17) Malignancy of Urinary Tract Flashcards
What is the most common cancer in men?
Prostate cancer
Are those with prostate cancer likely to die form it?
No
What are some risk factors for prostate cancer?
Increasing age
Family history
Ethnicity
What ethnicities are more at risk of developing prostate cancer?
Black > White > Asian
What is meant by a family history of prostate cancer?
If 1st degree relative diagnosed before 60
BRCA2 gene mutation
What screening programmes are available for prostate cancer?
Opportunistic if patients are counselled and present with urinary symptoms
What are some issues with screening?
Overdiagnosis
Overtreatment
Cost effectiveness
Serum PSA can be raised in infection, inflamm and hyperplasia of prostate
How does prostate cancer present?
Asymptomatic (majority)
Enlargement of prostate, bladder overactivity
Bone pain - metastasis to bone and LN
If prostate cancer is advanced what other symptom may be seen?
Haematuria
In what ways can prostate cancer be diagnosed?
Digital rectal exam
Serum PSA (prostate specific antigen)
Lower urinary tract symptoms
Why and how is a biopsy of the prostate carried out?
If needed after DRE or serum PSA
Transrectal ultrasound guided biopsy
What is carried out if prostate cancer is suspected from lower urinary tract symptoms?
Transurethral resection of prostate - cutting away small bits of prostate to relive symptoms
What factors affect treatment decisions of prostate cancer?
Age T stage by DRE PSA level Gleason Grade - biopsy MRI and bone scan for metastasis
Describe the T stages obtained by DRE:
T1/2 - Localised
T3 - Locally advanced, nodules
T4 - Advanced, hard with smooth surface due to nodules coalescing
What treatment is there for localised prostate cancer?
Surveillance - treatment may do more damage
Radical prostatectomy
Radiotherapy
What is a radical prostatectomy?
Removal of part of all of the prostate
What treatment is there for locally advanced (T3) prostate cancer?
Surveillance
Hormones +/- radiotherapy
What treatment is there for metastatic prostate cancer?
Surgical castration
Medical castration - LHRH agonists
Palliation - radio, chemo, bisphosphonates
How do LHRH agonists work?
Firstly stimulate testosterone but after a week cause decrease in normal LHRH so decrease in LH and testosterone, therefore, slow growth of prostate and cancer cells
Describe bone metastasis in prostate cancer and how they can be spotted:
They are sclerotic (osteoblastic)
Spotted as hot spots on bone scan
What is non-visible haematuria?
Seen on dipstick or microscopy
State some causes of haematuria:
Renal cell carcinoma Bladder cancer Advanced prostate cancer Stones Infection Inflamm Glomerular diseases
What examinations would you do if haematuria was present?
BP Abdominal mass Varicocele - veins in scrotum Leg swelling DRE
What tests and investigations would you carry out if haematuria was present?
FBC
Urine culture
Flexible cystoscopy
Ultrasound
What type of cancer are most bladder cancers?
Transitional cell carcinoma
What are some risk factors for bladder cancer?
Smoking
Occupational exposure - rubber, plastic, hydrocarbons, paints and dyes
(Schistosomiasis)
What two stages of bladder cancer are there?
Superficial and muscle invasive
What treatment is there for high risk non-muscle invasive bladder cancer?
Cystoscopy, intravesical chemotherapy
What treatment is there for low risk non-muscle invasive bladder cancer?
Cystoscopy +/- intravesical chemotherapy
What treatment is there for muscle invasive bladder cancer?
Neoadjuvant chemo + radical cystectomy or radiotherapy
or Palliative chemo/radiotherapy
What is a radical cystectomy?
Removal of bladder (womb and ovaries). Ileum may be used to make a channel for ureters and urine collected in bag. May attempt to reconstruct bladder from intestine
What cancer causes most upper urinary tract tumours?
Renal cell carcinoma
What are risk factors for RCC?
Smoking, obesity, dialysis
Where can RCC spread?
Perinephric fat
Lymph node
IVS to right atrium
What treatment is there for localised RCC?
Surveillance
Radical or partial nephrectomy
Ablation - erosive process removing tumour
What is a radical nephrectomy?
Removal of kidney, adrenal, surrounding fat and upper ureter
What treatment is there for metastatic RCC?
Palliative - molecular therapies targeting angiogenesis
What is the other causes of upper urinary tract malignancy?
Upper tract transitional cell carcinoma
What are risk factors for upper tract TCC?
Smoking, phenacetin abuse, Balkan’s nephropathy
What percentage of UUT cancers spread up from bladder?
5%
What percentage of UUT cancers spread to bladder?
40%
What investigations can you use in upper tract TCC?
Ultrasound - hydronephrosis
CT urogram
Retrograde pyelogram
Ureteroscopy - biopsy
What treatment is there for upper tract TCC?
Nephro-ureterctomy - removal of kidney, fat, ureter and cuff of bladder
What is hydronephrosis?
Swelling of kidney due to urine back up
