10- Cancer and Cyst

Question 1

Common malignancies of urinary tract

Answer 1

Prostate
RCC
TCC

Question 2

How do RCC and TCC present normally

Answer 2

Micro/Macroscopic haematuria

Question 3

Where does RCC involve?

Answer 3

Parenchyma of kidneys (function tissue- medulla, cortex, pyramids)

Question 4

Where does TCC involve?

Answer 4

Calyx to Bladder

Question 5

What epithelium does RCC arise?

Answer 5

Tubular

Question 6

What age is common for RCC

Answer 6

60-70

Question 7

Presentation of RCC

Answer 7

Haematuria, Fatigue, Weightloss, Fever, Mass in loin
Normally metasize before local symptoms develop
Varicocele
PTH-rP Tumour- Hypercalcemia

Question 8

Investigations

Answer 8

USS, CT, Cystoscopy, Cystology (Urine)

Question 9

Treatment of RCC

Answer 9

Surveillance, Partial nephrectomy to preserve function, Radical nephrectomy with removal of adrenal gland, perinephric fat, ureter, para-aortic lymph nodes.

Question 10

Treat metastatic

Answer 10

Little effective treatment
Palliative to target angiogenesis
Chemotherapy and radiotherapy resistant

Question 11

TCC presentation

Answer 11

Haematuria, Incidental finding, weight loss, fatigue, obstruction

Question 12

Causes of TCC

Answer 12

Analgesic misuse, aniline (rubber, plastic, dyes), smoking, male

Question 13

Treat TCC

Answer 13

TURBT
low risk with no muscle invasion- TURBT+/- chemo
high risk with no muscle invasion- TURBT + intravesical chemo, BCG, cystectomy
muscle invasive- cystectomy + radio or palliative

Question 14

TCC of upper urinary tract

Treatment

Answer 14

5%
40% chance of developing bladder cancer
haematuria and obstruction as the renal pelvis projects directly into pelvicalyceal cavity

Treat with nephroureterectomy. (kidney, fat, ureter, cuff of bladder)

Question 15

Risk factors of prostatic cancer

Answer 15

Increased age, family history, ethnicity B>W>A

Question 16

Zones of prostate for BPH and Cancer

Answer 16

BPH- Transitional
Cancer- Peripheral
also central and anterior zones

Question 17

Raised PSA

Answer 17

Prostate cancer
Infection
Inflammation
BPH
Urinary retension

Question 18

Presentation of Prostatic Ca

Answer 18

Obstruction, bone pain, raised PSA, bipsy, incidental finding from PR

Question 19

Why bone pain

Answer 19

Sclerotic lesions (thickening)

Question 20

Grading

Answer 20

T1-T4 (impalpable tumour - fixed to other structures)

Question 21

What would prostate feel like

Answer 21

Hard and irregular

Question 22

Diagnosis cancer

Answer 22

USS, PR, PSA, Biopsy to see histological diagnosis, Radiographs and Bone scans.

Question 23

Treatment of prostate cancer

Answer 23

Surgery, hormone therapy, radiotherapy
T1/T2 surgical resection + TURP
If unit- local radiotherapy
Surveillance

Question 24

Why castration

Answer 24

Testosterone powerful for tumour growth.

Question 25

Survival rates for prostate cancer

Answer 25

5 year- 75-90%

If metastatic- 30-45%

Question 26

Side effects of castration

Answer 26

Hot flashes, Impotence, Thinning bone, Weight gain, Increased breast size, Lower muscle mass

Question 27

Why inheritance pattern does Cystic Kidney Disease take?

Answer 27

Autosomal dominant

Question 28

When does it usually present

Answer 28

30-40 year old

Question 29

How does cystic kidneys present

Answer 29

Complications of hypertension, acute groin pain, haematuria, palpable kidneys, impaired renal function

Question 30

Why impaired renal function in cystic kidneys

Answer 30

Cysts compress surrounding parenchyma and impair renal function

Question 31

What fills cysts

Answer 31

yellow fluid like stuff that replaces parenchyma. Haemorrhage can occur.

Question 32

What epithelium lines the cysts

Answer 32

Cuboidal

Question 33

Problems causes by cystic kidneys

Answer 33

HTN = MI and cerebral vascular disease.

Progressive CKD leading to dialysis and transplant of end stage renal failure develops.