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Neph/Uro Cancers
Clinical Medicine II
| Question | Answer |
|---|---|
| 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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