Carcinomas Of The Gu Tract

Front 1

***How common are carcinomas of the GU tract?

Back 1

NOT common; very rare!

Front 2

What 4 regions constitute the GU tract?

Back 2

renal
bladder
ureteral
prostate

Front 3

*What is the epidemiology of renal cell carcinoma?

Back 3

-3% of adult malignancies
-90-95% of neoplasms arising from the kidney
-5th-8th decade**
-slightly higher incidence in males

Front 4

*What is the pathophysiology of renal cell carcinoma?

Back 4

-originates in proximal renal tubular epithelium
-associated hereditary syndromes

Front 5

*What is the prognosis for renal cell carcinoma?

Back 5

5 year survival rate:
-Stage I: 66%
-Stage IV: 11%

Front 6

What are the clinical symptoms of renal cell carcinoma?

Back 6

-25-30% remain asymptomatic
-classic triad***- flank pain, hematuria, flank mass
-weight loss
-HTN, fever, night sweats
-paraneoplastic syndrome

Front 7

***What is the classic triad (of clinical symptoms) of renal cell carcinoma?

Back 7

-flank pain
-hematuria
-flank mass

Front 8

Where might renal cell carcinoma metastasize to?

Back 8

**lung
soft tissues
bone
liver

Front 9

What are 4 risk factors for renal cell carcinoma?

Back 9

genetic factors
**cigarette smoking (doubles risk)
obesity, HTN
PCKD (polycystic kidney disease)

Front 10

How is renal cell carcinoma diagnosed?

Back 10

IVP (67% sensitive)
US (79% sensitive)
CT 94% sensitive
MRI with gadolinium
Gold Standard -->Tissue

Front 11

What is the gold standard for diagnosing renal cell carcinoma?

Back 11

tissue

Front 12

Treatment of renal cell carcinoma

Back 12

-tx based on ability to cure
-radiation therapy, chemo, hormonal therapy, immunotherapy (or a combination)
-surgery (radial nephrectomy)

Front 13

What percentage of those who receive a radical nephrectomy still develop metastasis?

Back 13

20-30%

Front 14

What is the epidemiology of Wilm's tumor?

Back 14

-5th MCC pediatric malignancy
-MC type of renal tumor in children
-mean age of dx is 3.5 years

Front 15

What is the etiology/pathophysiology of Wilm's tumor?

Back 15

-sporadic, association with genetic syndrome, familial
-abnormal proliferation metanephric blastema cells

Front 16

What are the clinical manifestations of Wilm's tumor?

Back 16

**palpable abdominal mass (MC presentation)
abdominal pain (30-40%)
HTN, fever, hematuria, anemia

Front 17

What is the treatment for Wilm's tumor?

Back 17

nephrectomy, radiation and chemotherapy

Front 18

What is the prognosis for Wilm's tumor?

Back 18

90% survival

Front 19

Bladder cancer epidemiology

Back 19

-4th MCC cancer in males in US
-3:1 male: female
-50-70 years of age

Front 20

What is the pathophysiology of bladder cancer?

Back 20

-epithelial origin
(90% TCC, 5% SCC, 2% adenocarcinoma)

Front 21

Prognosis for bladder cancer

Back 21

-high recurrence
-depends on depth

Front 22

Bladder cancer clinical manifestations

Back 22

-painless gross hematuria (80-90%)**
-dysuria, frequency, urgency (usually more advanced)

Front 23

What are 80% of causes of bladder cancer associated with?

Back 23

environmental exposure

Front 24

What are some causes of bladder cancer?

Back 24

-smoking (50%)**
-industrial exposure (dyes, paints, solvents, textiles)
-prior radiotherapy exposure of pelvis
-long-term indwelling catheters
-chronic cystitis

Front 25

How is diagnosis of bladder cancer made?

Back 25

cytoscopy with biopsies

Front 26

Treatment of bladder cancer

Back 26

-depends on depth of invasion
-intravesicular immunotherapy/chemo
-radiotherapy
-bladder resection

Front 27

What is BCG?

Back 27

-live attenuated strain of mycobacterium bovis
-local immune reaction agaisnt tumor
-for bladder cancer T1 or CIS
-70% effective against superficial cases
-likely to have positive PPD

Front 28

What is the epidemiology of prostate cancer?

Back 28

-2nd MCC cancer death in males
- >50 years of age; peak 75
-more men die WITH rather than OF prostate CA

Front 29

What are 2 aspects of the anatomy of the prostate?

Back 29

-beneath bladder, in front of rectum
-surrounds proximal urethra

Front 30

Function of prostate

Back 30

-produces and stores seminal fluid
-androgen production

Front 31

What type of cancer is prostate cancer?

Back 31

adenocarcinoma (glandular)

Front 32

What are the symptoms of prostate cancer?

Back 32

-early disease asymptomatic
-frequency
-nocturia
-urgency/hesitency
-hematuria
-dysuria
-sexual dysfunction

Front 33

What are the symptoms of advanced prostate cancer?

Back 33

-bone pain (spine, pelvis, ribs)
-weight loss
-lymphadenopathy

Front 34

What does the CDC say (in terms of screening for prostate cancer)?

Back 34

supports informed decision
-understand nature and risks of prostate cancer
-understand risks of, benefits of, and alternatives to screening
-participates in making the decision to be screened
-makes a decision consistent with his preferences and values

Front 35

What does the US Preventative Task Force recommend (in terms of screening for prostate cancer)?

Back 35

-benefits of screening do NOT outweigh harms
-recommend against screening of healthy men

Front 36

What are the 2 markers of prostate cancer?

Back 36

DRE and PSA

Front 37

How is prostate cancer staged?

Back 37

TMN Staging (I-IV)

Front 38

How is prostate cancer diagnosed?

Back 38

-biopsy (Gleason score)
-transrectal US (guided biopsy)***

Front 39

What are the general options (in terms of tx) for prostate cancer?

Back 39

1) **active surveillance
2) surgery (radical prostatectomy)
3) brachytherapy
4) external beam radiation
5) chemo drugs
6) hormonal therapy

Front 40

How does one choose the correct option for treating prostate cancer?

Back 40

-age
-general health
-tx side effects