Term
| what is the risk for prostate CA in white men and black men? |
|
Definition
| white: 1 in 6, black: 1 in 5. prostate CA is also simply more aggressive in black pts. |
|
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Term
| why is it more rare for its to have symptoms such as urinary retention/back+leg pain/hematuria w/prostate CA in 2010? |
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Definition
| b/c of PSA, pts do not usually progress to these symptoms before being diagnosed/treated |
|
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Term
| what is the etiology of prostate CA? |
|
Definition
| environmental factors have not been determined. there is a strong familial predisposition (presents 6-7 yrs earlier) involving the HPC1 and PCAP gene on chromosome 1 |
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Term
| what are the screening recommendations for prostate CA? |
|
Definition
| PSA test @ 50 for white pts w/no risk factors, and PSA test @ 40 for black pts w/no risk factors. |
|
|
Term
| what is the absolute normal PSA level? |
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Definition
|
|
Term
| when is free PSA used to dx? |
|
Definition
| to cross-check against a negative bx. if the bx was negative, but the free PSA is <20%, there is a higher probability of prostate CA and another bx should be performed |
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Term
|
Definition
| how fast the PSA level is changing, >0.75 change in a year is worrisome - but not diagnostic |
|
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Term
| what does PSA density refer to? |
|
Definition
| the ratio of PSA/gland size; >0.15 is worrisome |
|
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Term
| if there is an abnormality of PSA/DRE, what is the next step? |
|
Definition
| US guided prostate bx reviewed by a pathologist |
|
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Term
| what is the gleason grading system? |
|
Definition
| the two most common cell patterns from several prostate CA bx's are graded 1-5 and then added together. <3 do well, >8 don't do well, etc |
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Term
| why is tx of prostate CA sometimes more difficult than kidney or bladder? |
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Definition
| b/c there are several good tx choices, and the pt ultimately has to decide what they want |
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Term
| what is watchful waiting and active surveillance? |
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Definition
| watchful waiting: for older pts diagnosed w/prostate CA who are likely to die of something else first. active surveillance: postponing tx in a younger healthy pt (~50) w/low risk prostate CA while continuing to run PSAs/get bx's to maintain good quality of life for as long as possible until the disease progresses to the point where tx is deemed necessary (need a compliant pt). |
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|
Term
| what are radiation therapy options for prostate CA? |
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Definition
| external beam radiation therapy, brachytherapy (radioactive seeds), and high dose brachytherapy |
|
|
Term
| who is cryotherapy good for? |
|
Definition
| prostate CA pts who have failed radiation therapy - but doesn’t usually work as well as surgery or radiation & side effects are as bad, if not worse |
|
|
Term
| what characterizes the radical prostatectomy options? |
|
Definition
| open sx (older way), conventional laparoscopic sx, and robotic-assisted laparoscopic sx (better b/c better visualization, minimally invasive, less pain, faster recovery, less bleeding (watertight anastamosis), shorter catheter time, shorter length of hospital stay, and smaller incision) |
|
|
Term
| who gets renal cell CA (RCC) more commonly, M or F? why is there a 100% increased incidence since 1970? how lethal is RCC? |
|
Definition
| males get RCC more commonly, there is a 100% increased incidence since 1970 b/c of imaging technology, and it RCC is the most lethal of all GU malignancies (40% mortality rate vs. 20% w/ bladder and prostate) |
|
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Term
| *exam question: what is the most common cause of RCC?* other etiologic agents? |
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Definition
| *tobacco* other etiologic agents: high fat/protein diet (obesity), coffee, occupational exposure, iatrogenic radiation, and familial factors (von hippel-lindau disease and hereditary papillary RCC) |
|
|
Term
| what is the classic triad associated with RCC? |
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Definition
| hematuria, flank pain, and palpable mass in flank/abdomen. *this is only seen 10% of the time in clinical practice, so this is more board-related information* |
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Term
|
Definition
| most RCC pts are asymptomatic and are diagnosed incidentally (even though 25% are metastatic. commonly seen signs/symptoms: wt loss, fever, HTN, hypercalcemia, night sweats, malaise, and varicocele (esp if on R side b/c L is more common) |
|
|
Term
| what is paraneoplastic syndrome associated w/RCC? |
|
Definition
| hypercalcemia, erythrocytosis, nonmetastatic hepatic dysfunction (stouffer syndrome - elevated LFTs that go away when RCC is removed), anemia, fever, cachexia, wt loss, increased ESR, and HTN |
|
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Term
|
Definition
| CT/MRI (need to show active CA w/contrast enhancement to differentiate it from other renal masses) and surgical removal (radical nephrectomy). bx is usually not done due to risk of increased metastasis, needle track seeding, and *bleeding*. |
|
|
Term
| what is the most common RCC? |
|
Definition
| clear cell (70-80%), followed by papillary, chromophobic, collecting duct, and medullary (last 3 are rare, but aggressive). any of these can be a sarcomatoid variant, which means it will be more aggressive. |
|
|
Term
| do radiation/chemo work for RCC? what characterizes sx for RCC? |
|
Definition
| no, sx is the best option - laparoscopic radical nephrectomy is the gold standard. nephron-sparing sx such as partial nephrectomy is better if possible, but it is difficult. ablative sx techniques: RFA (radiofrequency ablation) burns it or cryosx freezes it (*better for kidney then prostate CA, easiest modality) |
|
|
Term
| what is the 2nd most common urologic tumor? |
|
Definition
|
|
Term
| who is bladder CA more common in? |
|
Definition
| white males - however bladder CA is more aggressive if blacks or women have it |
|
|
Term
| what is the most common cause of bladder CA? other risk factors? |
|
Definition
| smoking. other risk factors: industrial exposure, prior pelvic radiation, and long-term indwelling catheters. |
|
|
Term
| what is cyclophosphamide? |
|
Definition
| a chemotherapy agent which has a breakdown product: acrolein that increases bladder CA risk, however if mesna is coadministered this risk should be negated |
|
|
Term
| how does bladder CA present? |
|
Definition
| most common: *painless gross hematuria. also: irritative bladder symptoms (dysuria, frequency, urgency), bony/pelvic pain, and flank pain |
|
|
Term
| what does evaluation of hematuria consist of? |
|
Definition
| UA, urine cx, +/- cytology, upper tract imaging (CT/MRI +/- contrast), and cystoscopy |
|
|
Term
| how is bladder CA diagnosed/staged? |
|
Definition
| transurethral resection (same as TURP for prostate CA) -> goal is to get muscle |
|
|
Term
| *exam question: what is the most common type of bladder CA in the US?* |
|
Definition
| *transitional cell carcinoma* followed by SCC (most common *globally), and more rarely, adenocarcinoma (suspect metastasis). |
|
|
Term
| what is bladder SCC associated with? |
|
Definition
| in the US: persistent inflammation, as seen w/bladder stones/foley catheter. in underdeveloped countries ("walking barefoot by the nile"): schistosomiasis. |
|
|
Term
| what is the difference between superficial and muscle invasive bladder CA? |
|
Definition
| superficial bladder CA (Ta/T1) sits on, but not in the lamina propria - they will recur 75% of the time but they are not lethal unless they progress to muscle invasive type (25% occurrence). muscle invasive bladder CA invades muscle/fat and can be lethal. |
|
|
Term
| what is tx for superficial bladder CA? |
|
Definition
| scrape out tumor, r/o muscle involvement, f/u w/surveillance therapy. intravesical therapy can be used for more aggressive tumors, the most common type of which is BCG a live TB strain. |
|
|
Term
| what is tx for muscle invasive bladder CA? |
|
Definition
| either sx (radical cystectomy: M - remove bladder/prostate, F - remove basically everything in the pelvis) or chemo+radiation (bladder preserving tx: gemcitabine/cisplatin). |
|
|
Term
| what characterizes urothelial tumors of the renal pelvis/ureter? |
|
Definition
| basically the same thing as bladder CA, but higher up. etiology: *smoking (esp upper tract TCC). cell types: TCC (90%), SCC (1-7%) and adenocarcinoma. |
|
|
Term
| what is the most common location of urothelial CA? |
|
Definition
| renal pelvis (58%) then the ureter |
|
|
Term
| what are symptoms of urothelial CA of the renal pelvis/ureter? |
|
Definition
| gross/microscopic hematuria (75%), flank pain (not as common b/c slowly progressive), dysuria, and advanced disease (wt loss/anorexia/flank mass/bone pain). |
|
|
Term
| how is urothelial CA of the renal pelvis/ureter diagnosed? |
|
Definition
| CT/MRI (hematuria evaluation), cystoscopy/retrograde pyelogram, and ureteroscopy w/bx |
|
|
Term
| *exam question: what is the the goblet sign?* |
|
Definition
| *dye filling up around the base of a tumor in a retrograde pyelogram at the top of the ureter* this indicates a need to perform a bx. |
|
|
Term
| what is treatment for urothelial CA of the renal pelvis/ureter? |
|
Definition
| nephroureterectomy (w/excision of bladder cuff): gold standard, TCC is treated more aggressively (remove kidney, entire ureter, part of bladder). nephron sparing sx does have a higher rate of recurrence, so it is only done if CA is just at the distal ureter. ureteroscopic tx: scope+laser, only really done in very sick pts or those w/superficial, low grade CA (higher risk of recurrence, requires more f/u) |
|
|
Term
| who is testicular CA seen in? |
|
Definition
| whites and in 3 modal peaks: infancy, age 25-40, and age >60. germ cell testicular CA is the most common solid tumor in men 15-35. |
|
|
Term
| what is the etiology of testicular CA? |
|
Definition
| pts w/cryptorchism: 10-40x higher risk |
|
|
Term
| what are the signs/symptoms of testicular CA? |
|
Definition
| painless testicular scrotal mass (most common), scrotal pain (less commone), gynecomastia (if hCG secreting - chorioCA), back pain, cough, and hemoptysis (last 3 - metastasis) |
|
|
Term
| how is testicular CA evaluated? |
|
Definition
| US, CXR, CT scan (chest, maybe head), and biomarkers (used to f/u primary therapy - AFP, beta-hCG, and LDH) |
|
|
Term
| what is the most common type of testicular CA? |
|
Definition
| germ cell, either seminoma or nonseminomatous (embryonal CA, teratoma, chorioCA, and yolk sac - treated differently) |
|
|
Term
| what is tx for testicular CA? |
|
Definition
| radical inguinal orchiectomy (need to keep lymph nodes+drainage separate). additional chemo/radiation depending on type/stage. |
|
|
Term
| how common is penile CA in the US? |
|
Definition
| very rare, esp in circumcised pts. there is an increase in incidence between 60-80 yr old and if pts do have this they have generally delayed dx/tx. |
|
|
Term
| what is the most common type of penile CA? |
|
Definition
| SCC (often under foreskin) |
|
|
Term
| how does penile CA present? |
|
Definition
|
|
Term
| what is tx for penile CA? |
|
Definition
| sx (partial/total penectomy), chemo/radiation = not helpful |
|
|
Term
| what characterizes incidence of urethral CA? |
|
Definition
| very rare. SCC is the most common. more common in white females >60 yrs old. |
|
|
Term
| what is important in urethral CA pts? |
|
Definition
| make sure its not coming don from the bladder/prostate. |
|
|
Term
| how does a urethral CA pt present? |
|
Definition
|
|
Term
| how is non-spreading urethral CA treated? |
|
Definition
| like bladder CA, radical cystectomy |
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