10.1 Carcinoma Of The Kidney And Bladder Flashcards
What are the 2 types of renal cell cancers?
Renal cell carcinoma
Transitional cell carcinoma
Where does renal cell carcinoma present?
In the parenchyma of the kidney ( medulla, renal pyramids, cortex)
Where does transitional cell carcinoma affect?
Anywhere from the calyx to the bladder (includes ureters)
What type of tumours are the most common malignant renal tumour?
Renal cell carcinomas
What type of epithelium do renal cell carcinomas arise from?
Tubular epithelium
In what age group is renal cell carcinoma most commonly seen?
60 to 70 year olds
Rare in children
What are risk factors for renal cell carcinoma?
Increasing age ( 60 to 70) Male Dialysis Smoking Obesity
How are renal cell carcinomas assessed?
Staged based on size of tumour, localisation, involvement of other tissues and metastatic spread
What occurs at stage IV renal cell carcinoma?
Metastasis to other organs, travel in lymph system or venous system. Can be deposited in the atria of the heart
How does renal cell carcinoma present?
~90% with hematuria (may be microscopic or macroscopic) or incidental finding
Non specific symptoms include fatigue, weight loss and fever. May be mass in the loin if advanced.
Varicocele as in late stage tumour can occlude venous drainage (IVC) causing back up of blood, no valves in veins causing pooling of venous blood in scrotum
Why is prognosis of renal cell carcinoma poor?
As often metastasise before local symptoms develop. Frequently metastasis to the lungs, liver, bones, other kidney, adrenal glands.
RCC are radiotherapy and chemotherapy resistant
How might an advanced renal cell carcinoma present?
Large mass in loin
Varicocele
Secretion of PTH-rP causing hypercalcaemia
How do we investigate a renal cell carcinoma?
Radiology • Ultrasound or CT scan Endoscopy • Flexible cystoscopy up urethra Urine • Cystology - looking for cancerous cells in urine
How do we treat localised renal cell carcinoma?
Surveillance
Increasing small tumour = Partial nephrectomy
Large tumours with no distal metastasis = radical nephrectomy with removal of associated adrenal gland, perinephric fat, upper ureter and the para-aortic lymph nodes
How do we treat metastatic renal cell carcinoma?
Chemotherapy and radiotherapy resistant
Palliative treatment - Target angiogenesis ( reduces increase in blood supply to the tumour and slows progression and growth of cancer)
What is angiogenesis?
Creation of new blood vessels
How does transitional cell carcinoma present?
Haematuria (microscopic or macroscopic)
Incidental finding on imaging (ultrasound or CT)
Weight loss, loss of appetite
Signs/symptoms of obstruction
Where is the most common location of a transitional cell carcinoma?
Within the bladder
What are risk factors of bladder transitional cell carcinoma?
Analgesia misuse Exposure to aniline dyes Smoking Male Previous UTI
How might people have been exposed to aniline dyes?
Used in the Industrial manufacture of dyes, rubber and plastics
Why do women have more sever presenting symptoms of bladder transitional cell carcinoma?
As women more frequently experience UTIs than men
How are bladder transitional cell carcinomas diagnosed?
Transurethral resection of the bladder tumour(TURBT)
Diagnosis based on cytological examination of the urine to check for the presence of malignant cells and cystoscopy of the lower urinary tract
What is transurethral resection of the bladder tumour?
Scope put up through urethra into the bladder to view any tumours. If tumours are small, they can be removed straight away
What stage are the majority of bladder cancers?
Ta - superficial.
Just on the lining of the bladder
What is a carcinoma in situ?
A rare tumour of the bladder. Is a flat tumour that grow along the surface of the epithelium rather than travelling inwards and invasive.
How are bladder TCC assessed?
Diagnosed via a transurethral resection of bladder tumour
Investigation via cystoscopy and biopsy allows histological examination and staging
Staged based on invasiveness
Graded based on nuclei of cells.
How are bladder TCC treated?
Varied based of staging and grading of the tumour
• Low risk non-muscle invasive – Treated with TURBT +/- intravesical chemotherapy to bladder
• High risk non muscle invasive – TURBT + intravesical chemotherapy, intravesical BCG treatment, cystectomy
• Muscle invasive cancer – Cystectomy + radiotherapy (with radiosensitiser) or palliative care
What is cystectomy?
Surgical removal of the bladder. Part of the ileum is used to create a conductive route out of the body, creating a stoma to collect urine
What is intra vesicle chemotherapy?
Chemotherapy placed in the bladder and left (~1hour) before being drained
What is BCG treatment?
Altered vaccine given for BGC treatment. Vaccine placed directly into tumour. Stimulated bodies immune response against the cancer
How common are transitional cell carcinomas of the upper urinary tract?
Rare - only 5% of all malignancies
What are TCCs of upper urinary tracts?
Cancers in calyxes, renal pelvis or ureters
What conditions are associated with TCC of the upper urinary tract?
Bladder cancer
How do patients with TCC of upper urinary tract present?
Early obstruction
Haematuria
How do we treat TCC of upper urinary tract?
Treated with nephro-ureterectomy
kidney, perirenal fat, ureter, cuff of bladder
