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46 Cards in this Set
- Front
- Back
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What is the most significant cause of bladder cancer?
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Cigarette smoking
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What carcinogens are major risk factors associated with bladder cancer?
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Aryl amines, benzidine, naphthylamines, phenacetin, cyclophosphamide, infection due to schistosomiasis, or chronic inflammation.
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What is the incidence of Von Hippel Lindau gene mutation in sporadic kidney cancer?
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60%
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What percent of patient with Von Hippel Lindau syndrome have kidney cancer?
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30%
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What is the most common malignancy among men aged 15 to 35?
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Testicular cancer
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What percent of patients with metastatic testicular cancer are cured with chemotherapy +/- radiation therapy?
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90%
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What are the screening tests for prostate cancer for all men 50 years old?
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PSA and digital rectal exam, although they have not been proven to reduce prostate cancer mortality.
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What is the median age of diagnosis of bladder cancer?
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65
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What is the percentage of bladder cancers that recur?
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50-75%
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What occupations are associated with a higher risk of bladder cancer?
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Aluminum workers, chimney sweeps, motor vehicle operators, and dry cleaners
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Which parasite is associated with an increased risk of bladder cancer?
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Schistosoma haematobium increases the risk of both squamous and transitional cell carcinomas of the bladder.
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What is the most common type of bladder cancer?
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Transitional cell carcinoma (90-95%), the squamous cell carcinoma (3-8%), and then adenocarcinoma (2%)
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What is the clinical presentation of bladder cancer?
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Hematuria is the presenting sign in 80% to 90% of cases. Frequency, bladder irritability, and dysuria are present in 1/3 of the patients and increase in the later stages of the disease. Ureteral obstruction may develop, resulting in flank pain, discomfort, and overall reduced renal function.
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What is the gold standard diagnostic test for bladder cancer?
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Cystoscopy; it allows direct examination of the bladder mucosa and eventually biopsy of suspicious lesions.
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When is Mycobactenum bovis used in treatment of bladder cancer?
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Bacille Calmette-Guerin (BCG) is an attenuated strain of M. bovis that is used as a human TB vaccine in endemic areas. It is used to prevent recurrence after resection of superficial bladder cancers by causing inflammation in the bladder mucosa. By an "innocent bystander effect", residual tumor cells are destroyed, theoretically.
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What is the treatment for tumors that invade the bladder wall?
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Cystectomy; this is a major procedure requiring diversion of the ureters to a jejunal pouch. Administration of neoadjuvant chemotherapy, may increase the cure rate or even obviate the need for cystectomy. In patients who are not candidates for cystectomy, combined radiation and chemotherapy is an effective option.
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What is the treatment for metastatic bladder cancer?
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By definition, this stage of bladder cancer is incurable. The clinical concern is how to prolong life. A commonly used combination of chemo drugs is MVAC (methotrexate, vinblastine, adriamycin, and cisplatin) and GC (gemcitabine and cisplatin).
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What percentage of renal turmors are renal cell carcinoma? What percentage of those carcinomas are clear cell carcinoma?
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90% of renal tumors are renal cell carcinoma; 85% of these are clear cell tumors.
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What is renal cell carcinoma chemoresistant?
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Tunules cells overexpress the multi-drug resistant m-RNA and its protein product P-glycoprotein.
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What is the clinical presentation of renal cell carcinoma?
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Hematuria, flank pain; there could be cough, lower back pain, or bone pain due to metastasis.
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What percentage of patients with renal cell carcinoma present with anemia?
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1/2
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What is the intitial test for renal carcinoma?
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IVP or renal US; CT of the abdomen and pelvis will show other metastic masses and liver metastases.
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What is the treatment for early stage and non metastatic renal cell carcinoma?
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Radical nephrectomy
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What is the treatment for metastatic renal cell carcinoma?
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Cytoreductive nephrectomy, immunotherapy (alpha interferon, IL-2), and targeted therapies (sorafenib, sunitib, benvacizumab)
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What is the surgical cure rate for tumors limited to the kidney?
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75%
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What is the incidence of prostate cancer by age 80?
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70%
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Which hormone is prostate cancer dependent on? What conditions are rarely found with prostate cancer?
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Testosterone; eunuchs and men with chronic liver failure who have elevated levels of estrogen rarely develop prostate cancer.
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What is the most common type of prostate cancer?
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Adenocarcinoma (99%)
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What is the clinical presentation of prostate cancer?
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Bladder outlet obstruction for urethra compression, anemia, weight loss, and profound weakness due to myelophtisis.
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How are distant metastases spread in prostate cancer?
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Hematogenously
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How is prostate cancer detected on physical exam?
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A majority of prostate cancers can be palpated by digital exam as a nodular or as diffuse induration.
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What levels of PSA are usually indicative of malignancy?
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PSA levels > 10 ng/mL are usually indicative of malignancy, but levels of 4-10 ng/mL should be investigated as well.
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What are the most useful tests in diagnosing prostate cancer?
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US or MRI of the prostate are most useful, but often underestimate the extent of the disease. Bone scan is routinely done as a screening for bone metastases.
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Localized, well differentiated cancers may have a 10 year survival rate of what without treatment?
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70%
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What is the definitive surgical procedure for prostate cancer? How does compare with the cure rates by radiation therapy?
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The definitive procedure is radical prostatectomy. It appears that radiation therapy produces cure rates comparable to surgery.
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Luteinizing hormone releasing hormone (LHRH) analogues
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These drugs cause down-regulation of pituitary LHRH receptors, which is followed by reduced pituitary gonadotrophic horomone production which leads to reduced androgen production by the testes. Common agents are leuprolide and goserelin. Common side effects are impotence and loss of libido.
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Flutamide
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Anti-androgen; used in combination with LHRH analogues to inhibit androgens that are not produced via the pituitary-testicular axis, such as from the adrenals.
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What is the only chemotherapy agent shown to improve survival in metastatic hormone refractory prostate cancer?
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Docetaxel
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How much does crytorchidism increase the risk of testicular cancer?
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10 fold
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What is the most common type of testicular cancer?
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Seminoma (40%)
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What is the clinical presentation of testicular cancer?
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Mass in testis, lower back pain due to metastasis in retroperitoneal lymph nodes, cough (lung mets), SVC syndrome (mets), and neurologic symptoms (mets)
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What lab values will be elevated in testicular cancer?
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Serum alpha fetoprotein may be elevated in embryonal type, serum BHCG may be elevated in choriocarinoma, and LDH may be elevated in any type.
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What is the best radiological test for testicular cancer?
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US
Needle biopsy is contraindicated |
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What is the best surgical intervention for testicular cancer?
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Most cases of testicular cancer and almost all cases of seminoma are cured by orchiectomy.
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What is the most commonly used chemo combinations for testicular cancer?
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Cisplatin, bleomycin, and etoposide (BEP)
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What is the overall cure rate for testicular cancer?
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>90%
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