11 Flashcards
How does RCC present?
Localized or advanced
- haematuria
- incidental finding on imaging
- rare to be palpable
If advanced
- large varicocele may be present
- pulmonary/tumour embolus
- weight loss/loss of appetite/symptom from metastasis
- hypercalcaemia
See session 11 urological cancers slide 5
How does TCC present?
Localized or advanced
- haematuria
- incidental finding on imaging
If advanced
- weight loss/loss of appetite/symptom of metastasis
- DVT
- lymphoedema
See session 11 urological cancers slide 6
In terms of haematuria, how would you classify, diagnose and investigate it?
- it is either visible or non visible
- can be present because of cancers, stones, infection, inflammation, or benign prostatic hyperplasia
- pt. History of smoking, occupation, family history
- examine BP, abd mass, varicocele, leg swelling, assess prostate by DRE
See session 11 urological cancers slide 7-13
What is the epidemiology of RCC?
- 95% of all upper urinary tract tumours
- more common in males than females
- white > non-white
- 30% metastases on presentation
- aetiology: smoking, obesity, dialysis
See session 11 urological cancers slide 15
How does RCC spreads?
- perinephric spread
- lymph node metastases
- IVC spread to right atrium
See session 11 urological cancers slide 16
What diagnostic investigations would you use for RCC?
- ultrasound
- CT
See session 11 urological cancers slide 17
What treatment would you give for localized RCC?
- surveillance
- excision
- ablation: removal/destruction
See session 11 urological cancers slide 18
What is the treatment for metastatic RCC?
Palliative
- biological therapies
- targeted therapies
See session 11 urological cancers slide 19
What is a renal TCC?
-malignant tumour arising from transitional epithelial cells lining the urinary tract from the renal calyces to the urethral orifice
What is bladder TCC?
- most common primary neoplasm of the urinary bladder
- most common tumour of the entire urinary system
See session 11 urological cancers slide 20-21
What is the epidemiology of bladder TCC?
- incidence is decreasing
- presentation is often more advanced in women
- more common in males
- white > non-white
- risk factors: smoking, occupational exposure (ex. Rubber or plastics manufacture, smelting, painting, mechanics, printers, hairdressers)
See session 11 urological cancer slide 22
What is the treatment for bladder TCC?
- superficial TURBT
- depends on how risky the muscle invasion is
- do chemo, radiotherapy or cystectomy
See session 11 urological cancers slide 23, 26-28
How would you stage and grade a bladder TCC?
TNM staging
-usually acheived with cystoscopy and full thickness biopsy
See session 11 urological cancers slide 24-25
What is aetiology of renal TCC?
- smoking
- phenacetin abuse
- Balkan’s nephropathy
See session 11 urological cancers slide 30-32
What investigations would you do for renal TCC?
Ultrasound
-hydronephrosis
CT urogram
- filling defect
- ureteric stricture
Retrograde pyelogram
Ureteroscopy
- biopsy
- washings for cytology
See session 11 urological cancers slide 33
What is the treatment for renal TCC?
- Nephro-ureterectomy
- kidney, fat, ureter, cuff of bladder
See session 11 urological cancers slide 34
How would you treat a metastatic TCC?
- systemic chemotherapy
- immunotherapy
See session 11 urological cancers slide 35
What is the most common presenting complaint in haematuria?
- haematuria
- can be macroscopic or microscopic
- tumour near VUJ may result in ureteral obstruction and hydronephrosis which will present as flank pain
- tumour near ureteral orifice may result in bladder outlet obstruction and urinary retention
How does benign prostate hyperplasia occur?
-as the prostate grows it can press on the urethra and interfere with urine flow
What are the risk factors for prostate cancer?
- increase in age
- family history
- BRCA2 gene mutation
- ethnicity: black>white>Asian
See prostate cancer slide 9
How would you screen for prostate cancer?
PSA blood test
See prostate cancer slide 10-13
What issues can occur with PSA screening?
- over-diagnosis
- over-treatment
- QoL
- cost-effectiveness
- infection, inflammation, large prostate, urinary retention
- cannot rely on a PSA within 6 weeks of a urianry infection
See prostate cancer slide 14-16
How do men with prostate cancer present?
- urinary symptoms
- bone pain
- had their PSA checked, then biopsied
- DRE for another reason
See prostatic cancer slide 17-20
What factors influence treatment decisons for prostate cancer?
- age
- DRE
- PSA leve
- biopsies
- MRI scan and bone scan
See prostatic cancer slide 21-23
How would you treat localized prostate cancer?
- surveillance
- robotic radical prostatectomy
- radiotherapy
See prostatic cancer slide 24-25
How would you treat advanced prostate cancer?
- surveillance
- hormones
- hormones and radiotherapy
See prostatic cancer slide 26-27
How would you treat metastatic prostate cancer?
- hormones (chemo)
- palliation: single-dose radiotherapy, chemo
See prostatic cancer slide 28-29
In which zones of the prostate does benign growth occur and prostate cancer develop?
- transition zone: where most benign growths occur leading to BPH
- peripheral zone: where most prostate cancer develops
