Urothelial and Renal Cell Carcinomas Flashcards
(27 cards)
Therapeutic plan for urothelial and RCC
Surgical problems- cut out
Chemo/rad- not cure
improves success rate for surgery
Urothelium
Epithelium to most of UT
Renal papilla to proximal urethra
Includes prostatic urethra in men
UC in any of these places
Structure of urothelium
Cells can shape with emptying/filling
Round/heaped up when empty
Flat, stretched out when full
Luminal surface has uroplakins
Uroplakins
Benefits
Harm
B- contribute to permeability barrier (keep noxious subst in urine from penetrating bladder)
stabilize cell membrane w repeated stretch/fold of bladder
H- uroplakins contain mannose
T1 pilli of E coli attach to mannose
Symptoms of Bladder carcinoma
Painless, visible hematuria (maybe pain)
Acute/inc- bladder pain, pain while voiding, frequent urination, urgency to urinate urge incontinence
Bladder carcinoma RF
Smoking Exposure to dye/tar/fumes/fert inc age, male Radiation Chronic irritation (stone, catheter) Cyclophos
Cyclophosphamide
Treatment of cancer/AI do
Metabolized to acrolein- leads to hemorrhagic cystitis, inc risk of BC
Symptoms of urothelial carcinoma
Potential symptoms
Painless vis hematuria
No sx unless blood clot- dif urinating
Flank pain if acute ureteral obstruction from bc
large, invasive kidney tumor
Weight loss, cachexia, +/- pain from advanced dz
RF for urothelial carcinoma
Unique factor for upper tract location
Similar to bladder cancer
Smoking
Exposure to dyes/tars/fume/fert
Rad/chronic irritation
Bladder is more common- carcinogens stay in bladder
HNPCCC
UC PE curable
Advanced dz
localized to bladder, ureter, kidney lumen (not palpable)
Cachexia
Mass in pelvis/flank
Lymphad
Bone/brain metastases
Cachexia
Most common
Weight loss and tissue wasting bc of underlying dz
Advanced cancer
UC diag tests
urine tests
cytoscopy
imaging
UC urine test
UA
UC
Cytology
UA- RBC w/wo WBC
suspect cancer- acute/increase bladder sx/rf
UC- no growth
carcinoma cells shed in urine
Diagnostic if +
UC cytoscopy
office procedure, look into bladder with scope
UC Imaging
CT urogram
If allergic
CT with cntrast- delayed images to show ureters, large bladder tumors
MRI w gado
Cytoscopy w retrograde pyelogram- contrast into ureters from below
RCC
Subtypes
most common type of KC
Clear (MC), papillary
RCC symptoms
Flank pain/hematuria
Sx of metastases- pain/fracture
mental status changes
Paraneoplastic Syndroms
HyperCa
HTN
Polycy
Stauffer syndrome
HyperCa- tumor makes PTH
Osteolytic bone mets
tumor makes renin/compresses renin vessels
Tumor/hypoxic adjacent tisseu makes EPO
Liver dysfunction from inflam cytokines
RCC RF
Familial
VHL/tuberous sclerosis
ESRD w dialysis
Smoking
Obesity
HTN
RCC PE
Varicocele
curable- not palpable
Familial do, advanced dz, paraneop
Inc pressure of spermatic veins- dilation
Healthy youn mang
maybe a retroperitoneal mass
Variococele side
much more common on left
Left is parallel to gravity, right has gntle slope
Variocele and suspected cancer
YM with unilateral R varicocele- suspect retroperitoneal tumor of RGV (think testi cancer)
OM with new varicocele
Interim development of tumor
R or L (kidney cancer)
RCC Diag tests
Urine
Imaging
Hematuria (No cyto)
US can show solid mass vs cyst
CT/MRI w contrast
focal areas of dec RF
Ab/pelvic masses
vHL
Normal
Dz
about 90% of sporadic clear cell carcinoma have ___
tumor suppressor
for health
AD
Multiple tumors, including cc RCC
VHL mutation
