Urothelial Tumors

Question 1

What is an upper urinary tract tumor

Answer 1

Neoplastic growth that affects lining of urinary tract from the calyx to the distal ureter

Question 2

Which is more common, bladder urothelial cancer or upper urinary tract tumor

Answer 2

Bladder urothelial cancer

Question 3

Main difference between bladder urothelial cancer and upper urinary tract tumors

Answer 3

Upper urinary tract tumors are less common and linked with familial syndromes

Question 4

Centage of urothelial tumors involving the renal pelvis or ureter

Answer 4

5%

Question 5

Which countries have the highest incidence in urothelial cancer representing 40% of all renal cancer there

Answer 5

Balkan countries

Question 6

Who is more at risk of upper urinary tract tumors , men or women?

Answer 6

Men twice as likely

Question 7

Who is more at risk of upper urinary tract tumors, whites or blacks?

Answer 7

Whites , twice as likely

Question 8

Factors of upper urinary tract tumors

Answer 8

Dietary exposure to aristolochic acid
Smoking
Coffee consumption
AnalGesic abuse
Arsenic poisoning
Occupation in chemical , petroleum , plastic , coke, asphalt , tar
Aniline dye
Chronic inflammation , infection
Exposure to chemotherapeutic agents
Heredity ( lynch syndrome II)

Question 9

Location of ureteral tumors

Answer 9

Lower part of ureter mostly 70%
Mid ureter 25%
Proximal ureter 5%

Question 10

True Or false , patients with upper urinary tract tumors are at risk of development of bladder cancer

Answer 10

True

Question 11

Centage of incidence of bladder cancer in people with upper urinary tract tumor

Answer 11

15 to 75% within five years

Question 12

Prognosis . of upper tract urothelial cancer

Answer 12

Poor

Question 13

Percentage of patient that presents with upper tract tomorrow already in metastatic disease

Answer 13

19%

Question 14

Method of spread of upper tract tumor tumor

Answer 14

Epithelial
Lymphatic
hematogenous

Question 15

Main form of upper tract tumors

Answer 15

Urothelial cancer’s

Question 16

Main type of urothelial cancer

Answer 16

Transitional cell

Question 17

Other types of urothelial cancer

Answer 17

squamous cell cancer
adenocarcinomas

Question 18

most common symptom in upper tract urothelial tumors

Answer 18

hematuria gross or microscopic

Question 19

Gun must come on symptom in urothelial tumors

Answer 19

Flank pain- dull

Question 20

Percentage of asymptomatic patients diagnosed with incidental lesion found a radiologic evaluation

Answer 20

15

Question 21

Presentation of patients when advanced dx

Answer 21

Flank or Abdominal mass
weight loss
anorexia
bone pain

Question 22

Situation of upper tract lesion

Answer 22

Ct urography
IVU
Mri
Cytoscopy
Flexible and rigid ureteroscopy
Urine cytology

Question 23

Findings on radiologic evaluation in upper tract lesions

Answer 23

Radiolucent filling defects
obstruction or incomplete filling of parts of upper tract
non-visualization of collecting system

Question 24

Methods of investigation used to determine main contribution of diseased and presumed normal kidney to patient overall renal function

Answer 24

Split function renal scan

Question 25

method of investigation used in staging of upper tact tumort

Answer 25

ct or MRI

Question 26

What investigation do you used to always excludes coexistent bladder lesions in upper urinary tract tumor

Answer 26

Cystoscopy

Question 27

Single most important determinant of outcome in upper urinary tract tumors

Answer 27

Tumor stage ( tnm staging )

Question 28

Patient for surgery in upper urinary tract tumors

Answer 28

When nephron sparing for preservation of renal function required Solitary kidney tumor synchronous bilateral tumor predisposition to multiple recurrences

Question 29

Patient for open radical nephroureterectomy

Answer 29

Large high-grade invasive tumors of renal pelvis and proximal ureter

Question 30

Indication for open segmental ureterectomy ureteroureterostomy

Answer 30

Noninvasive grade 1 and 2 tumors of proximal or midureter too large for complete endoscopic ablation Grade 3/ invasive tumor with nephron sparing as goal

Question 31

Indications for Distal ureterectomy, direct neocystostomy, ureteroneocystostomy with bladder psoas,muscle hitch or boari flap

Answer 31

Tumor in distal ureter that can’t be removed by endoscopy

Question 32

Treatment of metastatic disease of urothelial tumors

Answer 32

Systemic chemotherapy used in TCC Of bladder

Question 33

Most common benign tumors of the bladder

Answer 33

Epithelial metaplasia Leukoplakia inverted papilloma nephrogenic adenoma Leiomyoma cystitis cystica cystitis glandularis

Question 34

Etiology of malignant tumors of the bladder

Answer 34

Aniline dyes radiation chemotherapy artificial sweeteners Vesicle schistosomiasis vesicle calculi

Question 35

Symptoms of bladder urothelial carcinoma

Answer 35

Gross painless hematuria

Question 36

Investigation in bladder cancer

Answer 36

Cystoscopy, urine cytology for hematuria Ct scan PSA blood test

Question 37

Main diagnostic test for bladder cancer

Answer 37

Cystoscopy Biopsy

Question 38

Urine markers of urothelial cancers

Answer 38

BTA stat BTAtrak NMP22 ImmunoCyt

Question 39

Initial treatment for visible lesions of bladder treatment

Answer 39

Transurethral resection of bladder tumor - TURBT

Question 40

Goal of TURBT

Answer 40

Remove all visible tumor obtain specimen for pathologic examination for stage and grade determination

Question 41

Main Chemotherapeutic agents used perioperatively To prevent tomorrow in plantation in bladder cancer

Answer 41

Mitomycin C Adriamycin Intravesical BCG

Question 42

Indications for radical cystectomy and bilateral pelvic and iliac lymphadenectomy

Answer 42

Muscle invasive tumor

Question 43

What are the indications for partial cystectomy

Answer 43

Visible Lesion Location is suitable for bladder preservation mostly on dome and away from ureteral orifices

Question 44

Management Metastatic bladder cancer

Answer 44

Systemic combination chemotherapy ( cisplatin based first Line)