Flashcards in 05b: Urinary tract/Kidney Deck (46):
1
Most common presenting feature of genitourinary tract cancer
Hematuria
2
The vast majority of renal tumors in adults prove to be (X), (benign/malignant) tumors.
X = clear cell renal tumors (80%)
Malignant
3
T/F: Autosomal dominant polycystic kidney disease (ADPKD) does not increase risk of renal cancer.
True
4
T/F: Renal cancer accounts for under 3% of all malignancies in adults.
True (2.6%)
5
T/F: Cancer of renal pelvis arises from renal epithelium and accounts for 40% of renal cancers.
False - considered urothelial (transitional cell) cancer and accounts for 5% of renal cancers
6
Genetic disorders that increase irsk of CCRC carcinoma:
1. von Hippel-Lindau disease
2. Familial chromosome 3 translocations
3. Tuberous sclerosis
7
Non-genetic diseases/factors that increase irsk of CCRC carcinoma:
1. ESRD (acquired cystic kidney disease)
2. Smoking (2-4x risk)
3. Heavy metal exposure (2-4x risk)
8
CCRC carcinoma: cells of origin?
Prob proximal tubule
9
CCRC carcinoma: cells are filled with (X) and express high levels of (Y) growth factor.
X = lipid (high glycogen content)
Y = VEGF (highly vascular)
10
Classic triad of CCRC:
1. Flank pain
2. Hematuria
3. Abdominal mass
**found in less than 10% of cases! So many various Sx presentation
11
The "internist's tumor"
CCRC (due to wide breadth of paraneoplastic features/Sx)
12
CCRC carcinoma: most effective therapy
Nephrectomy
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CCRC carcinoma: 5y survival if disease confined in renal capsule is (X)%.
X = 90
14
CCRC carcinoma: 5y survival if disease invades renal capsule but has not spread past (X) is (Y)%.
X = Gerota's fascia
Y = 60
Stage III
15
CCRC carcinoma: 5y survival if disease spreads beyond Gerota's fascia is (X)%
X = 10%
Locally invasive - Stage IV
16
(X) renal cell cancers may undergo spontaneous remission. Which characteristic of this cancer may account for this?
X = CCRC carcinoma
This carcinoma may be relatively responsive to chances in host immunity
17
T/F: Renal cancer responds poorly to conventional cytotoxic chemotherapy and radiation therapy.
True
18
T/F: Renal cancer that responds to chemo "completely" implies the patient has been cured.
False! Indicates disappearance of radiographic evidence of tumor, but relapses may occur
19
CCRC carcinoma: 5y survival if disease spread to renal vein is (Y)%.
Y = 60%
Stage IIIA
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CCRC carcinoma: 5y survival if disease spread to one lymph node is (Y)%.
X = 20%
Stage IIIB
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Von Hippel-Lindau (VHL) disease: most common cause of death
CCRC carcinoma
22
Major renal cancer cell gene in adults:
VHL (tumor suppressor)
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Von Hippel-Lindau (VHL) disease: inheritance pattern
AD
24
VHL protein function
Down-regulates hypoxia-induced genes by targeting HIF-alpha (TF) for destruction
25
Renal cancer: VHL loss results in overexpression of which key factors?
1. VEGF
2. PDGF-beta
3. TGF-beta
Angiogenic factors!
26
Renal cancer: VHL loss allows cancer cell to form cooperative relationship with (X)
X = neighboring endothelial cell (gives it oxygen, nutrients via neovascularization)
27
T/F: loss of second VHL allele results in renal cancer
False -forms cyst that (with additional mutations)can become cancer
28
(X) renal tumors are small (<5mm), present in (cortex/medulla) as pale yellow nodule with papillary growth pattern. If larger than (Y) size, they're re-classified as...
X = renal papillary adenoma
Cortex
Y = 3 cm
RCC (due to malignant potential)
29
List some tyrosine kinase inhibitor targets for RCC
VEGF-R
PDGF-R
30
List the urothelial tumor cell types and star the most common
1. Transitional cell* (95%)
2. Squamous Cell
3. Adenocarcinoma
31
Bladder cancer: (X) is the major risk factor and is responsible for (Y)% of cases
X = smoking (4x risk)
Y = 50
32
Chronic inflammation, such as in (X) conditions, increases risk of which urothelial cancers?
X = catheter or schistosomiasis
Squamous and transitional cell carcinomas of bladder
33
Which drug causes 9x increased risk of bladder cancer?
Cyclophosphamide
34
Bladder cancer: T1 involves (X) layer. T2 involves (Y) layer. T3 involves (Z) layer.
X = mucosa
Y = mucosa and muscularis
Z = mucosa, muscularis, and fat
35
Bladder cancer: Rx and prognosis for stage T1
TUR (Transurethral resection)
Good prognosis, but can recur
36
Bladder cancer: Rx and prognosis for stage T2
Cystectomy
60% 5y survival
37
Bladder cancer: prognosis for stage T3
10% 5y survival
38
Bladder cancer can be identified early with thorough work-up of (X) patients that present with (Y)
x = >40 years old
Y = hematuria (evaluate by cytoscopy)
39
Bladder cancer: Deletion of (X) is an early event. Deletion of (Y) happens later and has been linked to poorer prognosis.
X = chromosome 9q
Y = Rb and p53
40
List the two main benign tumors of the kidney
1. Renal papillary adenoma
2. Oncocytoma
41
(X) renal tumors are small (<5mm), present in (cortex/medulla) as pale yellow nodule with papillary growth pattern. If larger than (Y) size, they're re-classified as...
X = renal papillary adenoma
Cortex
Y = 3 cm
RCC (due to malignant potential)
42
Oncocytoma: composed of (small/large) (eosinophilic/basophilic) cells thought to arise from the (X) cells.
Large; eosinophilic
X = interacalated cells of collecting duct
43
Oncocytoma: (X) color and can grow up to (Y).
X = mahogany-brown
Y = 12 cm
44
Pt has renal mass resected that shows numerous mitochondria on EM. Which type of tumor is this a characteristic of?
Oncocytoma
45
Aside from the most common malignant renal tumor, (X), which other malignant tumors can arise in kidney? Star the one with the best prognosis.
X = CCRC carcinoma (80%)
1. Papillary carcinoma
2. Chromophobe renal carcinoma*
46