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Neph/Uro Cancers

Clinical Medicine II

What do we do when we find kidney cancer aka Hypernephroma, refer to urology
What is the MC type of kidney cancer renal cell carcinoma
What is a good agent to use on RCC antiangiogensis (highly vascular kidney, ↓ new vasculature→↓RCC)
What are some RF’s for RCC tobacco use, PKD, end stage renal dz, tuberous sclerosis
What is von Hippel-Lindau syndrome VHL is a gene on chrom 3: 33% develop RCC
What other tumors may be associated w/ RCC hemangioblastoma of spinal cord, cerebellum, retinal, neuro endocrine tumors, cysts of the epididymis and broad ligament in women
MC type of cancer and location clear cell carcinoma, bilateral and multifocal
Sxs triad of RCC Hematuria, abd/flank pain/mass. (10-20%)
Other sxs of RCC fever, wt loss, anemia, varicocele
Dx and evaluation of RCC CT scan of abd and pelvis, UA, urine cytology
Tx RCC radical nephrectomy: ipsilateral renal gland, regional lymph nodes, radiofrequency heat ablation or cryoablation
Do we use chemo and radiation on RCC chemo not effective for RCC, radiation for metastasis only
What are two newer therapies for advanced cancer sunitinib (tyrosine kinase inhibitor) and interleukin-2
How can we prevent kidney cancer smoking cessation, ↓ obesity, ↓ HTN, fam hx detection (VHL dz)
What is the MC primary malignant renal tumor of childhood Nephroblastoma (80% detected before 5yo)
Nephroblastoma Wilms tumor
What is a wilms tumor embryonal tumor that develops from fragments of immature kidney. CP: mass
What is WAGR syndrome wilms tumor, aniridia, genital anomalies, MR (DNTK for test)
What is Denys-Drash syndrome male pseudohermaphroditism, renal mesangial sclerosis, neroblastoma (DNTK for test)
Tx for Wilms surgery, transperitoneal radical nephrectomy, removal of tumor, Chemo?
RF’s of wilms AA’s lower in east Asians compared to north Americans
5 types of bladder cancer transitional cell, squamous cell, adenocarcinomas, lymphomas, melanomas
Where does transitional cell cancers come from 90% develops in bladder, 8% in renal pelvis, 2% ureter or urethra (MC types of transitional)
RF’s of bladder cancer >65yo, Men>Women, Caucasions>AA’s, (4th leading in men), smoking, chemicals/dyes, drugs, schistosoma haematobium (parasite from Africa)
What drugs are commonly found assocaiated w/ bladder cancer phenacetin, and chloranphazine
What is the clinical staging of cancer TNM, tumor, node, metastasis, Grades x-4. X: can’t be assessed 1: well differentiated 4, undifferentiated
Dx of bladder cancer hematuria, (frequency, urgency,): painless gross hematuria, must investigate (cystoscopy w/ biopsy)
Tx of bladder cancer (high grade) removal, Bacille Calmette-Guerin (BCG) chemo to eradicate residual dz (into bladder) weekly for 6m, then monthly or every 3m, subQ interferon w/ failed BCG, Radiation (limited),
When to we use cystectomy when muscle is involved, and/or other therapies have failed, gold std for invasive dz (Mets)
Tx of testicular cancer surgery, radiotherapy, chemo (teach male self exams)
RF for testicular cancer cryptorchidism, decreased if orchiopexy prior to puberty
What are Genetic assocaiations for Testicular cancer klienfelders, downs, hermaphrodites, androgen insensitivity (testicular feminization), Mullerian syndrome, cutaneous ichthyosis
Sxs of testicular cancer Painless swelling, enlargement and mass of the testis, heavy in scrotum, abd ache
When would we have pain w/ testicular cancer torsion or ischemia d/t tumor
What is a sign of metastatic dz L supraclavicular nodal involvement
Dx of testicular cancer US, chest radiography (metastasis), CT, MRI if CNS involvement
MC type of testicular cancer seminoma
If a testicular mass is found what lab tests should we order alpha-fetoprotein, and B subunit of hCG
Infx/inflammation of testes orchitis
Pain on groin, scrotum, edema, redness, fever epididymitis
Acute sxs of painful, elarge testes testicular torsion
Engorgement of veins in scrotum varicocele
Abd accumulation of fluid in scrotum ant of testes hydrocele
Tx of testicular cancer radical inguinal orchiectomy, lympadectomy if mets found/suspected, Chemo: high grade,
When do we use radiation seminomas to lymphatic drainage of the testes
Prevention of TC self exam at teens, 3yrs >20 1yrs >40
Most frequent diagnosed cancer other than skin prostate cancer, 2nd MC death to lung cancer
Why has diagnosis ↑ (3) ↑ screening, and techniques, ↑elderly population
Mets of prostate cancer bones, pelvis, axial skeleton, lymph nodes, lungs, liver, bladder, adrenal glands
CP of prostate cancer PSA (can ↑ w/ prostatis), urinary sxs
Dx of prostate cancer Dig rectal exam, PSA, US w/ biopsy to confirm dx, bone scan and CT for mets
MC types of prostate cancer adenocarcinoma
What is another type of cancer scoring Gleason score, 2-10, differentiation scores
Tx PC radical prostatectomy, cryosurgery, radiation: older men or not surgical canidates, hormonal tx, orchiectomy,
What are some hormonal txs of PC Leutinizing hormone, and antiandrogenic (↓testosterone: feeds tumor cells)
When do we use chemo metastatic dz where hormonal tx is refractory
Prevention for PC none currently (dietary? Screening?)
Created by: becker15
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