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Kidney and Bladder Cancer for the Physician Assistant Exam

Two conditions you don’t want to skip for the Physician Assistant Exam are kidney cancer and bladder cancer. You need to be aggressive in your investigation of possible malignancy because, many times, it presents rather insidiously.

Renal cell carcinoma (RCC)

When you think about kidney cancer, the most common histological cell type you see is renal cell carcinoma (RCC). Although experts can’t name a definitive cause, renal cell carcinoma is linked to specific risk factors, including the following:

  • Cigarette smoking

  • Von Hippel-Lindau (VHL) disease

  • Acquired cystic kidney disease (This condition occurs over time. The cysts that form have a tendency to become malignant.)

Most of the time, the initial presentation of renal cell carcinoma is painless hematuria, either macroscopic or microscopic. Renal cell carcinoma is called the internist’s tumor because internists often found the carcinoma when it presented the class triad of unilateral flank pain, hematuria, and palpable mass. The triad occurs in people with renal cell carcinoma less than 10 percent of the time, however.

The best diagnostic test for renal cell carcinoma is a CT scan with intravenous contrast. To trace a local tumor to the surrounding vessels, undertake a study of the blood vessels, such as a CT angiogram dedicated to the area or an angiogram of the renal vessels. The initial line of treatment is surgical. Depending on the area and degree of spread, sometimes only a partial nephrectomy can be performed.

Paraneoplastic phenomena associated with renal cell carcinoma include high calcium levels, polycythemia, and hypertension.

Bladder cancer

The two most common cell types of bladder cancer are squamous cell carcinoma (SCC) and transitional cell carcinoma (TCC), with transitional cell carcinoma being the more common.

Common presentation of bladder cancer includes hematuria, either gross or microscopic. Risk factors include smoking and certain jobs related to dye-making, rubber, or chemicals. The diagnosis is made by cystoscopy.

A history of recurrent urinary tract infections and catheterization points toward squamous cell carcinoma. The treatment is based on the degree of tumor invasion. Options for the treatment of bladder cancer include intravesical therapy (put into the bladder itself) such as bacillus Calmette-Guérin (BCG) instillation, surgery (cystectomy), and/or chemotherapy.

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