Neoplasms Of Kidney, Bladder, Testes

Front 1

What are 3 types of benign renal tumours?

Back 1

Adenomas (earliest stage of renal cell carcinoma)
Oncocytoma (invades locally)
Renal angiomyolipoma (hamartoma)

Front 2

What 3 cell types are found on histology of a renal angiomyolipoma?

Back 2

Smooth muscle
Fat
Blood vessels

Front 3

Angiomyolipoma: symptoms, diagnosis, treatment, high risk group

Back 3

Symptoms: Pain or bleeding if large
Diagnosis: U/S and CT for fat content
Treatment: <4cm=observation, >4cm or symptomatic=partial nephrectomy or embolization
At risk population: Tuberous Sclerosis

Front 4

Renal Cell Carcinoma: Epidemiology, Risk Factors, Etiology, Pathological Subtypes, Symptoms, Work-up, Modes of and location of metastasis, Complicated forms

Back 4

Epidemiology: 3% of cancers, M>F, 50's and 60's
Risk Factors: Occupational exposures, smoking
Etiology: Inherited or sporadic mutations (especially of chromosome 3p-)
Pathologic Subtypes: Clear cell (most common), papillary, chromophobe, collecting duct, neuor-endocrine; all +/- sarcomatoid elements
Symptoms: 50% asymptomatic, hematuria + flank pain + palpable flank mass
Work-up: Abdo U/S +/- CT, Blood work, CXR +/- CT chest, Bone scan
Metastasis: Vascular or lymphatics; Lymph nodes, lung, liver, bone, adrenal gland, contralateral kidney, brain, subcutaneous
Complicated forms: Bilateral, Von Hippel Lindau, paraneoplastic

Front 5

What are symptoms of paraneoplastic syndromes?

Back 5

Weight loss, fever of unknown origin,anemia, HTN, erythrocytosis, hypercalcemia, endocrinopathy, neuro/myopathy, Stauffer syndrome

Front 6

What are indications for performing a biopsy in renal cell carcinoma? (3)

Back 6

Need to confirm primary when have mets
Establish a diagnosis in non-surgical patients
Establish diagnosis in those undergoing observation or percutaneous ablative therapy

Front 7

Renal Cell Carcinoma Treatment: Localized disease, Metastatic disease

Back 7

Localized: Surgical Removal (partial vs radical, open vs laproscopic vs percutaneous)
Metastatic: Surgical resection of kidney or limited metastatic disease +/- biologic agents (antiangiogenics)

Front 8

Why is renal cell carcinoma chemo resistant?

Back 8

Expresses P-glycoprotein which pumps chemo out of cancer cells

Front 9

Bladder Tumours: Epidemiology, Risk Factors, Clinical Presentation, Histological Subtypes

Back 9

Epidemiology: 2nd most common urologic cancer, caucasians, >65
Risk Factors: smoking, occupational exposures, cyclophosphamide, Radiation, chronic trauma (stones, infection), deletion of p53 gene
Clinical Presentation: Gross, painless hematuria +/- irritative voiding symptoms
Histological Subtypes: Transitional Cell (90%), mixed, squamous, adenocarcinoma, small cell, undifferentiated

Front 10

What is the importance of gross, totally painless hematuria and how do you work it up?

Back 10

Bladder cancer until proven otherwise
Hx/Px, upper tract imaging, urine x3 (urinalysis, C&S, cytology), cystoscopy

Front 11

What is the T staging system for bladder cancer?

Back 11

Superficial/non-invasive (can scrape out by TUR): Tis, Ta, T1
Invasive (radical cystectomy): T2-T4

Front 12

How do you work-up for metastasis in bladder cancer?

Back 12

CT abdomen/pelvis, CXR, bone scan

Front 13

Bladder Cancer Treatment: Superficial (Tis, Ta, T1), Invasive (T2-T4), Metastatic

Back 13

Superficial: TUR +/- BCG +/- chemo
Invasive: Radical cystectomy +/- chemo +/- radiation
Metastatic: Systemic chemo + selective surgery or radiation

Front 14

Testis Cancer: Epidemiology, risk factors, clinical presentation, pathological subtypes, work-up/diagnosis, treatment

Back 14

Epidemiology: Most commone solid tumour males 15-35, 90-95% germ-cell
Risk Factors: Crytorchidism (seminoma), trauma/infection-related atrophy, exogenous sex hormones in utero, marijuana
Clinical presentation: Solid painless mass in testis +/- hydrocele
Pathological subtypes: Seminoma, choriocarcinoma, embryonal, mixed, teratoma
Work-up: Hx, Px, scrotal ultrasound, serum markers (beta HCG, alpha fetoprotein, LDH)
Treatment: Radical orchidectomy +/- chemo +/- radiation

Front 15

What are the risk factors for developing testis cancer? (4)

Back 15

Cryptorchidism
Trauma/infection-related atrophy
Exogenous sex hormones in utero
Marijuana

Front 16

Where does testis cancer metastasize to?

Back 16

Renal hilar lymph nodes (most)
Other lymph nodes
Lung, liver, brain, bone, kidney, adrenal, spleen