1.06 - Urological Cancer Flashcards
Risk factors for prostate cancer.
- family history
- African
- increased age
- chronic inflammation
- obesity
- smoking
- BRCA mutation
What is the most common type of prostate cancer?
Adenocarcinoma
Primary prevention of prostate cancer.
- smoking cessation
NB: no dietary supplements or medication are known to be effective in prevention.
Secondary prevention of prostate cancer.
- androgen deprivation therapy
- prostatectomy
Tumour marker associated with prostate cancer.
PSA - sensitive but not specific.
Differential diagnoses for prostate cancer.
- prostatitis
- BPH
- prostatic trauma (ie. DRE, catheterisation)
- long ride (e.g. airplane, cycling)
Presentation of prostate cancer.
- asymptomatic
- voiding symptoms
- haematuria
- hydronephrosis
- bone pain (?mets)
What scoring system is used to classify prostate cancer?
Gleason score
Laboratory tests for prostate cancer.
- PSA
- prostate cancer gene 3 (PCA3)
Imaging techniques used in prostate cancer.
Multiparametric MRI GOLD STANDARD
Ultrasound guided biopsy, and CT for staging, may be used.
What is the issue with prostate cancer screening?
Associated with potential harms of psychological and physical stress of over-treatment of an indolent cancer.
Treatment options of prostate cancer.
- watchful waiting
- active surveillance
- prostatectomy
- hormone therapy
- chemotherapy
- radiotherapy
- bisphosphonates
Role of watchful waiting in prostate cancer.
Avoids the use of surgery or radiation, often suitable in older men or those with significant comorbidities.
It is aimed at people with localised prostate cancer who are either not suitable for, or do not wish to receive, curative treatment.
Role of active surveillance in prostate cancer.
A curative strategy aimed at people with localised prostate cancer, keeping them within a ‘window of curability’.
Active surveillance may avoid or delay the need for radiotherapy or surgery.
Difference between active surveillance and watchful waiting.
Active surveillance includes repeating the prostate biopsy and PSA levels at intervals, to allow prognostic risk category to be reassessed.
Treatment is only offered when risk increases, but with curative intent, in active surveillance.
Types of radical treatments in prostate cancer.
- radical prostatectomy
- external beam radiotherapy
- brachytherapy
Role of hormonal treatments in prostate cancer.
Control of cancer by removing or blocking the effects of hormones that stimulate the growth of prostate cancer cells.
Androgen deprivation (ie. orchidectomy, LHRH agonists) and androgen blockades can be used.
When is chemotherapy indicated in prostate cancer?
Hormone-relapsed metastatic disease.
Role of bisphosphonates in prostate cancer.
Offered to people having androgen deprivation therapy and have osteoporosis.
What are the side effects of hormonal treatments in people with prostate cancer?
- hot flushes
- fatigue
- osteoporosis
- gynaecomastia
Side effects of radical prostatectomy.
- stress urinary incontinence
- erectile dysfunction
- infertility / aspermia
Pelvic floor muscle exercises and medical therapies.
Side effects of radiotherapy in prostate cancer.
- urinary incontinence
- bowel incontinence
- erectile dysfunction
- urethral strictures
- infertility
- haemorrhagic cystitis
- bladder irritation
- rectal irritation
Differential diagnoses for prostate mass detectable by DRE.
- prostate cancer
- normal asymmetry
- BPH
- prostatitis
- cyst
- prior TURP / biopsy scar
Patterns of spread of prostate cancer.
- local spread (ie. seminal vesicles)
- lymphatic spread
- haematogenous spread (ie. bone)
Which urological cancers may present with haematuria?
- renal cell carcinoma
- transitional cell carcinoma
- bladder carcinoma
- advanced prostate cancer
What are the two broad categories of testicular tumours?
Germ cell tumours (~95%)
Non-germ cell tumours (~5%)
What are the types of germ cell tumours?
- seminomas
- mixed germ cell tumour
- non-seminomas
What are the types of non-germ cell tumours?
Leydig cell tumour
Sertoli cell tumour
Prognosis of seminomas vs nonseminomas.
Seminoma - rarely metastasises and cure rate almost 100%.
Nonseminomas - spread more quickly and have a higher capacity for haematogenous spread.
Non-germ cell tumours are more common in children / adults?
Children
Risk factors for testicular cancer.
- HIV infection
- hypospadia
- ectopic testis
- mumps orchitis
- personal history
- family history
- cryptorchidism
Screening for testicular cancer.
No formal testicular screening programme - men encouraged to perform monthly testicular self-examinations.
Signs of germ cell tumours.
- enlarged testicle
- non-tender and solid testicular mass
- scrotal oedema
- gynaecomastia
Symptoms of germ cell tumours.
- dull pain in groin, abdomen or back
- sensation of scrotal heaviness
- testicular pain
Common sites of testicular cancer metastasis.
- lymph nodes
- lung
- liver
- brain
- bone
Diagnostic workup for testicular cancer.
- scrotal ultrasound
- AFP, hCG and LDH tumour markers
- CXR and CTA to exclude metastatic disease
- biopsy
Serum tumour markers for testicular cancer.
- LDH
- AFP
- beta-hCG
Staging of testicular cancer.
TNM
Management of testicular cancer.
Active surveillance.
Orchiectomy.
Chemotherapy.
Radiotherapy.
Complications of orchiectomy.
- bleeding
- infection
- changes to appearance
- erectile dysfunction
- retrograde ejaculation
- issues with fertility
How can issues with fertility be mitigated with testicular cancer?
A baseline sperm count and sperm cryopreservations should be discussed with all males diagnosed with testicular cancer.
Prognosis of testicular cancer.
5 year survival is 97% overall.
Risk factors for renal cell carcinoma.
- smoking
- hypertension
- obesity
- CKD
- genetics
- chronic hepatitis C
- kidney stones
- sickle cell disease
Presentation of renal cell carcinoma.
- haematuria
- palpable mass
- flank pain
Incidental finding often.
Paraneoplastic syndromes associated with kidney cancer.
- anaemia
- hepatic dysfunction
- hypercalcaemia
- polycythaemia
- hypertension
Differential diagnoses for renal masses.
- renal cysts
- renal adenomas
- renal cell carcinoma
- Wilm’s tumour
Most common type of kidney cancer in adults and children.
Adults: renal cell carcinoma
Children: Wilm’s tumour
Diagnostic workup for kidney cancer.
- urinalysis (gross haematuria)
- U&Es
- serum calcium
- CT CAB
- biopsy
Staging of renal cell carcinoma.
TNM
Management of renal cell carcinoma.
Localised cancer:
- radical nephrectomy
- partial nephrectomy
- thermal ablation
- active surveillance
Advanced cancer:
- immunotherapy
- radiotherapy
- targeted therapy
Examples of targeted therapies in renal cell carcinoma.
- anti-VEGF therapy
- TK inhibitors
- mTOR inhibitors
Prognosis of renal cell carcinoma.
Risk factors for bladder cancer.
- smoking
- aromatic amines
- recurrent cystitis
- bladder stones
- schistosomiasis infection
- male sex
- increasing age
- Caucascian race
- family history
- pelvic irradiation
Presentation of bladder cancer.
- painless haematuria
- irritative voiding
- abdominal pain
- constipation
Diagnostic test for bladder cancer.
Flexible cystoscopy.
Treatment of non-muscle invasive bladder cancer.
- transurethral resection of bladder tumour (TURBT)
- intravesical immunotherapy with BCG
Treatment of muscle invasive bladder cancer.
- cystectomy
- radiotherapy
- chemotherapy
Common side effects of intravesical BCG.
- chemical cystitis
- visible haematuria
- general fatigue / malaise
- fever
- prostatitis
- sepsis
- renal abscess
