Urological Cancers/KSW

  1. Label:
    Image Upload 2
    • 1.renal cortex
    • 2. fibrous capsule
    • 3. minor calyces
    • 4. blood vessels entering renal perenchyma
    • 5. renal sinus
    • 6. major calyces
    • 7. renal pelvis
    • 8. fat in renal sinus
    • 9. minor calyces
    • 10. ureter
    • 11. base of renal pyramid
    • 12. medullary rays
    • 13. renal column(of Bertin)
    • 14. renal papilla
    • 15. renal medulla(renal pyramid)
  2. Label:
    Image Upload 4
    • 1.median umbilical ligament
    • 2. transitional epithelium
    • 3. lamina propria
    • 4. submucosa(2&3)
    • 5. detrusor muscle
    • 6.adventitia
    • 7. external urethral sphincter
    • 8.internal urethral sphincter
    • 9. neck of urinary bladder
    • 10. trigone
    • 11.ureteral opening
    • 12.detrusor muscle
    • 13. peritoneum
    • 14. ureter
  3. What are the parts of the urinary system and what are their functions?
    • 1)Kidneys(primary organ or urinary system)
    • lie on either side of body at level T12-L3
    • left kidney slightly higher(liver on right)
    • function: 1)excretion of bodily wastes such as water, urea, and uric acid 2)disposal of excess water and salts  3)regulation of ph of blood and body fluids
    • 2)Ureters-transposts urine away from the kidneys
    • 3)Urinary Bladder- stores urine
    • 4)Urethra-a tube that transports urine from the bladder to outside the body
  4. What are the primary organs of the urinary system?
    the kidneys
  5. What are the three functions of the kidneys?
    • 1)excretion of bodily wastes such as water, urea and uric acid
    • 2)disposal of excess water and salts
    • 3)regulation of ph of blood and body fluids
  6. Where do the kidneys lie anatomically?
    The kidneys lie on either side of the vertebral body at about the level of T12-L3. The kidneys are positioned retroperitoneally, which means behind the parietal peritoneum and against the deep muscles of the back. The right kidney is lower because of the liver.
  7. Bladder Cancer peaks at age ___.
  8. Bladder cancer affects (men/women?) ______times more than (men/women?).
    men ,4, women
  9.  Important prognostic factors for bladder cancer are:
    • 1)Tumor extent and depth of muscle invasion
    • 2)Tumor morphology: papillary tumors are usually low grade and superficial. 
    • Infiltrating lesions tend to be high grade, sessile(fixed), and nodular
  10. The areas of the bladder that cancer is likely to occur are:

    • 1)trigone
    • 2)posterior/ lateral walls
    • 3) neck of the bladder
  11. The žmost common tumor of urinary tract:
  12. Etiology of bladder cancer includes:
    • 1)žDye, rubber, textile, leather, pain working
    • 2)Chronic bladder infections
    • 3)Smoking
    • 4)Previous pelvic irradiation
    • 5)Pesticide exposure
    • 6)Contaminated water supply
  13. Clinical presentation of bladder cancer:
    • 1)Gross painless hematuria(Blood in the urine that can be seen with the naked eye)-THIS IS HOW MY DAD'S WAS DISCOVERED-TINY LITTLE RED DOTS IN HIS URINE
    • 2)Urinary tract infection
    • 3)Clotting and urinary retention may occur
    • 4)žFrequency, urgency, dysuria, and hematuria
  14. Detection and diagnoses of bladder cancer is done with:
    • 1)žHistory and physical
    • 2)Transurethral biopsy of the bladder (TURB)
    • 3)žChest xray
    • 4)žUrinalysis
    • 5)žComplete blood work
    • 6)Liver function test
    • 7)Cystoscopic evaluation
    • 8)CT/žMRI
  15. Most bladder cancers are epithelial(98%):  92% of which are ____________. 7% are_________.
    2% are ____________.
    • transitional cell
    • squamous cell(–Patients who have had chronic irritation from catheters)
    • adenocarcinomas
  16. Bladder cancer morphologies include:
    • 1)Papillary(finger-like projections) -most common LEAST AGGRESSIVE
    • 2)Papillary infiltrating(agressive)
    • 3)Solid infiltrating(agressive)
    • 4)Nonpapillary or carcinoma in situ (agressive)-
  17. *Most bladder cancers are a type of malignancy called ___________, and are discovered in the early stages of the disease when it is superficial and has not penetrated deeply into the wall of the bladder. This form of bladder cancer has a limited capacity to spread
    through the bladder wall to other organs, and is highly treatable but often recurs locally within the bladder.
    transitional cell carcinoma
  18. Where does bladder cancer spread to?
    • lung
    • bone
    • liver
  19. Lymphatic drainage for the bladder:
    • External iliacs
    • Internal iliacs
    • presacral nodes
  20. Staging of bladder cancer if done by:
    the depth of invasion into the bladder wall
  21. Low grade bladder tumors are:
    papillary(NON infiltrating)
  22. High grade bladder tumors are:
    infiltrating lesions
  23. Bladder cancer spread is through:
    • direct extension
    • perineural(Near a nerve or nerves)
    • lymphatic
    • blood vessels
  24. When bladder cancer spreads by direct extension it spreads
  25. ___________%  of bladder cancers are superficial at diagnosis.
  26. After the bladder cancer has invaded the muscle, it spreads through:
    • perinueral
    • lymphatic
    • blood vessels
  27. Treatment for bladder ca staged at Ta and T1:
    • Transurethral resection and fulguration or radical
    • cystectomy.  Intravesical immunotherapy
    • chemotherapy is added
  28. Treatment for carcinoma in situ(cis) is________,  but
    for lesions that don’t involve bladder neck, prostatic urethra, or ureters treatment consists of_________.
    • Surgery(radical cystectomy)
    • electrofulguration followed by intravesicle chemotherapy orbacillus Calmette-Guerin (bCG)
  29. Bladder cancer Tis,Ta, T1 failures are treatment with:
    radical cystectomy for salvage
  30. Bladder cancer T2,T3, and T4a can treated with:
    radical cystectomy

    • *ALSO Tis, Ta, T1 failures are treatment with radical
    • cystectomy for salvage
  31. For bladder cancer,radiation therapy can be used____and save surgery for ____.
    initially, salvage
  32. For  bladder cancer, chemotherapy:_______________________.
    tumor.  Drugs include:______________________________
    • is used with RT to sensitize the local
    • methotrexate, cisplatin, and vinblastine
  33. RT portals for bladder cancer
    should include:
    entire bladder and tumor volume, prostate and prostatic urethra,and pelvic lymph nodes
  34. Radiation therapy 4 field box borders for bladder cancer are:
    • Top border – L5/Si
    • –Bottom border – 1 cm
    • below obturator foramen
    • –Width – 1.5 cm beyond
    • bony pelvis
    • –Anterior – encompass
    • the entire bladder
    • –Posterior – encompass
    • the entire bladder
  35. Radiation therapy dose for bladder cancer is:
    •  Large pelvic field 45-50Gy Boost fields15-20Gy
    • (Total: 60-70 Gy)
  36. Position for RT for bladder cancer:
    • ž1)Supine with hands folded on abdomen
    • 2)žBladder volume should be consistent so instruct patient to empty bladder before treatment-treat bladder cancer when the bladder is empty but boost it when it is full
    • 3)Immobilization for the lower extremities with alpha cradle, vac lock, simple block, and velcro feet
  37. Side effects of radiation therapy for bladder cancer include:
    • 1)cystitis,
    • 2)proctitis
    • 3)diarrhea
    • 4)žDecreased blood counts
  38. 5 year survival for superficial disease is_____.  Disease invading the muscle is ____.
    • 85-90%
    • 60%
  39. žRenal Cell Carcinoma peak age is ____
    with male-to-female ratio ____.
    • 55-60
    • 2:1
  40. Etiology for renal cell carcinoma:

    • 1)žEnvironmental, occupational, hormonal, cellular, andgenetic factors
    • 2)žDiabetes
    • 3)Hypertension
    • 4)Cigarette and tobacco use
    • 5)Obesity
    • 6)žAnalgesic abuse
    • 7)žAsbestos
    • 8)žVon hippel-Lindau disease(rare, genetic disease that causes tumors and cysts to grow in your body)
  41. Etiology for Renal Pelvic and Ureteral Carcinoma:
    • 1)Urban residency
    • 2)Cigarette and tobacco use
    • 3)Aminophenol exposure
    • 4)Renal stones
    • 5)Analgesics
  42. Renal Pelvic and Ureteral Carcinoma: what is the men to womwn ratio?
    Men versus women in 3:1
  43. Peak incidence for Renal Pelvic and Ureteral Carcinoma is___________.
    50-60 years of age
  44. Prognostic Indicators for renal cell cancer:
    • 1)Stage and histologic grade
    • 2)Lymph node involvement

    *same as Renal Pelvic and Ureteral Carcinoma:
  45. Prognostic Indicators for Renal Pelvic and Ureteral Carcinoma:
    • 1)Stage and histologic grade
    • 2)Lymph node involvement

    *Same as renal cell cancer
  46. Lymphatic drainage from kidneys:
    • Paraaortic(1-4) and paracaval(5-7) nodes
    • Image Upload 6
    • Left Lumbar Lymph Nodes (Paraaortic Lymph Nodes)
    • 1. Lateral aortic
    • 2. Preaortic
    • 3. Postaortic
    • 4. Intermediate Lumbar
    • *Para aortic means surrounding the aorta
    • Rt Lumbar Lymph Nodes (Paracaval Lymph Nodes)
    • 5. Lateral caval
    • 6. Precaval
    • 7. Postcaval
    • *Para Caval means surrounding the vena cava
  47. žLymphatic drainage from ureters:
    • Paraaortic, paracaval-    (same as kidney) &
    • common iliac,internal iliac, and external iliac nodes-
    • (all the iliacs)
    • ž*Lymphatic drainage from ureters is the same as the kidneys-PARAAORTIC, PARACAVAL, & ALL OF THE ILIACS
    • Image Upload 8
    • 1)para aortic lymph nodes
    • 2)right common iliac lymph nodes
    • 3)right common iliac lymph nodes
    • 4)right external iliac lymph nodes
    • 5)right internal iliac lymph nodes
    • 6)left external iliac lymph nodes
    • 7)left internal lymph nodes
  48. Clinical presentation of renal cell cancer:
    • 1)Occult primary tumor
    • 2)Gross hematuria
    • 3)Abdominal mass
    • 4)Pain
    • 5)Weight loss
    • 6)Fatigue
    • 7)Fever
  49. Clinical presentation of žRenal pelvic and ureteral carcinoma:
    • 1)Gross or microscopic hematuria
    • 2)Pain
    • 3)Bladder irritation
  50. Detection and diagnoses of renal cell, renal pelic and ureteral cancers:
    • 1)History and physical
    • 2)CT
    • 3)Pet/CT
    • 4)MRI
    • 5)žBone scan
    • 6)žCystoscopy
    • 7)žBlood chemistry
    • 8)žUrine cytology
  51. The tissue of origin for renal cell carcinoma is ______ The most common type of renal cell carcinoma is ____________.
    • Epithelium
    • Clear cell carcinoma
  52. Pathology of Renal Pelvis and Ureteral cancer is:
    • 1)Transitional cell 90%
    • 2)Squamous cell 7%
  53. Staging of renal and ureretal cancers
    (TNM) is based on:
    extent through the layers of the kidney or pelvis
  54. 5 year survival for renal cancers:
    • 5 year survival:
    • Stage 1-88%
    • Stage II-67%,
    • StageIII-40%
    • Stage IV-2%
  55. Renal cell routes of spread:
    • 1)Local infiltration through the renal capsule
    • 2)Direct extension in the venous channels
    • 3)Retrograde venous drainage to the testis
    • 3)Lymphatic drainage to the renal hilar, paraaortic, and paracaval nodes
    • 4)Hematogenous route to lung, liver, CNS, and bone
  56. žRenal Pelvis and Ureteral Carcinoma routes of spread:
    • 1)Multifocal
    • 2)Direct extension, blood, and lymphatics
  57. Treatment Techniques for renal cell cancer:
    • 1)T1 and T2radical nephrectomy
    • 2)Definitive radiotherapy is limited due to low tolerance doses in the upper abdomen.  Usually considered palliative
    • 3)Chemotherapy
    • 4)Immunotherapy – interferon and interleukin
  58. Treatment Techniques for Renal Pelvis and Ureteral Carcinoma:
    • 1)Nephroureterectomy with the excision of a cuff of bladder and bladder mucosa
    • 2)Chemotherapy- methotrexate, vinblastine, doxorubicin,and cisplatin
  59. Radiation therapy for renal cell carcinoma:
    • 1)Post-Op or for recurrence following surgery
    • 2)Treatment volume includes renal fossa, and paraaortics
    • 3)Doses 4500-5500 cGy
    • 4)IMRT, AP/PA, or wedge pair.–Spare as much bowel
    • as possible
  60. Radiation therapy for Renal Pelvis and Ureteral Carcinoma:
    • 1)Post-Op
    • 2)Treatment volume involves renal fossa, ureteral bed and ipsilateral bladder trigone
    • 3)Doses 5040 with 540 boost
  61. Side effects to RT for renal cancers:
    • 1)N and V
    • 2)žDiarrhea
    • 3)žAbdominal cramping
    • 4)Bowel obstruction

  62. Describe the classic triad of kidney cancer and state what stage they are associated.
    • The classic triad is hematuria
    • (blood in the urine), flank pain and an abdominal mass.
    • This triad only occurs in 10-15% of cases, and is generally indicative of more advanced
    • disease.
    • Today, the majority of renal tumors are asymptomatic and are detected incidentally on imaging, usually for an unrelated cause.
  63. What is the most common type of kidney
    Renal Cell Carcinoma (RCC) is the most common type of kidney cancer, accounting for approximately 85% of all malignant kidney tumors.

    • In RCC, cancerous (malignant) cells develop in the lining of the kidney tubules
  64. State the frequency of adult kidney tumors and state which age they most often occur?
    Overall, the lifetime risk for developing kidney cancer is about 1 in 63 (1.6%)

    • Renal cell carcinoma-Peak Age is 55-60 with male-to-female ratio 2:1
    • Renal Pelvic and Ureteral Carcinoma -Peak age 50-60 years of agemale-to-female ratio 3:1  
  65. What are the possible etiologic agents for kidney tumors?
    • žDiabetes
    • žHypertension
    • žCigarette and tobacco use
    • žObesity
    • žAnalgesic abuse
    • žAsbestos
    • žVon hippel-Lindau disease
    • Urban residency
    • Aminophenol exposure
    • Renal stones
  66. Where do most kidney tumors arise?
    The proximal tubular epithelium is the tissue of origin for renal cell carcinoma. Clear cell carcinoma is the predominant subtype
  67. What is the percentage of tumors arising
    in the renal pelvis? State the most common type of tumor found here.
    • About 7% of renal  neoplasms are
    • transitional cell carcinoma(which are renal pelvis cancers)
  68. What is the most common presenting symptom of kidney cancer?
    gross hematuria
  69. Whay is the treatment of choice for renal cell cancer?
    • surgery:radical
    • nephrectomy

    Once the disease has metastasized, obviously surgery is not effective(T3 and up)
  70. What is the role of XRT in the treatment
    of kidney cancers?
    Post op or for reccurance following surgery
  71. What is the max dose that can be given
    to both kidneys without causing acute radiation nephritis?
    23 Gy
  72. Discuss where the filtration of the blood   for  the  production  of  urine  occurs.
  73. State where  reabsorption  of  useful  substance in the  filtrate  occurs.
    in the renal tubules and collecting ducts
  74. Discuss  how  urine  volume  is regulated.
    • Urine volume is regulated primarily by ADH. 
    • When blood volume decreases, the concentration of salts increases; this change is sensed by the hypothalamus, which in turn stimulates the posterior lobe of the pituitary to release ADH. ADH travels to the collecting ducts where the ADH makes the walls permeable to water.  Consequently, more water is reabsorbed into the bloodstream instead of being excreted, and urine
    • volume decreases.

    Image Upload 10
  75. Track the flow of urine from the glomerulus to outside the  body.
    • 1)Glomerulus
    • 2)Bowman's  Capsule
    • 3)Proximal  convoluted  tubule
    • 4)Loop  of  Henle
    • 5)Distal  convoluted  tubule
    • 6)Collecting  duct
    • 7)Minor  calycx
    • 8)Major  calycx
    • 9)Renal  pelvis
    • 10)Uteters
    • 11)Bladder
    • 12)Urethra
  76. Describe  the  inner  most  layer  of  the  bladder.
    • It is Transitional epithelium (also known as ca found in the urinary tract, especially around the urinary bladder
    • The most common kind(92%) of bladder cancer is transitional cell carcinoma which starts in the transitional epithelium.
  77. Describe  the  anatomic  location  of the  bladder.
    It is located in the pelvic cavity behind the pubic symphysis, in the male it lies against the rectum posteriorly, in the female it contacts the anterior walls of the uterus and the vagina.
  78. Discuss  diagnostic  procedures  used  to  detect  
    kidney  cancers.
    • žHistory and physical
    • žCT
    • žPet/CT
    • žMRI
    • žBone scan(bone mets)
    • žCystoscopy
    • žBlood chemistry
    • žUrine cytology
  79. Discuss the  patterns  of  spread  for  kidney  tumors.
    • žRenal Cell
    • •Local infiltration through the renal capsule
    • •Direct extension in the venous channels
    • •Retrograde venous drainage to the testis
    • Lymphatic drainage to the renal hilar, paraaortic, and paracaval nodes
    • Hematogenous route to lung, liver, CNS, and bone

    • žRenal Pelvis and Ureteral Carcinoma
    • Multifocal
    • •Direct extension, blood, and lymphatics
  80. LABEL:
    IImage Upload 12
    • 1)pyramid(medulla)
    • 2)renal cortex
    • 3)medulla
    • 4)fat pad
    • 5)renal rcapsule
    • 6)ureter
    • 7)renal pelvis
    • 8)renal vein
    • 9)renal artery
    • 10)calycs
  81. What is a transurethral resection(TUR) and when is it used?
    • Transurethral resection (TUR) of the bladder is a surgical procedure that is used both to diagnose
    • bladder cancer and to remove cancerous tissue from the
    • bladder. This procedure is also called a TURBT (transurethral resection for bladder tumor).
    • General anesthesia or spinal anesthesia is usually
    • used. During TUR surgery, a cystoscope is passed into the bladder through the urethra. A tool called a resectoscope is used to remove the cancer for biopsy and to burn away any remaining cancer cells.
Card Set
Urological Cancers/KSW
Urological Cancers/KSW