Term
| what is the test of choice for a hematuria pt? |
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Definition
| CT urogram (can evaluate the ureter+kidneys) w/contrast |
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Term
| where do other CT scans need to be run if a pt has RCC? |
|
Definition
| head and great vessels for metastasis |
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Term
| if regional nodes are positive w/RCC, how does this affect the pt's prognosis? |
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Definition
| prognosis = poor, oncology should be brought in |
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Term
| what is the source of the majority of RCC tumor chemo resistance? how was this addressed - what are the new chemo agents? |
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Definition
| MDR gene/glycoprotein pumping back out the chemo agents. *bevacizumab (IgG1 monoclonal antibody) was the first chemo agent to show improvement w/RCC b/c it targeted angiogenesis in the tumor. then it was discovered that RCC had PI3 kinase activation w/ BRAF and mTOR, and a higher incidence w/ VEG-F and EGF-R. therefore *temsirolimus (mTOR kinase inhibitor) and *sunitinib/*sorafenib (tyrosine kinase inhibitors) were developed and found to be effective. |
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Term
| what is cytoreductive therapy? |
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Definition
| removal of the kidney in metastatic RCC pts followed by more therapy - has been shown to benefit pts w/advanced disease |
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Term
| what are important questions to ask a pt w/testicular swelling? |
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Definition
| ask about pain, duration, trauma, previous instances, and regular self exams |
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Term
| what should be in the ddx for testicular swelling? |
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Definition
| infectious: orchitis, epididymitis, abscess. trauma: hematoma, testis fracture. neoplasm: testicular CA. structural: hernia, varicocele, and hydrocele. |
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Term
| how should the scrotum be palpated? |
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Definition
|
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Term
| what is a way to test for varicocele? |
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Definition
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Term
| what would the notes for a normal scrotum evaluation look like? |
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Definition
| loose wrinkled pouch w/ 2 compartments; testicles ovoid shape, 3-5 cm w/ smooth surface. testis should be down in scrotal sac and non-tender. |
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Term
| what would be common labs to order for testicular swelling? |
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Definition
| urinanalysis and WBC count: r/o infection. Hgb/platelets: r/o bleeding disorders. LFTs |
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Term
| what tumor markers should you look for in a testicular swelling pt? what is very important about the timing of getting these markers? |
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Definition
| beta-hGC (produced by syncytiotrophoblasts), LDH (indicator of bulk metstasis), and AFP. *a set of these markers needs to be drawn before going into the OR* |
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Term
| what kinds of imaging would be appropriate for a testicular swelling pt? |
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Definition
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Term
| how will a testicular tumor appear on ultrasound? |
|
Definition
| echogenicity is not smooth nor uniform and an area outlined on US that appears like a solid mass |
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Term
| what are preop considerations for orchectomy? |
|
Definition
| draw tumor markers, discuss prosthesis, sperm banking, and sx approach |
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Term
| why is radical inguinal orchectomy the best approach for removal of a testicle w/a tumor? |
|
Definition
| a radical inguinal orchectomy (approach like hernia repair) will protect the scrotum from being violated w/CA cells |
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Term
| t/f: many seminomas will usually not have any elevations of marker (except hCG)? |
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Definition
|
|
Term
| what characterizes a seminoma? |
|
Definition
| age 30-40 yrs or >50. never secretes AFP. secretes hCG in 10%. radio/chemosensitive. |
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|
Term
| what characterizes an embryonal testicular CA? |
|
Definition
| 25-35 yrs. secretes AFP and hCG. |
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|
Term
| what characterizes a yolk sac testicular CA? |
|
Definition
| seen in infants and children <2 yes. secretes AFP and hCG. metastasizes via blood. schiller-duval bodies may be seen. |
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Term
| after dx of embryonal CA, what is the next step? |
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Definition
| staging - CT scan of abdomen, pelvis and then CXR b/c testicular cancer metastasizes early on up aorta, vena cava, to chest, lungs … will involve everything depending on aggressiveness. |
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Term
| if there is positive nodes associated with embryonal testicular CA, what procedure should be carried out? |
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Definition
| radical peritoneal lymphadenectomy |
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|
Term
| why are testicular CA's sensitive to chemotherapy? |
|
Definition
| most germ cell tumors have a high proliferative index -> very sensitive to chemotherapy |
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|
Term
| what is the traditional tx for seminoma? |
|
Definition
| orchectomy followed by chemo |
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