Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
112 Cards in this Set
- Front
- Back
|
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
|
