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Urinary > 11 > Flashcards

11 Flashcards

1
Q

How does RCC present?

A

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

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2
Q

How does TCC present?

A

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

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3
Q

In terms of haematuria, how would you classify, diagnose and investigate it?

A
  • 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

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4
Q

What is the epidemiology of RCC?

A
  • 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

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5
Q

How does RCC spreads?

A
  • perinephric spread
  • lymph node metastases
  • IVC spread to right atrium

See session 11 urological cancers slide 16

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6
Q

What diagnostic investigations would you use for RCC?

A
  • ultrasound
  • CT

See session 11 urological cancers slide 17

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7
Q

What treatment would you give for localized RCC?

A
  • surveillance
  • excision
  • ablation: removal/destruction

See session 11 urological cancers slide 18

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8
Q

What is the treatment for metastatic RCC?

A

Palliative

  • biological therapies
  • targeted therapies

See session 11 urological cancers slide 19

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9
Q

What is a renal TCC?

A

-malignant tumour arising from transitional epithelial cells lining the urinary tract from the renal calyces to the urethral orifice

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10
Q

What is bladder TCC?

A
  • most common primary neoplasm of the urinary bladder
  • most common tumour of the entire urinary system

See session 11 urological cancers slide 20-21

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11
Q

What is the epidemiology of bladder TCC?

A
  • 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

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12
Q

What is the treatment for bladder TCC?

A
  • superficial TURBT
  • depends on how risky the muscle invasion is
  • do chemo, radiotherapy or cystectomy

See session 11 urological cancers slide 23, 26-28

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13
Q

How would you stage and grade a bladder TCC?

A

TNM staging
-usually acheived with cystoscopy and full thickness biopsy

See session 11 urological cancers slide 24-25

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14
Q

What is aetiology of renal TCC?

A
  • smoking
  • phenacetin abuse
  • Balkan’s nephropathy

See session 11 urological cancers slide 30-32

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15
Q

What investigations would you do for renal TCC?

A

Ultrasound
-hydronephrosis

CT urogram

  • filling defect
  • ureteric stricture

Retrograde pyelogram

Ureteroscopy

  • biopsy
  • washings for cytology

See session 11 urological cancers slide 33

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16
Q

What is the treatment for renal TCC?

A
  • Nephro-ureterectomy
  • kidney, fat, ureter, cuff of bladder

See session 11 urological cancers slide 34

17
Q

How would you treat a metastatic TCC?

A
  • systemic chemotherapy
  • immunotherapy

See session 11 urological cancers slide 35

18
Q

What is the most common presenting complaint in haematuria?

A
  • 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
19
Q

How does benign prostate hyperplasia occur?

A

-as the prostate grows it can press on the urethra and interfere with urine flow

20
Q

What are the risk factors for prostate cancer?

A
  • increase in age
  • family history
  • BRCA2 gene mutation
  • ethnicity: black>white>Asian

See prostate cancer slide 9

21
Q

How would you screen for prostate cancer?

A

PSA blood test

See prostate cancer slide 10-13

22
Q

What issues can occur with PSA screening?

A
  • 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

23
Q

How do men with prostate cancer present?

A
  • urinary symptoms
  • bone pain
  • had their PSA checked, then biopsied
  • DRE for another reason

See prostatic cancer slide 17-20

24
Q

What factors influence treatment decisons for prostate cancer?

A
  • age
  • DRE
  • PSA leve
  • biopsies
  • MRI scan and bone scan

See prostatic cancer slide 21-23

25
Q

How would you treat localized prostate cancer?

A
  • surveillance
  • robotic radical prostatectomy
  • radiotherapy

See prostatic cancer slide 24-25

26
Q

How would you treat advanced prostate cancer?

A
  • surveillance
  • hormones
  • hormones and radiotherapy

See prostatic cancer slide 26-27

27
Q

How would you treat metastatic prostate cancer?

A
  • hormones (chemo)
  • palliation: single-dose radiotherapy, chemo

See prostatic cancer slide 28-29

28
Q

In which zones of the prostate does benign growth occur and prostate cancer develop?

A
  • transition zone: where most benign growths occur leading to BPH
  • peripheral zone: where most prostate cancer develops

Urinary (11 decks)

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