11. Urinary cancers Flashcards
from which part of the developing kidney does RCC come from?
metanephric blastema
from which part of the developing kidney does TCC come from?
ureteric bud
explain how RCC can cause varicocele
tumour grows along L renal vein, gonadal vein cant drain properly so fluid collects in scrotum
why does RCC only cause varicocele on LHS?
on RHS, gonadal veins drains straight into IVC not renal vein first
investigations for RCC
US/CT
flexible cystoscopy
cystology
aim of palliative treatment for metastatic RCC
target angiogenesis to reduce tumour’s blood supply
why might someone with urinary cancer be pale?
anaemic due to haematuria
investigations for bladder TCC
-urinalysis (exclude UTI)
-cystoscopy
-FBC (Hb)
-U&Es (renal function)
-US
-urine culture and sensitivity
non-muscle invasive bladder TCC can be treated with intra-vesical chemo, what does this mean?
chemo directly inside bladder
risk of having TCC of upper urinary tract
40% chance of getting bladder cancer from ‘seeding’
how could patients with prostate cancer present?
-urinary symptoms e.g. urgency, frequency, nocturne
-bone pain due to sclerotic bone metastases
examination for prostate cancer , and results
DRE
-enlarged, hard, irregular prostate
differentials for prostate cancer
UTI
BPH
prostatitis
parkinson’s
urethral stricture
risk of surgery for prostate cancer
affects pudendal nerve, causing incontinence, impotence
hormone that promotes prostate tumour growth
testosterone (and its more potent form: dihydrotestosterone)
what’s used in medical castration for prostate cancer?
LHRH + GNRH agonists
affects of cysts in kidney
compress surrounding parenchyma, imparting renal function
can haemorrhage into cysts = abdo pain, haematuria
epithelium lining cysts of kidney
cuboidal
why Is it important to explore history/ FH of cardiovascular issues in PKD?
berry aneurysms common as vessel walls are weaker and fill with blood, due to chronic HTN
treatment of APKD
-control BP by ACEi, ARB
-pain control (from haemorrhage= renal colic)
-IV fluids to wash out clots, increase urine output
-avoid contact sports
dialysis and transplant if end stage failure
would it be worth screening a patients child if patient had PKD? what should be done?
no
screen annually for BP and urine dipstick (blood)
US in late teens for cysts, again at 30
if nothing= not inherited PKD
