, cisplatin
23
Q
treatment testicular cancer drugs
A
BEC: bleomycin, etoposide, cisplatin
PVB: Cisplatin, Vinblastin, Bleomycin
24
Q
renal pelvic and ureter tumor incidence?
A
10% of renal tumors
5% of urothelial tumors
25
what is regularly ass with upper ureter tumors?
Seen in Balkan country: interstitial nephropathy
26
normal location of ureter tumor?
Lower is most common
27
symptoms of renal pelvis cancer
colic pain
hematuria
flank pain
abdominal mass
28
Diagnosis of pelvic and ureter cancer
Retrograde urography first then urethral catheter for urine cytology
Ureteroscopy with biopsy
Nephroscopy through a pyelotomy
29
treatment of pelvic and urethral cancers?
Total nephro-uretherectomy in high risk
in low risk: localized non-metastatic: kidney-spearing surgery
30
what hereditary syndrom is ass with pelvic and ureter cancer?
Lynch syndrome, also known as hereditary non-polyposis colorectal cancer (HNPCC)
31
what is the second most common cancer in urology?
Bladder cancer
32
male vs female bladder cancer epidemiology
2.5 x more in men
33
risk factors of bladder cancer
smoking (increase by x3)
aromatic amines
printing
iron or alumni processing
gas and tar manufacturing
industrial painting
34
hallmark symptom of bladder cancer
PAINLESS hematuria
35
T staging in bladder cancer
Non-muscle invasive
pTa/pT1/CIS
Muscle-invasive
pT2-4
36
N staging in bladder cancer
NX: cannot be assessed
N0: no nodes involved
N1: one single LN <2cm
N2: one or more LN <2-5cm
N3: one or more LN > 5cm
37
histological classification of bladder cancer
1. Transitional carcinoma (90%)
2. Adenocarcinoma
3. Squamous cell carcinoma
38
diagnosis of bladder cancer
History
Physical exam
Labs
US
CT
Cystoscopy
MRI
Urine cytology
39
treatment of bladder cancer
TURB + intravesical chemo to decrease recurrence or BCG
40
what is dangerous about CIS in bladder cancer?
has a direct relationship with muscle invasive tumor
41
what is the indication for total cystectomy?
Bladder cancer at stage T2-4 (muscle invasive)
High risk superficial tumor
42
what is removed in cystectomy?
Bladder
prostate
seminal vesicles
uterus + lower vagina
Regional LN
43
what are the 4 treatment options after blader removal?
Ileal conduct (brickers bladder)
ureterocutaneostomy
Orthotopic bladder
44
mortality of prostate cancer?
Mortality: in 2020, second leading cause of cancer deaths in men in the US (after lung cancer)
45
Prostate cancer risk factors
Advanced age (> 50 years)
Family history
African-American descent
Genetic disposition (e.g., BRCA2, Lynch syndrome)
46
Prostate cancer grading
Gleasons 1-3: well diff
Gleasons 4-7 moderate diff
Gleason 8-10 non diff
47
how do you decide staging of prostate cancer?
DRE
PSA
Gleasons score
Imaging
48
when do you get symptoms in prostate cancer?
Locally advanced stage (T3-T4)
49
Normal PSA leven?
4ng/ml
50
if the prostate cancer is located anteriorly what should be done in diagnosis?
transrectal US
51
size of prostate?
walnut
52
prostate structures for out to in?
1. Hard capsule of SM
2. Peripheral zone (biggest)
3. Central zone (Ejaculatory ducts)
4. Transitional zone (urethra)
53
what part of prostate undergoes hyperplasia?
transitional zone
54
what is prostate adenocarcinoma
cancer of glandular tissue of prostate
55
Gene mutation in prostate cancer
BRCA1 and BRCA 2
56
Risk factor for prostate cancer?
Old age
Obesity
Low fiber diet
57
Growth rate of prostate cancer ?
Very slow so no symptoms
58
other forms of prostate cancer?
Neuroendocrine - small cell prostate cancer
Transitional cell carcinoma
59
most common location of prostate cancer?
posterior, so far away from urethra, therefore no symptoms in early stages
60
symptoms of prostate cancer
Urinary retention
Hematuria
Incontinence
Flank pain (due to hydronephrosis)
61
medication hiding an increased PSA
5-alpha reductase inhibitors suppress PSA production. This should be taken into consideration in patients on long-term 5-ARIs for BPH
62
define Localized prostate cancer
T1-T2 stage and only local
63
imaging in prostate cancer?
MRI (gold standard)
Transrectal US + biopsy
64
what to talk about n topic 2.7 localized prostate cancer
the treatment methods!!
65
treatment of choice for advanced prostate cancer
Hormonal therapy
1. Antiandrogens PO 1/day to reduce flare-up phenomenon
2. LHRH after a few days, Depot injection every 3 month
66
What is the androgen blockage phase in prostate cancer treatment
when Antiandrogens PO and LHRH agonists depot injections are given at the same time.
67
how long can you give hormonal therapy in prostate cancer?
after 3-5 years it will become resistant - chemo must begin
68
first and second line chemo in porstat cancer
1. Docetaxel
2. Cabazitaxel
69
what to do in bone metastasis of prostate cancer?
Bisphosphonates and palliative irradiation
70
Penile cancer epidemiology
1. very rare
2. low in circumcised countries
3. high in south Africa
4. mostly elderly
71
Risk factors
Poor hygiene
STD
Long term phimosis
Viral infections like HPV
Chronic inflammation
72
what is Phimosis
A congenital or acquired constriction of the foreskin (prepuce) causing inability to retract it
73
symptoms of penile cancer
Painless lump/ ulceration (glans and the foreskin the most common)
A concurrent phimosis may conceal the lesion
Chronic penile rash or subtle burning sensation
Voiding and sexual function typically remain unimpaired
Swollen inguinal lymph nodes
74
types of penile tumor?
95% are SCC
5% are Sarcoma, Kaposi, BCC, melanoma
75
Location of penile cancer
48% glans
21% prepuce (foreskin)
9% glans and prepuce
76
Precancerous skin lesions on penis
Bowen disease
Leukoplakia
77
important DDx in penile cancer
Benign tumors or lesions:
- Condylomata acuminata
- Buschke-Löwenstein tumor
- Sexually transmitted infections
78
staging of penile cancer
79
penile cancer lymph node metastasis
80
testicular lymph node metastasis
81
prostate LM metastasis
82
Penile cancer treatment
Small (< 3cm) primary tumors:
- Local excision with or without circumcision
- Laser ablation
- Radiation therapy
Invasive or bulky primary tumors
- Partial penectomy: if penile length is adequate
- Total penectomy and perineal urethrostomy
Regional ipsilateral lymph node dissection
Recurrent or metastatic disease: penectomy or palliative chemo
83
systemic chemo in penile cancer
MTX
5-FU
Cisplatin
Bleomycin
84
Epidemiology of testicular tumors
Most common solid malignant tumor in young men
Peak incidence: 20–35 years
Non-seminomas peak in 3 decade of life
Seminomas in the 4 decade of life
85
risk factors of testicular cancer
Cryptorchidism (increased risk for germ cell tumors)
Contralateral testicular cancer
Germ cell neoplasia in situ (GCNIS)
Family history of testicular cancer
Klinefelter syndrome, trisomy 21
86
classification of testicular tumor
87
marker to look for in testicular cancer?
HCG is always elevated in choriocarcinoma and sometimes seminoma. AFP is always elevated in yolk sac tumors.
Both AFP and HCG may be elevated in mixed germ cell tumors.
88
symptoms of testicular cancer
Painless testicular nodule or swelling
Negative transillumination test
Dull lower abdominal or scrotal discomfort
Gynecomastia
In Leydig cell tumors: androgen excess features
89
Normal levels of AFP and B-HCG
AFP < 40ng/ml
B-HCG < 5mlU/ml
90
what staging is used in testicular cancer
American Joint Committee on Cancer (AJCC) groups, which combines TNM stage and serum tumor marker levels.
91
testicular cancer stages?
I. lesion confined to testis
II. Retroperitoneal node involvement
III. supradiaphragmatic nodal involvement or visceral metastasis
92
Diagnosis of testicular cancer?
Laboratory markers
US
CT
Histopathological confirmation: following orchiectomy
93
treatment of testicular cancer
Surgery - prior to surgery: sperm cryopreservation
Radical inguinal orchiectomy
94
are testicular cancers radiosensitive?
Only seminomas
95
Chemo in testicular cancer?
yes, always needed
96
should you do a biopsy in testicular cancer?
The testis should be REMOVED and sent to pathology.
Trans scrotal biopsy should not be conducted because of the risk of tumor seeding!
97
Hematuria classified acc to appearance
Macroscopic hematuria (gross hematuria)
- Suggests damage to the kidneys, upper/lower urinary tract
Microscopic hematuria
- RBCs are present in the urine sediment but no urine discoloration
- Can indicate damage to the glomeruli
98
Hematuria classified acc to timing when voiding
Initial hematuria: at beginning of micturition and clears by the end
- Suggests urethral damage
Terminal hematuria: blood or clots during the last part of micturition
- Suggests damage to the bladder neck, prostate, or trigonal area
Total hematuria: throughout the entire micturition
- Suggests damage to the bladder, ureters or kidneys
Painless hematuria (asymptomatic hematuria)
- Suggests malignancy
99
etiology of non-glomeruli hematuria
Urolithiasis
Infection
- Cystitis
- Urethritis
- Prostatitis
Malignancy: especially if otherwise asymptomatic
- Urothelial cancer
- Renal cell carcinoma
- Prostate cancer
Coagulation disorders
- Platelet dysfunction
- Hemophilia
Urinary tract obstruction
- Benign prostatic hyperplasia
- Congenital anomalies
Polycystic kidney disease
Trauma (e.g., urethral, bladder, ureteral, or renal injury)
Drugs
- Cyclophosphamide, sulfonamides
- Warfarin, heparin
100
Glomeruli causes of hematuria
Nephritic syndrome: characteristic of glomerulonephritis
(Hematuria with proteinuria)
101
urinalysis in hematuria?
Dipstick
Urin culture
Urine sediment and microscopic analysis
Cystoscopy may be done
102
how much blood is needed to say it is hematuria
> 1+
103
what is the correlation in % between hematuria and cancer
20% of gross hematuria is due to malignancy
