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22 Cards in this Set
- Front
- Back
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Second most common urologic cancer
Fourth most common cancer in men, thirteenth in women More common in men than women Higher in whites than blacks Mean age of diagnosis is 65 |
Bladder Cancer
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What are the bladder cancer risk factors?
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Cigarette Smoking
Exposure to industrial dyes (aniline) or solvents (cyclophosphamide) External beam radiation |
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What are the clinical manifestations of bladder cancer?
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Gross Painless Hematuria
Irritative Voiding Complaints Frequency, Urgency Flank Pain Metastatic Disease Symptoms Hepatomegaly, Palpable Lymphadenopathy, Lower Extremity Lymphedema |
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What labs do you use to diagnose bladder cancer?
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Urinalysis
Urine Cytology Exfoliated cancer cells CBC |
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What types of imaging do you use to diagnose bladder cancer?
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Filling defects caused by tumor size can be detected on US, CT or MRI
IVP Allows for imaging of the entire upper tract Cystoscopy with Biopsy & Transurethral Resection For diagnosis, treatment, & staging*** Distant metastases assessed by CT of chest & abdomen, MRI of skeleton |
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What are the four types of histological cells associated with bladder cancer?
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Transitional Cell (Urothelial Cancer) 90%
Squamous cell 7% Adenocarcinoma 2% Small Cell <1% |
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How is bladder cancer graded?
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Grading
Determined by the degree of differentiation of cells that compose the tumor Grade I through IV Grade I (highly differentiated) rarely progresses Progression and recurrence are strongly correlated with grade |
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TNM staging of bladder cancer is dependent on what factors?
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Based on the extent of bladder wall penetration and presence of regional or distant metastases
Probability of spread increases with the T-stage Also described as superficial (T1) or invasive disease (TII-TIV) Superficial Tumors: Confined to the mucosal layer or have penetrated through the epithelial basement membrane into underlying connective tissue Invasive Tumors: Extend into the superficial or deep muscle layer or extend more deeply into the perivesical fat |
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What are the treatment options for bladder cancer?
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Treatment Options
Surgery Transurethral Resection, Partial Cystectomy, Radical Cystectomy Bilateral Pelvic Lymph Node Dissection Adjunctive Intravesical Chemotherapy Radiotherapy Chemotherapy |
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How do you treat Superficial bladder Cancer?
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Complete transurethral resection with or without intravesical therapy
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How do you treat Invasive bladder Cancer
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Radical Cystectomy with creation of conduit or reservoir for urinary flow
Increasing trend toward partial cystectomies Adjuvant chemotherapy |
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How do you tx metastatic bladder cancer?
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Metastatic Disease
Surgery (+/-) with curative or palliative chemotherapy |
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Accounts for about 3% of adult cancers
Occurs more often in men than women Peak incidence occurs in the sixth decade Sporadic incidence more common than familial or as a result of cystic disease in patients with end-stage renal cancer Major risk factor is Cigarette Smoking |
Renal Cell Cancer
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What two types of renal cancer appear in the proximal tubule?
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Clear Cell: Originates in the proximal tubule, found in >80% with metastases
Papillary: Originates in the proximal tubule, tends to be bilateral |
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What type of renal cancer appear in the cortical collecting tubule?
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Oncocytic: Originates in the cortical collecting duct, benign in nature
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What 2 types of renal cancer appears in the medullary collecting tubule?
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Collecting Duct: Originates in the medullary collecting duct, rare, very aggressive, tends to affect younger patients
Chromophobic: Originates in the medullary collecting duct, typically an indolent clinical course |
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What are the manifestations of renal cell cancer?
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Usually presents as Gross or Microscopic Hematuria
Flank Pain or Abdominal Mass Triad of flank pain, abdominal mass and hematuria often a sign of advanced disease Fever, Chills, Weight Loss Metastatic disease symptoms: cough, bone pain Incidental finding on CT/US in asymptomatic patients |
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What are the lab diagnostics used for renal cell cancer?
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UA and Urine Cytology
Hematuria, Cancer Cells CBC Anemia Electrolytes Hypercalcemia Alkaline Phosphatase Liver Function Associated with hepatic dysfunction |
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What diagnostic imaging is used for renal cell cancer?
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Ultrasound
Identifies solid from cystic kidney lesions Abdomen and Pelvic CT Scan is the modality of choice for imaging Identifies and defines renal masses Allows for visualization of regional lymph nodes, renal vein and/or hepatic involvement Allows for visualization of the contralateral kidney Chest CT to rule out pulmonary metastases Bone Scan to rule out bony metastases |
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How are renal cell cancers staged?
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American Joint Committee on Cancer (AJCC)
Stage I: Tumors <7cm, confined to kidney Stage II: Tumors >7cm, confined to kidney Stage III: Extend through renal capsule but are confined to Gerota’s fascia or involve a single lymph node Stage IV: Invade adjacent organs (excluding adrenal gland) or multiple lymph nodes or distant metastases |
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What is the tx for renal cell cancer?
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Stage I, II, & selected III
Radical Nephrectomy Removal of kidney, surrounding fat, +/- hilar lymph nodes, +/- adrenal gland removal Radical Nephrectomy in the presence of metastatic disease is considered palliative Segmental nephrectomy an option for small renal masses (<4cm) or need to preserve kidney function |
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What is not effective for renal cell cancer treatment?
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Radiation is not effective
Metastatic renal cancer is highly refractory to chemotherapy IL-2 has been FDA approved for use |
