UROLOGICAL 12/3 CH

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RadTherapy
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185147
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UROLOGICAL 12/3 CH
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2012-11-25 13:47:17
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UROLOGICAL 12
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UROLOGICAL 12/3 CH
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  1. What age does bladder cancer peak?
    70
  2. Which gender does bladder cancer affect the most
    men 4xmore
  3. What are important prognostic factors for bladder ca
    Tumor extent/depth of muscle invasion
  4. 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.
  5. In bladder ca, what are tumors that are usually low grade and superficial
    papillary
  6. In bladder ca, what tumors are usually high grade, sessile, and nodular
    infiltrating lesions
  7. Where does bladder ca typically occur
    trigone posterior/lateral walls or neck of the bladder
  8. What is the most common tumor of the urinary tract
    bladder
  9. What are etiology effects for bladder ca
    • dye, rubber, textile, leather working
    • chronic bladder infections
    • smoking
    • previous pelvic rad
    • pesticide exposure
    • contaminated water
  10. What are some clinical presentations for bladder ca
    • gross, painless hematuria
    • urinary tract infection
    • clotting and urinary retention
    • frequency, urgency, dysuria, and hematuria
  11. 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
  12. What pathology are most bladder tumors
    • 98% epithelial
    • 92% transitional
    • 7% squamous- chronic irritation from catheters
    • 2% adenocarcinoma
  13. What are the 4 morphology of bladder tumors
    • #1 papillary
    • papillary infiltrating
    • solid infiltrating
    • nonpapillary or carcinoma insitu
  14. For bladder ca, what is staging based on
    depth of invasion thru the bladder wall
  15. What ways can bladder ca spread
    • direct extension
    • perineural
    • lymphatic
    • blood vessels
  16. When bladder ca spreads via direct extension, it can spread ___ and ____ to ____ are superficial at diagnosis
    • submucousally
    • 75%
    • 85%
  17. What invasions are common in bladder ca after the tumor has invaded the muscle
    • perinueral
    • lymphatic
    • blood vessels
  18. With bladder ca, how does lymphatic drainage occur
    • External iliacs
    • Internal iliacs
    • presacral nodes
  19. What are the distant mets for bladder ca
    • lung
    • bone
    • liver
  20. What is the treatment technique for bladder carcinoma in situ when the bladder neck, prostatic urethra, and ureters are involved?
    suregery (radical cystectomy)
  21. 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
  22. What is the treatment for bladder ca staged at Ta and T1
    • Transurethral resection and fulguration or radical cystectomy
    • Intravesical immunotherapy
    • chemo is added
  23. How are Tis, Ta, T1 failures treated in bladder
    Radical cystectomy for salvage
  24. For bladder ca, how are T2,T3, and T4 treated
    Radical cystectomy
  25. For bladder ca,what can be used initially and save surgery for salvage
    Rad Therapy
  26. Why is chemo used with XRT for bladder Ca and which chemo drugs are used
    • To sensitize the local tumor
    • methotrexate
    • cisplatin
    • vinblastine
  27. For bladder ca, what should portals include
    • entire bladder
    • tumor volume
    • prostate and prostatic urethra
    • pelvic lymphnodes
  28. What field and dose of radiation do you use for bladder
    Large pelvic field 45-50 Gy boost fields 15-20Gy
  29. Should the patient have a full bladder or empty bladder when receiving radiation
    empty, only treat full when boosting
  30. How should you position a patient for bladder ca treatment
    • Supine with hands folded on abdoment
    • empty bladder
    • imobilize lower extremities
  31. What can you use to immobilize the lower extremeties
    • alpha cradle
    • vac lock
    • simple block
    • velcro feet
  32. What are side effects for XRT of bladder
    • cystitis
    • proctitis
    • Diarrhea
    • decrease blood counts
  33. What is the 5 year survival rate for bladder ca is superficial
    85-90%
  34. What is the 5 year survival rate for bladder ca if the disease has invaded the muscle
    60%
  35. What is the peak age for renal cell carcinoma
    55-60
  36. List the etiology factors for renal cell carcinoma
    • envriomental
    • occupational
    • hormonal
    • cellular
    • genetic
    • diabetes hypertension
    • cigarettes
    • obesity
    • anagelsic abuse
    • asbestos
    • vonhippel-landeau disease
  37. Which gender is most likely to get renal pelvis and uretal cancer?
    men 3:1
  38. What is the peak age for renal pelvic and uretal cancer
    50-60
  39. What are etiology factors for renal pelvic and uretal cancer
    • urban
    • tobacco
    • aminophenol exposure
    • renal stones
    • analgesics
  40. What are prognostic indicators for renal cell carcinoma
    • stage and histologic
    • lymph node involvement
  41. What are prognostic indicators for renal pelvic and uretal carcinoma
    • stage and grade
    • lymph node involvement
  42. Where is the lymphatic drainage from the kidneys
    • paraaortic
    • paracaval nodes
  43. What is the lymphatic drainage from the ureters
    • paraaortic
    • paracaval
    • common iliac
    • internal iliac
    • external iliac
  44. What are the clinical presentations for renal cell
    • occult primary tumor
    • gross hematuria
    • abdominal mass
    • pain
    • weight loss
    • fatigue
    • fever
  45. What are clinical presentations for renal pelvic and uretal cancer
    • gross or micro hematuria
    • pain
    • bladder irritation
  46. 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
  47. What is the pathology for renal cell carcinoma
    • epithelium is tissue of origin
    • clear cell carcinoma
  48. What is the pathology for renal pelvis and ureter
    • Transitional 90%
    • Squamous 7%
  49. 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
  50. What is the 5 year survival rate for kidney and pelvis ca for state I,II,III,IV
    • I-88%
    • II-67%
    • III-40%
    • IV-2%
  51. 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
  52. What is the route of spread for renal pelvis and ureteral carcinoma
    • multifocal
    • direct extension
    • blood
    • lymphatics
  53. 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
  54. 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
  55. What are the doses for renal cell carcinoma
    4500-5500 cGy
  56. What are XRT dose to you use for renal pelvic and ureteral ca
    5040 cGy and 540 cGy boost
  57. What are side effects for renal cell, renal pelvic, and ureteral ca
    • N&V
    • diarrhea
    • abdominla cramps
    • bowel obstruction
  58. What are the parts of the urinary system
    • pair of kidneys
    • pair of ureters
    • bladder
    • urethra
  59. 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
  60. What do the ureters do
    Transport urine away from the kidneys
  61. What does the bladder do
    Stores urine
  62. What does the urethra do
    Carries urine from the bladder to the outside of the body
  63. What are the primary organs of the urinary system
    kidneys
  64. What are vital in maintaining homeostasis
    kidneys
  65. 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
  66. What holds the kidneys in place
    • Connective tissue (renal fascil) and
    • adipose tissue
  67. Each kidney receives blood from a ____ and is drained by a ____
    • Renal artery
    • Renal vein
  68. What connects with the kidney at its hilus
    • ureters and
    • blood vessels
  69. What covers the kidney
    A strong capsule of connective tissue (renal capsule)
  70. The superiror end of the ureter is expanded to forma a funnel shaped part called the
    Renal Pelvis
  71. The pelvis is divided up into 2-3 tubes called the ____ and they in turn are divided into 8-14_____
    • major calyces
    • minor calyces
  72. The kidney consists of an outer ___ and an inner ____
    • renal cortex
    • renal medulla
  73. The renal medulla is composed of conical masses of tissue called
    renal pyramids
  74. The ____ forms a shell around the medulla
    renal cortex
  75. Each kidney contains more than a million microscopic units called _____
    Nephrons
  76. What are the functional units of the kidneys
    nephrons
  77. The nephrons consist of 2 main structures
    • renal corpuscle
    • renal tubule
  78. Blood is filetered in the ____: the filtered fluid then passes thru the ____
    • renal corpuscle
    • renal tubule
  79. 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
  80. Blood flows into the glomerulus through a/an
    efferent arteriole
  81. What is an expansion at the closed end of a renal tubule
    Bowman's capsule
  82. The ___ leads away from the Bowman's capsule and becomes highly coiled and this portion is called the
    • Renal tubule
    • proximal convoluted tubule
  83. The Proximal tubule dips toward the
    renal pelvis
  84. After passing thru the proximal convoluted tubule, filtrate flows into the ____ and then into the distal convoluted tubule
    loops of Henle
  85. 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
  86. What are located in the renal cortex
    • renal corpuscle
    • PCT
    • DCT of each nephron
  87. The renal corpuscle, the PCT, and the DCT of each nephron are located within the
    renal cortex
  88. Loops of Henle dip down into the
    Medulla
  89. 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
  90. After the nephrons perform their functions, the end result is
    urine
  91. What is excreted out of urine outside of the body
    • excess water
    • waste
    • excess electrolytes
  92. 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
  93. Dehydration does not usually occur because about ____ of the filtrate is returned to the blood leaving only about ____ to be excreeted as urine
    • 99%
    • 1%
  94. While glomerulus filtration is ____ process (usueful substances are filtered as well as waster), tubular reabsorption is a ____ process
    • not a selective
    • highly selective
  95. By maintaining ____, the body maintains a steady volume and composition of blood
    urine volume
  96. Secretion of water by the kidneys is regulated by what
    • ADH
    • antidiuretic hormone
  97. Where is ADH secreted
    by the posterior lobe of the pituitary gland
  98. ADH serves as a chemical messenger carrying information from the ____ to the ___ and ____ of the kidneys
    • brain
    • dct
    • collecting ducts
  99. How is salt regulated and excreted
    • regulated by hormones, mainly aldosterone
    • secreeted by adrenal glands
  100. What increase urine volume by inhibiting reabsorption of water
    chemicals called diuretics
  101. Give examples of diuretics
    coffee, tea, alcohol
  102. 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
  103. 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
    • renal pelvis
    • ureter
  104. What is the process of emptying the bladder and expelling urine referred to
    urination or micturation
  105. When the volume in the bladder reaches about ____ ml, special nerve endings (stretch receptors) in the bladder wall are stimulated
    300
  106. What is a hollow, distensible muscular organ
    urinary bladder
  107. Where is the bladder located
    in the pelvi cavity behind the pubic symphysis
  108. Where does the bladder lie in a male
    against the rectum posteriorly
  109. Where does the bladder lie in a female
    it contacts the anterior walls of the uterus and vagina
  110. The internal floor of the bladder consists of a triangular area called the ____, which has an opening at each of its 3 angles
    trigone
  111. Poesteriorly, at the base of the trigone are the openings of the
    ureters
  112. The internal uretheral orifice, which opens into the ____, is located anteriorly at the apex of the trigone
    urethra
  113. How many layers does the bladder consist of
    4
  114. The inner layer of the bladder, or mucous coat, includes several thicknesses of epithelial cells called
    transitional epithelium
  115. 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
    • 2 or 3 cells
    • 5 or 6 cells
  116. 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
  117. 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
  118. What is the best treatment choice for renal cell ca
    surgery
  119. What is the most common symptom of bladder ca
    Hematuria
  120. Where in the bladder is the most common place to get bladder ca
    trigone
  121. Renal cell or Renal cortex cancer is called
    clear cell carcinoma
  122. Renal pelvic/ureteral cancer is called
    Transitional

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