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Semester 3 - Urinary > Session 9 - Cancers of the Urinary System > Flashcards

Session 9 - Cancers of the Urinary System Flashcards

1
Q

Name three main risk factors for prostate cancer

A
  • Age
    • Family history
    • Race
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2
Q

How is age a risk factor for prostate cancer?

A
  • There is a correlation with increasing age

* Uncommon in men younger than 50

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3
Q

How is family history a risk factor for prostate cancer?

A
  • 4x increased risk
    • If one 1st degree relative is diagnosed with prostate cancer before age 60
    • After 60 diagnosis probably age related
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4
Q

How is prostate cancer related to race?

A

• Incidence in asian < Caucausian < Afro-Carribean

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5
Q

Give the usual presentation of prostate cancer

A 
• Vast majory asymptomatic
	• Urinary symptoms
		○ Benign enlargement of prostate
		○ Bladder over activity
		○ +/- CaP
	• Bone pain 
		○ Advanced metastatic
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6
Q

Give an unusual symptom of prostate cancer

A

haematuria

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7
Q

Outline how prostate cancer is diagnosed

A

• A digital rectal examination
• A serum PSA
○ Used to assess wether or not a biopsy in necessary
• If it is, carried out via a TransRectal UltraSound guided biopsy of prostate
• Lower urinary tract symptoms are treated with a TransUrethral Resection of Prostate

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8
Q

Give 5 factors influencing treatment decisions in prostate cancer

A 
MADBP
	• Age
	• Digital Rectal Exam
	• PSA level
	• Biopsies
	• MRI scan and bone scan
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9
Q

What are the three different results you can get from a digital rectal exam?

A
  • Localised (T1/2)
    • Locally advances (T3)
    • Advanced (T4)
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10
Q

What can biopsies tell us about the advancement of prostate cancer?

A

• Gleason grade

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11
Q

What is a Gleason grading?

A

• Pathologist adds together grading score of most common cell type and adds to highest graded prostate tissue

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12
Q

Give three treatments for established prostate cancer

A

• Surveillance
○ Watch cancer, tumor not severe enough to outweigh risks of treatment
• Radical prostateectomy

Radiotherapy - External beams or low dose brachytherapy

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13
Q

Give three treatments for developmental prostate cancers

A
  • High intensity focused ultrasound
    • Primary cryotherapy - freeze the prostate
    • Brachytherapy - High dose (small rods implanted in prostate)
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14
Q

How can metastatic prostate cancer be treated?

A

• Hormones
○ Surgical castration, medical castration
• Palliation

Single-dose radiotherapy, bisphosphonates, chemotherap

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15
Q

Give three ways to treat locally advanced prostate cancer

A
  • Surveillance
    • Hormones
    • Hormones & radiotherapy
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16
Q

What is haematuria?

A
  • Blood in urine

* Classified as visible or non-visible

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17
Q

What does it mean if haematuria is visible?

A

• On investigation there is a 20% chance a malignancy is present

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18
Q

What does it mean if haematuria is non-visible?

A

• Can be symptomatic or asymptomatic

Detected via microscopy or urine dipstick

19
Q

Give three causes of haematuria

A
  • Cancer
    • Other

Nephrological

20
Q

Give four types of cancer which can cause haematuria

A
  • Renal cell carcinoma
    • Upper tract transition cell carcinoma
    • Bladder cancer
    • Advanced prostate cancer
21
Q

Give five non-cancerous causes of haematuria

A
  • Stones
    • Infection
    • Inflammation
    • Benign prostatic hyperplasi

Nephrological

22
Q

What questions must be taken on investigating the history of someone with haematuria?

A
  • Smoking
    • Occupation
    • Pain levels
    • Other UTI symptoms
    • Family history
23
Q

What should be looked for on examination of someone with haematuria

A
  • BP
    • Abdominal mass
    • Varicocele – collection of veins in the scrotum (‘bag of worms’)
    • Leg swelling
    • Assess prostate by DRE (male) – Size, texture
24
Q

What investigations should be done for haematuria?

A
  • Urine culture
    • Cytology
    • FBC
    • Ultrasound
    • Flexible cystoscopy
25
Q

Outline the epidemiology of bladder cancer

A
  • 7th most common cancer in the UK, but incidence decreasing]
    • Male to female ratio 2.5:1 and 90% are transitional cell carcinomas
26
Q

Give three large risk factors for bladder cancer

A
  • Smoking
    • Occupational exposure
    • Schistomiasis
27
Q

How much does smoking increase risk of bladder cancer?

A

• 4x increased risk

28
Q

Give three examples of occupational exposure increasing risk of bladder cancer

A
  • Rubber or plastics manufacture (arylamines)
    • Handling of carbon, crude oil, combustion (polyaromatic hydrocarbons)
    • Painters, mechanics, printers, hairdressers
29
Q

Outline the staging of bladder cancer

A
  • 75% of cancers are superficial
    • 5% are in situ
    • 20% are muscle invasive
30
Q

Give three types of bladder cancer which all have different treatments

A
  • High risk non-muscle invasive TCC (transitional cell carcinoma, you simpleton)
    • Low risk non-muscle invasive TCC

Muscle invasive TCC

31
Q

Give two treatments for high risk non-muscle invasive TCC

A
  • Check cystoscopies

* Intravesical chemotherapy/immunotherapy

32
Q

Give a treatment for low risk non-muscle invasive TCC

A

• Check cystoscopies

33
Q

Give two courses of treatment for muscle invasive TCC

A

• Potentially curative
○ Radical cystectomy or radiotherapy (+/- chemotherapy)
○ Not curative
• Palliative chemotherapy/radiotherapy

34
Q

What is a radical cystectomy?

A

• Removal of the urinary bladder

35
Q

What can be done after a radical cystectomy to simulate a bladder?

A
  • A piece of ileum may be used to make a conduit from the ureters to the abdomen, where urine can be collected in a bag
    • May also attempt to reconstruct the bladders from a piece of small intestine
36
Q

Outline the epidemiology renal cell carcinoma

A
  • 8th most common cancer in the UK, making up 95% of all upper urinary tract tumours
    • Male to female ratio of 3:2 and 30% have metastases on presentation
37
Q

Give three risk factors for RCC

A
  • Smoking
    • Obesity
    • Dialysis
38
Q

Where does RCC mestatasise to?

A
  • Lymph nodes
    • Up the renal vein
    • Vena cava into right atrium
    • Into subcapsular fat (perinephric spread)
39
Q

What is the established treatment for RCC?

A

• Surveillance
• Radical nephrectomy
○ Removal of kidney, adrenal, surrounding fate and upper ureter
• Partial nephrectomy

40
Q

Give a developmental treatment for RCC

A

• Ablation

○ Removal of tumour via erosive process

41
Q

Give two palliative treatments for RCC

A
  • Molecular therapies targeting angiogenesis

* Immunotherapy

42
Q

What is the epidemiology of Upper Tract Transitional Cell Carcinoma (TCC)

A
  • Only 5% of malignancies of URT (Rest are RCC)
    • 5% due to spread of cancer from bladder
    • 40% of cancers of the URT spread to bladder
43
Q

Give four investigations for Upper Tract TCC

A 
• Ultrasound
	• CT urogram
	• Retrograde pyelogram (inject contrast into ureter)
	• Ureteroscopy
		○ Biopsy
		○ Washings for cytology
44
Q

What is the treatment for upper tract TCC?

A

• Nephro-ureterectomy

Removal of the kidney, fat, ureter and cuff of bladder

Semester 3 - Urinary (33 decks)

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