Urologic Oncology (Kidney, Bladder, Prostate, Testis, Penis, Adrenal)
Core concepts
Oncology questions reward a stage-and-risk-driven approach. For renal cell carcinoma, know histologic subtypes (clear cell, papillary, chromophobe), the role of partial vs radical nephrectomy by size and location, and that RCC can present with paraneoplastic syndromes or venous thrombus. For bladder cancer, distinguish non-muscle-invasive (Ta, T1, CIS) from muscle-invasive disease; know risk stratification, the role of BCG for high-risk NMIBC, and that CIS is high grade. For prostate cancer, understand PSA kinetics, Gleason/Grade Group, risk stratification (D'Amico/NCCN), and the logic of active surveillance vs local therapy vs systemic therapy. For testis cancer, know tumor markers (AFP, beta-hCG, LDH), that pure seminoma does not raise AFP, and the retroperitoneal lymphatic drainage. Penile cancer: HPV association, inguinal nodal staging. Adrenal: functional vs nonfunctional masses, pheochromocytoma workup.
Traps
Questions confuse staging with grading, or test the marker that should not be elevated. A raised AFP in a presumed seminoma means the tumor is not pure seminoma. Partial nephrectomy is preferred for T1 tumors when technically feasible. BCG is for high-risk NMIBC, not for muscle-invasive disease.
Worked example / rule of thumb
A 30-year-old with a testicular mass and elevated AFP and beta-hCG: treat as nonseminomatous germ cell tumor until proven otherwise. Rule of thumb: seminoma = beta-hCG may rise, AFP never rises.