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Senior - GU Test 1 > 13 - Cancers Of Urinary Tract > Flashcards

13 - Cancers Of Urinary Tract Flashcards

1
Q

Who gets reanl cancer?

A

2:1 males

6th decade

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2
Q

Renal cell carcinoma is ___%?

A

> 80% ofd all primary cancers (2.6% of all adult cancers)

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3
Q

Cancer until proven otherwise?

A

Solid lesions of the kidney are renal cell carcinoma until proven otherwise

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4
Q

S/s of renal cell carcinoma?

A

Classic triad

  • flank pain
  • hematuria
  • mass

(Usually advanced disease)

Also see
- metastatic symptoms (cough, bone pain)

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5
Q

How is renal cell carcinoma diagnosed?

A

Usually its an incidental finding on US/CT

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6
Q

Labs for renal cell carcinoma?

A

UA - hematuria
Urine cytology
CBC - anemia
Hypercalcemia

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7
Q

Imaging for renal cell carcinoma?

A

Best

  • CT
  • MRI

Dont forget to check for metastases

  • pulm
  • bone scan
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8
Q

RCC tx?

A

Remove mass/cyst

Metastatic disease - oncology and urology referral

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9
Q

Types of RCC removal tx?

A

Nephrectomy - primary tx

Partial nepnrectomy

Radical nephroctomy

NO CHEMO works

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10
Q

Who gets partial nephrectomy?

A
  • single kidney
  • bilateral tumor
  • sig medical renal disease
  • small cancer
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11
Q

Who gets radical nephrectomy?

A

Cancer >7cm

Partial nephrectomy not feasible

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12
Q

Prognosis for RCC?

A

Confined to renal capsule (T1-T2)
- 5 yr - 90-100%

Beyond renal capsule (T3 - T4)
- 5 yr - 50-60%

Node-pos tumors
- 5 yr - 0-15%

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13
Q

Other renal tumors types?

A

Primary

  • oncocytomas (benign) (look like RCC)
  • angiomyolipomas (rare) (mc in young/middle aged women)

Secondary
- metastases

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14
Q

MC solid renal tumor in kids <15?

A

Wilms tumor (nephroblastoma)

2/3 diagnosed before age 5

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15
Q

Kidneys affected w wilms tumor?

A

Its unilateral

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16
Q

Presentation of wilms tumor?

A 
Abd mass
Abd pain
Hematuria
Fever
HTN
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17
Q

PE for wilms tumor?

A

Mass

  • Firm
  • Non-tender
  • Smooth
  • doesnt cross midline
18
Q

When doing PE on wilms tumor?

A

Be gentle, you can rupture it and spread the cancer

19
Q

Labs for wilms tumor (nephroblastoma)

A

UA - hematuria
Renal funciton (BUN/CR, eGFR)
CBC - anemia
LFT - H if metastases

20
Q

Imaging for wilms (nephroblastoma)

A

US - mass
- get a CT/MRI

CXR/chest CT - look for pulm mass

21
Q

Type of CT for wilms tumor?

A

Unenhanced CT scan

22
Q

Wilms tumor tx?

A

Multimodal

  • surgery
  • radiation
  • chemo
23
Q

Prognosis for wilms tumor (nephroblastoma)?

A

5 yr - 90%

24
Q

Ureter and renal pelvis cancer is rare but more common in pts who?

A

Have bladder cancer
Smoke
Hx of analgesic abuse

25
Q

MC type of ureter/renal pelvis cancer?

A

Urothelial cell carcinoma

- mucosal surface of renal calyces or pelvis, ureters

26
Q

Presentation of ureter/renal pelvis cancer?

A

MC - hematuria

  • flank pain
  • Urine cytology pos
  • filling defect (CT)
27
Q

Tx of ureter/renal pelvis cancer?

A

Excision of lesion

28
Q

2nd MC urologic cancer?

A

Bladder cancer

29
Q

Who gets bladder cancer?

A

Men 3.1:1
73yo

98% are epithelial malignancy

30
Q

Essentials of diagnosis for bladder cancer?

A

Hematuria
Irritative voiding symptoms
Pos urine cytology
US, CT, MRI - masses

31
Q

Risk factors for bladder cancer

A 
Smoking
Industrial dyes/solvents
Schistosomiasis
Vesical calculi 
Prolonged catheter use
32
Q

PE for bladder cancer?

A

Usually Unremarkable

Large - abd mass

Metastatic - hepatomegaly/lymphadenopathy

Advanced - lower extremity lymphedema

33
Q

Bladder cancer labs?

A

UA

  • hematuria
  • pyruia
  • azotemia

Urine cytology
Exfoliated cells in urine
CBC - anemia

34
Q

Bladder cancer diagnosis?

A

Confirmed by cystoscopy and biopsy

US, MRI, CT

35
Q

Bladder cancer staging?

A

Ta, T1 - superficial
T2+ - invasive

Pic on slide 33

36
Q

Bladder cancer tx?

A

Ta, T1 - transurethral resection and intravesicular chemo

T2, T3 - radical cystectomy OR chemo + surgery/irridation

Muscle invasive urothelial cell carcinoma (T2+) - chemo prior to radical cystectomy

37
Q

What is intravesicular chemo?

A

Immunotherapeutic or chemotherapeutic agents delivered into bladder

  • reduced recurrence
38
Q

Initial tx for ALL bladder tumors?

A

Surgery - transurethral resection

39
Q

Explain radiotherapy (bladder cancer)

A

External beam radiotherpay - over 6-8 week period

Radiotherapy alone - recurrence is common
- combine w systemic chemo and it works much better

40
Q

Prognosis for bladder cancer?

A

Ta, TIS, T1 = 81% survival

T2, T3 = 5 yr 50-75% (w tx)

Metastatic - bad

41
Q

Any old person w hx of smoking (esp male) w painless hematuria?

A

Bladder cancer until proven other wise

42
Q

Hello, incontinence helpline?

A

Can you hold?

Senior - GU Test 1 (13 decks)

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