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Malignancy causing flank pain
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Aisha AA
Malignancy is a term for diseases in which abnormal cells divide without control and can invade nearby tissues. Malignant cells can also spread to other parts of the body through the blood and lymph systems.
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MALIGNANCIES ASSOCIATED
WITH FLANK PAIN
RENAL CELL CARCINOMA
Adenocarcinoma from tubular epithelial cells (PCT)
(80-90% of malignant tumors of the kidney)
RISK FACTORS:
men > women (60-70 yo) | smoking | obesity | ACKD in ESRD |
von Hippel-Lindau dse
COMMON FORMS:
~CLEAR CELL CA (80%)
~PAPILLARY RENAL CA (15%)
~ CHROMOPHOBE RENAL CA (<5%)
HISTORY / PE:
painless hematuria | flank pain | palpable flank mass |
wt. loss | malaise | fever | left sided varicocele |fatigue |
anemia | polycythemia
DIAGNOSTICS:
RENAL UTZ | CT | histology
TREATMENT:
Surgical resection | radiation / chemo
TRANSITIONAL CELL CARCINOMA
MOST COMMON tumor of UTS (renal calyces, renal pelvis
ureters, bladders)
~Arise in th UT outside of kidney, predominantly in the bladder,
originating form transitional epithelium
affect men > women (50 - 70 years)
MANIFESTATIONS:
painless hematuria | flank pain that doesnt go away |
suprapubic fullness pain |fatigue |weight loss| painful or
frequent urination | hydronephrosis
associated with problems in your Pee SAC:
phenacetin | Smoking | Aniline Dyes | Cyclophosphamide
DIAGNOSIS:
Cystoscopy | urine cytology | pelvic CT
TREATMENT:
~ Transurethral resection / injection of chemotherapeutic
agents into the bladder.
~ Cystectomy
~ Radiation / Chemotherapy / both
VON HIPPEL-LINDAU DISEASE
An INHERITED CANCER SYNDROME with renal manifestations
caused by mutations in VHL tumor suppressor gene.
MANIFESTATIONS:
Multiple bilateral kidney cysts | renal cell ca | kidney cysts and
ca affects majority of VHL aeg. |
Non-renal features : pheochromocytomas |
cerebellar hemangioblastoma | retinal hemangioblastomas |
DIAGNOSTICS:
annual screening of the kidneys ~ CT / MRI
MANAGEMENT :
- Nephron-sapring surgical approaches for removal of
cancerous lesions
PROSTATE CANCER
most common ca in men.
2nd leading cause of ca death in men
RISK FACTORS:
advanced age | + family history
HISTORY / PE:
ASYMPTOMATIC | may present as obstructive urinary sx |
lymphedema due to obstructing metastases | back pain |
palpable nodule in DRE | tender prostate ~ prostatitis
DIAGNOSTICS:
markedly increased PSA ( >4 ng/mL) | utz0guided transrectal
biopsy | Gleason histologic syst. | CT to look for metastases
| bone scan
TREATMENT:
observation | Radical prostatectomy | radiation therapy | PSA |
androgen ablation
PANCREATIC CANCER
"SILENT DSE"
manifests as dull left flank pain
negative findings on an UTZ study (symptoms can be quite vague,
and theycan vary depending on the location of cancer in the pancreas)
aisha aa.
