12. Neoplasms

Question 1

What is the most common tumour type in the kidneys?

Answer 1

RENAL CELL CARCINOMA

• originates in PCT cells
• most common subtype: clear cell RCC - epithelial cells with clear cytoplasm due to glycogen accumulation and well-defined membrane, separated by delicate branching network of vascular tissue

Question 2

What are the main risk factors for renal cell carcinoma?

Answer 2

• smoking (2x increase)
• obesity
• hypertension
• long term dialysis

Question 3

How do renal cell carcinoma Ps usually present?

Answer 3

> 50% detected using USS to investigate non-specific features

classic triad of HAEMATURIA, LOIN PAIN and LOIN MASS now rarely seen

Question 4

Name the 2 most common sites of renal cell carcinoma metastasis

Answer 4

1. Lung - cannonball secondaries

2. Bone - osteolytic lesions

Question 5

What is the most common tumour of the urinary system?

Answer 5

Bladder transitional cell carcinoma

Question 6

What is the most common presentation for bladder transitional cell carcinoma?

Answer 6

painless haematuria

Question 7

What is the most common type of prostate malignancy? Which regions does this arise in?

Answer 7

ADENOCARCINOMA

• arise in peripheral zone
• usually slow growing but can be aggressive
• invade nearby organs, e.g. rectum, seminal vesicles

Question 8

Name the 2 most common sites for prostate cancer metastasis.

Answer 8

1. lymph nodes

2. bone - osteoblastic lesions cause increased bone density

Question 9

What are the main symptoms of prostate malignancy?

Answer 9

1. urinary symptoms, inc. weak stream, hesitancy, frequency, urgency, etc.
2. UTI

Locally invasive disease:

3. haematuria, dysuria, incontinence
4. perineal and suprapubic pain
5. impotence
6. rectal symptoms, e.g. tenesmus

Question 10

What might one feel in a DRE of prostate tumour?

Answer 10

hard, irregular gland with nodules

Question 11

What is PSA and what do increased levels indicate?

Answer 11

Prostate Specific Antigen - produced exclusively by epithelial prostatic cells in cases of:

• BPH
• prostate cancer
• prostatitis
• old age
• acute urinary retention

So non-specific for PC diagnosis (and some PC Ps have normal levels, but can be used to monitor treatment effectiveness).

Question 12

What does hormonal therapy for prostate cancer involve?

Answer 12

Involves ‘medical castration’ to reduce effects of testosterone and other androgens on cancer progression (although surgical castration considered gold standard).

LHRH agonists bind LH Rs in anterior pituitary… constant stimulation (rather than pulsatile) causes decreased testosterone production by Leydig cells.