Podcast: Play in new window | Download
Bladder Cancer
Definition
- Malignancy arising from the bladder urothelium
- Most common type is urothelial carcinoma
- Often presents with painless hematuria
Risk Factors
- Cigarette smoking
- Occupational chemical exposures such as dyes and rubber
- Chronic bladder irritation or infection
- Cyclophosphamide therapy (chemotherapy agent)
Clinical Presentation
- Painless gross hematuria is classic
- Irritative voiding symptoms such as frequency or urgency
- Flank pain if obstruction occurs
- The question stem would likely describe an older smoker with painless blood in the urine
Diagnostics
- Urinalysis: hematuria
- Urine cytology: may detect malignant cells
- Cystoscopy with biopsy: diagnostic test of choice
- CT urography or renal ultrasound: evaluate upper tracts for masses or obstruction
Treatment
- Transurethral resection of bladder tumor for diagnosis and initial management
- Urology referral for cystoscopy
- Advanced disease may require more extensive surgery or systemic therapy
- Ongoing surveillance cystoscopy due to high recurrence
Exam Keys
- Painless hematuria in older patient = bladder cancer
- Smoking is strongest risk factor
- Cystoscopy with biopsy is required for diagnosis
- High recurrence rate requires surveillance
Penile Cancer
Definition
- Malignancy of the penis, usually squamous cell carcinoma
- Rare in the United States
Risk Factors
- HPV infection
- Lack of circumcision with chronic smegma accumulation
- Phimosis
- Smoking
- Poor hygiene
Clinical Presentation
- Painless penile mass, ulcer, or lesion
- May bleed or become foul smelling
- Inguinal lymphadenopathy in advanced cases
- The question stem would likely describe an uncircumcised man with a persistent penile lesion or ulcer
Diagnostics
- Clinical exam and biopsy of the lesion
- HPV testing may be supportive but not required
- Imaging (CT or MRI) if concerned for nodal or metastatic spread
Treatment
- Surgical excision is mainstay
- Topical or laser therapy for very superficial lesions
- Partial or total penectomy for invasive disease
- Radiation or chemotherapy for advanced or metastatic cases
Exam Keys
- Uncircumcised male with chronic lesion = think penile cancer
- Strongly associated with HPV and poor hygiene
- Diagnosis requires biopsy
- Treatment is surgical excision
Prostate Cancer
Definition
- Malignancy of prostate gland, usually adenocarcinoma
- Most common non-skin cancer in men
- Often slow growing and asymptomatic early
Risk Factors
- Age over 50
- African American race
- Family history
- BRCA mutations
Clinical Presentation
- Often asymptomatic
- May have urinary hesitancy, weak stream, or nocturia
- Bone pain suggests metastasis
- The question stem would likely describe an older man with urinary obstructive symptoms or elevated PSA
Diagnostics
- PSA: elevated but nonspecific
- Digital rectal exam: hard, nodular, or irregular prostate
- Diagnosis confirmed by transrectal ultrasound-guided biopsy
- MRI used for staging and biopsy targeting
- Bone scan if metastatic disease suspected
Treatment
- Localized: active surveillance, radiation therapy, or prostatectomy
- Advanced: androgen deprivation therapy
- Metastatic: ADT plus systemic therapy such as chemotherapy
Exam Keys
- Elevated PSA or abnormal DRE → evaluate for prostate cancer
- Diagnosis requires biopsy
- Bone pain = metastasis
- Many cases managed with surveillance depending on age and risk
Testicular Cancer
Definition
- Malignancy of germ cells within the testis
- Most common solid tumor in men 15–35
- Two main types: seminoma and nonseminomatous germ cell tumor (NSGCT)
Seminoma vs Nonseminoma (Brief, High Yield)
- Seminoma: slower growing, normal AFP, radiosensitive
- NSGCT: more aggressive, AFP and/or hCG elevated
Risk Factors
- Cryptorchidism
- Family history
- Prior testicular cancer
- Caucasian race
- Klinefelter syndrome
Clinical Presentation
- Painless unilateral testicular mass
- Scrotal heaviness or dull ache
- Gynecomastia possible with hCG-producing tumors
- The question stem would likely describe a young man with a firm, painless testicular lump that does not transilluminate
Diagnostics
- Ultrasound: solid hypoechoic mass
- Tumor markers: AFP, beta-hCG, LDH
- Seminoma: AFP normal
- NSGCT: AFP and/or hCG elevated
- CT abdomen/pelvis and chest for staging
- No biopsy due to risk of tumor seeding
- Radical inguinal orchiectomy is both diagnostic and therapeutic
Treatment
- Radical inguinal orchiectomy for all suspected tumors
- Seminoma: radiation or chemotherapy depending on stage
- NSGCT: chemotherapy; may need retroperitoneal lymph node dissection
- Excellent cure rates even with metastasis
Exam Keys
- Young man with painless testicular mass → testicular cancer
- Ultrasound first, never biopsy
- Seminoma: radiosensitive, normal AFP
- NSGCT: AFP and/or hCG elevated
- First step in all cases is radical inguinal orchiectomy
