11a.) Urological Cancers

Question 1

Where in renal system does transitional cell carcinoma occur?

Answer 1

• Renal pelvis
• Ureters
• Bladder

Question 2

Where in the renal system does renal cell carcinoma occur?

Answer 2

Parenchyma of kidneys

Question 3

How does TCC present?

Answer 3

• Haematuria

If advanced…

• Loss of weight/loss of appetite/symptoms of metastsises
• DVT
• Lymphoedema

Question 4

How does RCC present?

Answer 4

• Haematuria
• Palpable mass in area of kidneys (rare)

If more advanced…

• Large varicocele (more common in left)
• Pulmonary/tumour embolus
• Loss of weight/loss of apetite/symptom from metastasis
• Hypercalcaemia
• Symptoms to do with hormone production of kidneys e.g. anaemia, hypertension
• Fever/ night sweats

Question 5

What do the following stand for:

• RCC
• TCC

Answer 5

• RCC= renal cell carcinoma
• TCC= transitional cell carcinoma

Question 6

Describe how we can classify haematuria

Answer 6

Question 7

State some differential diagnoses for haematuria

Answer 7

Question 8

If a patient comes in with haematuria, what questios should we be asking when taking a history?

Answer 8

• Smoking
• Occupation
• Painful or painless
• Other lower urinary tract symptoms
• Family history

Question 9

If a patient comes in with haematuria, what examinations should you do?

Answer 9

• BP
• Check for abdominal mass
• Varicocele
• Leg swelling
• Asses prostrate by DRE (male)
  
  • Size
  • Texture

Question 10

What investigations should be do for someone with haematuria?

Answer 10

Question 11

What % of upper urinary tract cancers are RCC?

Answer 11

95%

*Remember: UUT= kidneys & ureters

Question 12

Who is RCC more common in, white or non-white people?

Answer 12

White > non-white

Question 13

Who is RCC more common in, male or female?

Answer 13

M:F

3:2

Question 14

Approximately what % of RCC patients have metastases on presentation

Answer 14

30%

Question 15

State 3 risk factors for RCC

Answer 15

• Smoking
• Obesity
• Dialysis

Question 16

Describe how RCC can spread

Answer 16

Question 17

Describe what RCC looks like on:

• Ultrasound
• CT

Answer 17

Question 18

Describe the treatment of localised RCC

Answer 18

• Surveillance
• Excision
  
  • Radical nephrectomy (removal of kidney, adrenal gland, surrounding fat & upper ureter)
    
    • Open
    • Laproscopic
  • Partial nephrectomy (removal of diseased part of kidney)
    
    • Open
    • Robotic
• Ablation
  
  • Cryoablation: uses extreme cold to destroy tumour
  • Radiofrequency ablation: uses high enery radio waves to heat tumour

Question 19

Describe the treatment for metastatic RCC

Answer 19

• Palliative
  
  • Biological therapies: boost persons immune system to recognise and destroy cancer cells
  • Targeted therapies: number one choice is therapies that target angiogenesis

*RCC is typically radio- and chemo- resistant

Question 20

What type of carcinoma makes up 90% of bladder cancers?

Answer 20

TCC (transitional cell carcinoma)

Question 21

Presentation of TCC is often more advanced in men than women; true or false?

Answer 21

FALSE, women often present more advanced than men

Question 22

Is TCC more common in:

• White or non-white
• Male or female

Answer 22

• White
• Male (3:1)

Question 23

State some risk factors for bladder TCC

Answer 23

• Smoking (x4)
• Occupational exposure (20yr delay)
  
  • Rubber or plastics manufacture
  • Handling of carbon, crude oil, combustion, smelting
  • Painters, mechanics, printers, hairdressers

Question 24

Describe the initial definitive treatment for bladder TCC

Answer 24

• Superficial TURBT (transurethral resection of bladder tumour)
• Separate deep TUR (transurethral resection) of muscle
• Single intravesical instillation of mitomycin C (chemotherapy)

Question 25

What % of bladder tumours are superificial and what % are muscle invasive?

Answer 25

* 75% superficial * 20% muscle invasive

Question 26

Stage of bladder TCC can be 1,2,3,4 or TIS; what is TIS?

Answer 26

Non-invasive carcinoma/in situ/not invaded basement membrane

Question 27

Describe the staging of bladder TCC

Answer 27

Uses TNM

Question 28

Describe the treatment for each of teh following: * Low risk non-muscle invasive TCC * High risk non-muscle invasive TCC * Muscle invasive TCC

Answer 28

* For muscle invasive:* * *If potentially curative= radical cystectomy or radiotherapy +/- chemotherapy* * If not curative= palliative chemoterapy/radiotherapy*

Question 29

What is radical cystectomy?

Answer 29

* Surgery to remove the bladder * Then use ileum to make a conduit from ureter to stoma on abdomen or make a new bladder *NOTE: ileum better than just putting ureters into stoma as ureters would be stretched and so stenose*

Question 30

What % of TCCs are found in upper urinary tract?

Answer 30

5%

Question 31

State some risk factors for TCC of upper urinary tract

Answer 31

* Smokinig * Phenacetin abuse (pain and fever relieving drug that used to be used) * Balkan's nephropathy (degenerative interstitial nephritis)

Question 32

What is the likelihood, in terms of percentage, of getting a TCC in upper urinary tract if you previously had a TCC bladder?

Answer 32

Question 33

What is the likelihood, in terms of percentage, of getting a TCC in bladder if you previously had a TCC in upper urinary tract?

Answer 33

Question 34

State some investigations you might do if you suspect an upper urinary tract infection

Answer 34

* Ultrasound * Look for hydronephrosis * CT urogram * Look for filling defect or ureteric stricture * Retrograde peylogram * Put dye up urethra and follow it * Ureteroscopy * Obtain biopsy * Obtain washings for cytology

Question 35

What is the standard treatment for non-metastasised TCC of upper urinary tract?

Answer 35

Nephro-ureterectomy (remove kidney, adrenal galnds, surrounding fat, ureter & cuff of bladder)

Question 36

Describe the treatment for metastatic TCC of upper urinary tract

Answer 36

* Systemic chemotherapy (cis-platin based) * Biological therapies

Question 37

What % of patients with RCC are aysmptomatic?

Answer 37

25-30%