10- Cancer and Cyst Flashcards
Common malignancies of urinary tract
Prostate
RCC
TCC
How do RCC and TCC present normally
Micro/Macroscopic haematuria
Where does RCC involve?
Parenchyma of kidneys (function tissue- medulla, cortex, pyramids)
Where does TCC involve?
Calyx to Bladder
What epithelium does RCC arise?
Tubular
What age is common for RCC
60-70
Presentation of RCC
Haematuria, Fatigue, Weightloss, Fever, Mass in loin
Normally metasize before local symptoms develop
Varicocele
PTH-rP Tumour- Hypercalcemia
Investigations
USS, CT, Cystoscopy, Cystology (Urine)
Treatment of RCC
Surveillance, Partial nephrectomy to preserve function, Radical nephrectomy with removal of adrenal gland, perinephric fat, ureter, para-aortic lymph nodes.
Treat metastatic
Little effective treatment
Palliative to target angiogenesis
Chemotherapy and radiotherapy resistant
TCC presentation
Haematuria, Incidental finding, weight loss, fatigue, obstruction
Causes of TCC
Analgesic misuse, aniline (rubber, plastic, dyes), smoking, male
Treat TCC
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
TCC of upper urinary tract
Treatment
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)
Risk factors of prostatic cancer
Increased age, family history, ethnicity B>W>A
Zones of prostate for BPH and Cancer
BPH- Transitional
Cancer- Peripheral
also central and anterior zones
Raised PSA
Prostate cancer Infection Inflammation BPH Urinary retension
Presentation of Prostatic Ca
Obstruction, bone pain, raised PSA, bipsy, incidental finding from PR
Why bone pain
Sclerotic lesions (thickening)
Grading
T1-T4 (impalpable tumour - fixed to other structures)
What would prostate feel like
Hard and irregular
Diagnosis cancer
USS, PR, PSA, Biopsy to see histological diagnosis, Radiographs and Bone scans.
Treatment of prostate cancer
Surgery, hormone therapy, radiotherapy
T1/T2 surgical resection + TURP
If unit- local radiotherapy
Surveillance
Why castration
Testosterone powerful for tumour growth.
Survival rates for prostate cancer
5 year- 75-90%
If metastatic- 30-45%
Side effects of castration
Hot flashes, Impotence, Thinning bone, Weight gain, Increased breast size, Lower muscle mass
Why inheritance pattern does Cystic Kidney Disease take?
Autosomal dominant
When does it usually present
30-40 year old
How does cystic kidneys present
Complications of hypertension, acute groin pain, haematuria, palpable kidneys, impaired renal function
Why impaired renal function in cystic kidneys
Cysts compress surrounding parenchyma and impair renal function
What fills cysts
yellow fluid like stuff that replaces parenchyma. Haemorrhage can occur.
What epithelium lines the cysts
Cuboidal
Problems causes by cystic kidneys
HTN = MI and cerebral vascular disease.
Progressive CKD leading to dialysis and transplant of end stage renal failure develops.
