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What age does bladder cancer peak?
70
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Which gender does bladder cancer affect the most
men 4xmore
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What are important prognostic factors for bladder ca
Tumor extent/depth of muscle invasion
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Why is tumor morphology important in bladder ca
because papilary tumors are usually low grade and superficial and infiltrating lesions tend to be high grade, sessile (attached), and nodular.
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In bladder ca, what are tumors that are usually low grade and superficial
papillary
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In bladder ca, what tumors are usually high grade, sessile, and nodular
infiltrating lesions
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Where does bladder ca typically occur
trigone posterior/lateral walls or neck of the bladder
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What is the most common tumor of the urinary tract
bladder
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What are etiology effects for bladder ca
- dye, rubber, textile, leather working
- chronic bladder infections
- smoking
- previous pelvic rad
- pesticide exposure
- contaminated water
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What are some clinical presentations for bladder ca
- gross, painless hematuria
- urinary tract infection
- clotting and urinary retention
- frequency, urgency, dysuria, and hematuria
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How is bladder ca detected and diagnosed
- history and physical
- TURB-transurethral biopsy
- chest xray
- urinalysis
- complete blood work
- liver function test
- cystoscopic evaluation
- CT/MRI
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What pathology are most bladder tumors
- 98% epithelial
- 92% transitional
- 7% squamous- chronic irritation from catheters
- 2% adenocarcinoma
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What are the 4 morphology of bladder tumors
- #1 papillary
- papillary infiltrating
- solid infiltrating
- nonpapillary or carcinoma insitu
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For bladder ca, what is staging based on
depth of invasion thru the bladder wall
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What ways can bladder ca spread
- direct extension
- perineural
- lymphatic
- blood vessels
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When bladder ca spreads via direct extension, it can spread ___ and ____ to ____ are superficial at diagnosis
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What invasions are common in bladder ca after the tumor has invaded the muscle
- perinueral
- lymphatic
- blood vessels
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With bladder ca, how does lymphatic drainage occur
- External iliacs
- Internal iliacs
- presacral nodes
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What are the distant mets for bladder ca
-
What is the treatment technique for bladder carcinoma in situ when the bladder neck, prostatic urethra, and ureters are involved?
suregery (radical cystectomy)
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What is the treatment technique for bladder carcinoma in situ when the bladder neck, prostatic urethra and ureters are not involved
electrofulguration followed by chemo or bCG bacillus Calmette-Guerin
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What is the treatment for bladder ca staged at Ta and T1
- Transurethral resection and fulguration or radical cystectomy
- Intravesical immunotherapy
- chemo is added
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How are Tis, Ta, T1 failures treated in bladder
Radical cystectomy for salvage
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For bladder ca, how are T2,T3, and T4 treated
Radical cystectomy
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For bladder ca,what can be used initially and save surgery for salvage
Rad Therapy
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Why is chemo used with XRT for bladder Ca and which chemo drugs are used
- To sensitize the local tumor
- methotrexate
- cisplatin
- vinblastine
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For bladder ca, what should portals include
- entire bladder
- tumor volume
- prostate and prostatic urethra
- pelvic lymphnodes
-
What field and dose of radiation do you use for bladder
Large pelvic field 45-50 Gy boost fields 15-20Gy
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Should the patient have a full bladder or empty bladder when receiving radiation
empty, only treat full when boosting
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How should you position a patient for bladder ca treatment
- Supine with hands folded on abdoment
- empty bladder
- imobilize lower extremities
-
What can you use to immobilize the lower extremeties
- alpha cradle
- vac lock
- simple block
- velcro feet
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What are side effects for XRT of bladder
- cystitis
- proctitis
- Diarrhea
- decrease blood counts
-
What is the 5 year survival rate for bladder ca is superficial
85-90%
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What is the 5 year survival rate for bladder ca if the disease has invaded the muscle
60%
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What is the peak age for renal cell carcinoma
55-60
-
List the etiology factors for renal cell carcinoma
- envriomental
- occupational
- hormonal
- cellular
- genetic
- diabetes hypertension
- cigarettes
- obesity
- anagelsic abuse
- asbestos
- vonhippel-landeau disease
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Which gender is most likely to get renal pelvis and uretal cancer?
men 3:1
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What is the peak age for renal pelvic and uretal cancer
50-60
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What are etiology factors for renal pelvic and uretal cancer
- urban
- tobacco
- aminophenol exposure
- renal stones
- analgesics
-
What are prognostic indicators for renal cell carcinoma
- stage and histologic
- lymph node involvement
-
What are prognostic indicators for renal pelvic and uretal carcinoma
- stage and grade
- lymph node involvement
-
Where is the lymphatic drainage from the kidneys
- paraaortic
- paracaval nodes
-
What is the lymphatic drainage from the ureters
- paraaortic
- paracaval
- common iliac
- internal iliac
- external iliac
-
What are the clinical presentations for renal cell
- occult primary tumor
- gross hematuria
- abdominal mass
- pain
- weight loss
- fatigue
- fever
-
What are clinical presentations for renal pelvic and uretal cancer
- gross or micro hematuria
- pain
- bladder irritation
-
How do you detect and diagnose renal cell, renal pevlic, and ureteral ca
- history and physical
- CT/MRI
- PET
- bone scan
- cystoscopy
- blood chemisty
- urine cytology
-
What is the pathology for renal cell carcinoma
- epithelium is tissue of origin
- clear cell carcinoma
-
What is the pathology for renal pelvis and ureter
- Transitional 90%
- Squamous 7%
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What is the staging and how is it based for kidneys and pelvis
TNM-based on extent thru the layers of the kidney or pelvis
-
What is the 5 year survival rate for kidney and pelvis ca for state I,II,III,IV
-
What is the route of spread for renal ca
- Local infiltration thru the renal capsule
- direct extension thru the venous channels
- retrograde venouse drainage to the testis
- Lymphatic drainage to renal hilar, paraaortic, and paracaval
- hemtogenouse route to lung, liver, CNS, and bone
-
What is the route of spread for renal pelvis and ureteral carcinoma
- multifocal
- direct extension
- blood
- lymphatics
-
What are treatment techniques for renal cell
- T1 and T2 radical nephrectomy
- definitive RT is usually only palliative due to upper abdomen's low tolerance dose
- chemo
- immunotherapy-interferon and interleukin
-
What are the treatment techniques for renal pelvis and ureteral carcinoma
- nephrourectomy with excision of a cuff of bladder and bladder mucosa
- Chemo- methotrexae, cisplatin, vinblastine, doxorubicin
-
What are the doses for renal cell carcinoma
4500-5500 cGy
-
What are XRT dose to you use for renal pelvic and ureteral ca
5040 cGy and 540 cGy boost
-
What are side effects for renal cell, renal pelvic, and ureteral ca
- N&V
- diarrhea
- abdominla cramps
- bowel obstruction
-
What are the parts of the urinary system
- pair of kidneys
- pair of ureters
- bladder
- urethra
-
What do the kidneys do
- Excretion of metabolic waste such as water, urea, & uric acid
- Disposal of excess water and salts
- Regulation of pH of blood and body fluids
-
What do the ureters do
Transport urine away from the kidneys
-
What does the bladder do
Stores urine
-
What does the urethra do
Carries urine from the bladder to the outside of the body
-
What are the primary organs of the urinary system
kidneys
-
What are vital in maintaining homeostasis
kidneys
-
Where do the kidneys lie
- On either side of the vetebral body at about the level of T12-L3
- Left kidney is usually higher
- They are positioned retreperitoneally, which is behind the parietal peritoneum and against the deep muscles of the back
-
What holds the kidneys in place
- Connective tissue (renal fascil) and
- adipose tissue
-
Each kidney receives blood from a ____ and is drained by a ____
-
What connects with the kidney at its hilus
- ureters and
- blood vessels
-
What covers the kidney
A strong capsule of connective tissue (renal capsule)
-
The superiror end of the ureter is expanded to forma a funnel shaped part called the
Renal Pelvis
-
The pelvis is divided up into 2-3 tubes called the ____ and they in turn are divided into 8-14_____
- major calyces
- minor calyces
-
The kidney consists of an outer ___ and an inner ____
- renal cortex
- renal medulla
-
The renal medulla is composed of conical masses of tissue called
renal pyramids
-
The ____ forms a shell around the medulla
renal cortex
-
Each kidney contains more than a million microscopic units called _____
Nephrons
-
What are the functional units of the kidneys
nephrons
-
The nephrons consist of 2 main structures
- renal corpuscle
- renal tubule
-
Blood is filetered in the ____: the filtered fluid then passes thru the ____
- renal corpuscle
- renal tubule
-
A renal corpuscle is composed of a tangled cluster of blood capillaries called a ____, and a thin walled sac-like structure called ____, that surrounds the _____
- glomerulus
- Bowman's capsule
- glomerulus
-
Blood flows into the glomerulus through a/an
efferent arteriole
-
What is an expansion at the closed end of a renal tubule
Bowman's capsule
-
The ___ leads away from the Bowman's capsule and becomes highly coiled and this portion is called the
- Renal tubule
- proximal convoluted tubule
-
The Proximal tubule dips toward the
renal pelvis
-
After passing thru the proximal convoluted tubule, filtrate flows into the ____ and then into the distal convoluted tubule
loops of Henle
-
Urine from the DCT (distal convoluted tubuel) of several nephrons drain into a ____, which in turn passes into the ____ and into a ____
- collecting duct
- renal medulla
- minor calyx
-
What are located in the renal cortex
- renal corpuscle
- PCT
- DCT of each nephron
-
The renal corpuscle, the PCT, and the DCT of each nephron are located within the
renal cortex
-
Loops of Henle dip down into the
Medulla
-
What are the primary function of the nephrons
Removal of waste substances from the blood and regulation of water and electrolyte concentrations within the bodily fluids
-
After the nephrons perform their functions, the end result is
urine
-
What is excreted out of urine outside of the body
- excess water
- waste
- excess electrolytes
-
Urine formation involves
- Filtration into the renal tubules of various substances from the plasma within the glomerulus capillaries
- Reabsorption of needed substances byt the renal tubules and collecting ducts
-
Dehydration does not usually occur because about ____ of the filtrate is returned to the blood leaving only about ____ to be excreeted as urine
-
While glomerulus filtration is ____ process (usueful substances are filtered as well as waster), tubular reabsorption is a ____ process
- not a selective
- highly selective
-
By maintaining ____, the body maintains a steady volume and composition of blood
urine volume
-
Secretion of water by the kidneys is regulated by what
-
Where is ADH secreted
by the posterior lobe of the pituitary gland
-
ADH serves as a chemical messenger carrying information from the ____ to the ___ and ____ of the kidneys
-
How is salt regulated and excreted
- regulated by hormones, mainly aldosterone
- secreeted by adrenal glands
-
What increase urine volume by inhibiting reabsorption of water
chemicals called diuretics
-
Give examples of diuretics
coffee, tea, alcohol
-
Once urine is formed, it passes from ____ and enters ____
the collecting ducts through openings in the renal papillae and enters the major and minor calyces of the kidney
-
Once urine is in the major and minor calyces of the kidney, it passes through the _____ and is conveyed by a ____ to the urinary bladder
-
What is the process of emptying the bladder and expelling urine referred to
urination or micturation
-
When the volume in the bladder reaches about ____ ml, special nerve endings (stretch receptors) in the bladder wall are stimulated
300
-
What is a hollow, distensible muscular organ
urinary bladder
-
Where is the bladder located
in the pelvi cavity behind the pubic symphysis
-
Where does the bladder lie in a male
against the rectum posteriorly
-
Where does the bladder lie in a female
it contacts the anterior walls of the uterus and vagina
-
The internal floor of the bladder consists of a triangular area called the ____, which has an opening at each of its 3 angles
trigone
-
Poesteriorly, at the base of the trigone are the openings of the
ureters
-
The internal uretheral orifice, which opens into the ____, is located anteriorly at the apex of the trigone
urethra
-
How many layers does the bladder consist of
4
-
The inner layer of the bladder, or mucous coat, includes several thicknesses of epithelial cells called
transitional epithelium
-
The transitional epithelium in the bladder adapts to changes in tension and thickness as your bladder expands and contracts, in distension it may be ____ thick and in contraction it may be ____ thick
-
Track urine production start to finish
- affernt arteriole
- glomerulus
- bowman's capsule
- PCT
- loop of Henle
- DCT
- collecting duct
- minor calyx
- major calyx
- renal pelvis
- ureters
- bladder urethra
- I remember this as
- A Girls Bladder Pees Little Dark Colored Material More Regularly Until Bladder Upchucks
-
What is the classic triad of kidney ca and what stage
- hematuria
- flank pain
- abdominal mass
- usually well advanced statge of ca once you notice the above symptoms
-
What is the best treatment choice for renal cell ca
surgery
-
What is the most common symptom of bladder ca
Hematuria
-
Where in the bladder is the most common place to get bladder ca
trigone
-
Renal cell or Renal cortex cancer is called
clear cell carcinoma
-
Renal pelvic/ureteral cancer is called
Transitional
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