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112 Cards in this Set

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Essentials of diagnosis for renal cell carcinoma
gross or microscopic hematuria, flank pain or mass, systemic symptoms (fever, weight loss), solid renal mass
Classic triad in renal cell carcinoma
flank mass, hematuria, pain
Where does renal cell carcinoma originate?
proximal tubule cells
peak age for renal cell carcinoma
6th decade
What percentage of patients with renal cell already have mets at presentation?
33%
Renal cell carcinoma- MC in men or women
Major risk factor for renal cell carcinoma
cigarette smoking
Besides smoking, what are the other risk factors for renal cell carcinoma?
positive family history, horseshoe kidney, acquired renal cystic disease, obesity, and analgesic nephropathy
S/S of renal cell carcinoma
gross or microscopic hematuria, flank pain, abdominal mass
What will be seen on UA of renal cell carcinoma?
hematuria
What labs should be run when suspecting renal cell carcinoma?
UA, urinary cytology, CBC to check for anemia, ESR and alk phos (may be normal or elevated)
Most valuable imaging tests for renal cell carcinoma
CT with or without contrast
Why is a chest Xray done in patients with renal cell?
to find lung mets
#1 and #2 place for mets of renal cell carcinoma
lungs and spine
Primary tx for localized renal cell carcinoma
radical nephrectomy
What are instances where a patient may have a partial nephrectomy in renal cell?
tumor size less than 4 cm, single kidney, bilateral tumors, poor renal function
What is the treatment for renal cell mets?
no effective chemo, resistant to radiation
5 year disease free for tumors confined to renal capsule (T1-T2)
90-100%
5 year disease free for tumors beyond the renal capsule (T3-T4)
50-60%
What is the prognosis for node-positive tumors?
5 year survival of only 0-15%
Another name for nephroblastoma
Wilm's Tumor
MC solid renal tumor of childhood
Wilms Tumor
peak age for Wilm's Tumor
3 y/o
Wilm's Tumor has both ___________ and ______________ forms.
familial and nonfamilial forms
Is Wilm's Tumor usually unilateral or bilateral?
unilateral
Wilm's Tumor is generally large, multilobulated, with focal areas of ________ and _______________.
hemorrhage and necrosis
How does tumor dissemination occur with Wilm's?
direct extension through the renal capsule, hematogenously via renal vein and vena cava, or via lymphatic spread
Wilm's usually mets to what two sites?
lungs and liver
Why is there hypertension in Wilm's Tumor?
due to increased renin levels
What will the labs in Wilm's Tumor show?
UA- hematuria; CBC- anemia; LFTs- elevated if liver mets
What imaging is done in Wilm's?
US to evaluate for abdominal mass, CXR to check for pulmonary mets, CT scan preoperatively
Tx for Wilm's Tumor?
multimodal approach to tx, incorporating surgery, radiation therapy, and chemo--> goal to provide highest possible cure rate with lowest treatment related morbidity
5 yr survival rate for Wilms
90%
Follow up with Wilm's patients how often?
every 3 months
Essentials for bladder cancer
irritative voiding symptoms with normal prostate exam, gross or microscopic hematuria, positive urinary cytology, filling defect within bladder noted on imaging
second most common GU cancer
bladder cancer
Bladder cancer- more common in men or women?
men
Mean age of bladder cancer patients?
65
Fro for bladder cancer
cigarette smoking **, chronic cystitis, alcoholism, occupational such as chemical, texture, rubber industry workers
S/S of bladder cancer
hematuria, irritative voiding symptoms, may have mass/lymphadenopathy, many will be asymptomatic
What can be seen in voided urine in bladder cancer?
exfoliated cells
What is the purpose of urine cytology in bladder cancer?
make diagnosis or to check for recurrence
What imaging can be used to see filling defects in bladder cancer?
IVP, US, MRI, or CT
What is imaging in bladder cancer used for?
to evaluate upper tract and in staging more advanced lesions
Confirm bladder cancer by what means?
cystoscopy with biopsy
What is the staging of bladder cancer based on?
extent of bladder wall penetration and the presence of regional or distant mets
Initial tx for bladder cancer
Transurethral resection of bladder tumor (TURBT)
What tx can reduce the risk of tumor recurrence?
intravesical chemotherapy
How is intravesical chemo done?
agents are delivered directly into bladder by urethral catheter
What is radiotherapy used in conjunction with?
systemic chemotherapy in patients who are not surgical candidates
How is radiotherapy used?
an external beam radiotherapy is delivered in fractions over a 6-8 week period
What is used for metastatic disease treatment?
chemotherapy
When is chemo used for bladder cancer?
used after cystectomy in patients at high risk for recurrence
Five year survival rate for bladder cancer that presents in superficial stages
81%
How long do patients with metastatic bladder cancer live?
most die within 2 years
Essentials of diagnosis for prostate cancer
prostatic induration on DRE or elevation of PSA (prostate specific agent), most often asymptomatic, and rarely systemic symptoms of weight loss or bone pain
MC cancer detected in men in the US
prostate cancer
RF for prostate cancer
aging, Afr. Am., family history for prostate cancer, high fat intake, toxic exposures (smoking, welding, agent orange)
S/S of prostate cancer
most early are asymptomatic, symptoms prob suggest locally advanced or metastatic disease, obstructive or irritatve symptoms from local growth of tumor into urethra or bladder
What does metastatic pain in prostate cancer cause?
bone pain
What will DRE in prostate cancer reveal?
induration of prostate
What may lead to lymphadema of local extremities in prostate disease?
locally advance disease with bulky regional lymphadenopathyy
Where will most prostate cancer arise?
in peripheral zone
What does the serum level of PSA correlate with?
the volume o both benign and malignant tissue
What is measurement of PSA useful for?
useful in detecting and staging prostatic cancer, monitoring response to tx, and detecting recurrence before it becomes clinically obvious
Patients with PSA over 40 will have invasion in here other areas (more advanced disease)
seminal vesicle invasion, lymph node involvement, or occult distant mets
TX decisions for untreated prostate disease cannot be based on _______________ alone.
PSA levels
When will there be BUN or creatinine elevation in prostate disease?
urinary retention or urethral obstruction
If there are distant bony mets in prostate cancer, what lab values will be elevated?
alkaline phosphotase or hypercalcemia
Where are samples obtained from prostate during transrectal ultrasound?
apex, mid portion, and base of prostate (up to 10-12 samples)
The pictures taken during transrectal ultrasound are good for what?
staging of prostate cancer
MRI of the prostate is good for what?
staging and visualization of the regional lymph nodes
What type or cancers are the majority of prostatic cancers>
adenocarcinomas
What system is used for staging of prostate cancers?
Gleason grading system--grade correlates well with tumor volume, stage, and prognosis
What patients should undergo bone scan?
pts with more advanced local lesions, symptoms of mets like bone pain, and elevations in PSA greater than 10
MC site of distant mets in prostate cancer
axial skeleton
Tx for localized prostate cancer
based on tumor grade and stage and the age and health of the patient
What patients should be considered for prostate cancer treatment?
pts with life expectancy more than 10 years
Specific tx for prostate cancer
radiation therapy and radical prostatectomy
Why is losing weight important in prostate disease?
twice as likely to die if BMI greater than or equal to 25
What is removed with a radical prostectomy?
seminal vesicles, prostate, and ampullae of the vans deferens
What patients are ideal candidates for radical prostectomy?
stage T1 and T2 cancers
What is the purpose of cryosurgery to treat prostate cancer?
using liquid nitrogen to destroy tissue
What is the usual cause of death in prostate cancer?
almost always a result of failure to control metastatic disease
Why will 70% of prostate cancers respond to androgen deprivation?
most are hormone dependent
What is the vaccine for prostate cancer?
Provenge
Prevention of prostate cancer
antioxidants (Lycopene), cruciferous veggies (broccoli), Vit D, blocking cox-2, omega 3 fatty acids, stop smoking, high fiber/low fat diet, watch BMI, watch ETOH
What age group do we screen for prostate cancer?
men at average risk who want to be checked over the age of 40 should be offered DRE and PSA
Essentials of diagnosis for testicular cancer
patient identified painless mass at presentation, orchiectomy necessary for dx
MC neoplasm in men aged 15-35
testicular cancer
Most testicular tumors are what type?
germ cell tumors (seminoma and non-seminoma) that arise from spermatogenic cells within seminiferous tubules
Which side are testicular cancers more common on?
on right side
Only undisputed RF for testicular cancer
cryptorchidism
Other than cryptorchidism, what are the other risk factors for testicular cancer?
testicular trauma, torsion, infection related testicular atrophy, chemical exposures/pollutants, HIV/AIDS, maternal use of exogenous estrogen
S/S of testicular cancer
painless enlargement of testes, sensation of heaviness is +/-, typically delay presentation for several months, palpable mass, secondary hydrocele in 10%
What biochemical markers are drawn on testicular cancer?
human chorionic gonadotropin and alpha fetoprotein, and lactate dehydrogenase
If there is advanced testicular cancer, what should be checked for on CBC?
anemia
If a patient with testicular cancer gets chemo, what labs should be drawn?
obtain serum creatinine and GFR
What imaging should be done immediately to determine whether a testicular mass is intra or extratesticular?
scrotal US
What is used to determine clinical staging of testicular cancer?
chest, abdominal, and pelvic CT scanning
TX for testicular cancer
inguinal exploration with early vascular control of spermatic cord structures, tx depends on histology and staging, radical orchiectomy
Prognosis for testicular cancer
very good---5 year survival rate for stage I and Iia seminomas treated by radical orchiectomy and retroperitoneal irradiation is 98%
What is the most common testis tumor in patients over 50?
lymphoma
What age group do you most often find penile cancer?
in the 6th decade
Risk factors for penile cancer
uncircumcised, viral cause, poor hygiene
What part of penis is most commonly affected by cancer?
glans
What can penile cancer start as?
leukoplakia typically involving the meatus or as condylomata lesion
If velvety red lesions are on the penis, what do you suspect?
Bowen Disease (carcinoma in situ)
What type of cancer are most penile cancers?
SCC
Tx for penile cancer
biopsy mandatory to rule out benign conditions, tx depends on pathology and location, primary lesion--Effudex cream or laser therapy, Invasive dz of the glans- complete excision or shaft--complete penectomy
What is the tx for inoperable penile cancer and bulky inguinal mets?
chemotherapy
What is the tx of penile cancer that has spread to regional lymph nodes?
6 weeks of antibiotics and if still unresolved inguinal node dissections