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Urinary System > 17) Malignancy of Urinary Tract > Flashcards

17) Malignancy of Urinary Tract Flashcards

1
Q

What is the most common cancer in men?

A

Prostate cancer

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2
Q

Are those with prostate cancer likely to die form it?

A

No

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3
Q

What are some risk factors for prostate cancer?

A

Increasing age
Family history
Ethnicity

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4
Q

What ethnicities are more at risk of developing prostate cancer?

A

Black > White > Asian

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5
Q

What is meant by a family history of prostate cancer?

A

If 1st degree relative diagnosed before 60

BRCA2 gene mutation

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6
Q

What screening programmes are available for prostate cancer?

A

Opportunistic if patients are counselled and present with urinary symptoms

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7
Q

What are some issues with screening?

A

Overdiagnosis
Overtreatment
Cost effectiveness
Serum PSA can be raised in infection, inflamm and hyperplasia of prostate

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8
Q

How does prostate cancer present?

A

Asymptomatic (majority)
Enlargement of prostate, bladder overactivity
Bone pain - metastasis to bone and LN

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9
Q

If prostate cancer is advanced what other symptom may be seen?

A

Haematuria

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10
Q

In what ways can prostate cancer be diagnosed?

A

Digital rectal exam
Serum PSA (prostate specific antigen)
Lower urinary tract symptoms

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11
Q

Why and how is a biopsy of the prostate carried out?

A

If needed after DRE or serum PSA

Transrectal ultrasound guided biopsy

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12
Q

What is carried out if prostate cancer is suspected from lower urinary tract symptoms?

A

Transurethral resection of prostate - cutting away small bits of prostate to relive symptoms

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13
Q

What factors affect treatment decisions of prostate cancer?

A 
Age
T stage by DRE
PSA level
Gleason Grade - biopsy 
MRI and bone scan for metastasis
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14
Q

Describe the T stages obtained by DRE:

A

T1/2 - Localised
T3 - Locally advanced, nodules
T4 - Advanced, hard with smooth surface due to nodules coalescing

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15
Q

What treatment is there for localised prostate cancer?

A

Surveillance - treatment may do more damage
Radical prostatectomy
Radiotherapy

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16
Q

What is a radical prostatectomy?

A

Removal of part of all of the prostate

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17
Q

What treatment is there for locally advanced (T3) prostate cancer?

A

Surveillance

Hormones +/- radiotherapy

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18
Q

What treatment is there for metastatic prostate cancer?

A

Surgical castration
Medical castration - LHRH agonists
Palliation - radio, chemo, bisphosphonates

19
Q

How do LHRH agonists work?

A

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

20
Q

Describe bone metastasis in prostate cancer and how they can be spotted:

A

They are sclerotic (osteoblastic)

Spotted as hot spots on bone scan

21
Q

What is non-visible haematuria?

A

Seen on dipstick or microscopy

22
Q

State some causes of haematuria:

A 
Renal cell carcinoma
Bladder cancer 
Advanced prostate cancer
Stones
Infection
Inflamm
Glomerular diseases
23
Q

What examinations would you do if haematuria was present?

A 
BP
Abdominal mass
Varicocele - veins in scrotum
Leg swelling 
DRE
24
Q

What tests and investigations would you carry out if haematuria was present?

A

FBC
Urine culture
Flexible cystoscopy
Ultrasound

25
Q

What type of cancer are most bladder cancers?

A

Transitional cell carcinoma

26
Q

What are some risk factors for bladder cancer?

A

Smoking
Occupational exposure - rubber, plastic, hydrocarbons, paints and dyes
(Schistosomiasis)

27
Q

What two stages of bladder cancer are there?

A

Superficial and muscle invasive

28
Q

What treatment is there for high risk non-muscle invasive bladder cancer?

A

Cystoscopy, intravesical chemotherapy

29
Q

What treatment is there for low risk non-muscle invasive bladder cancer?

A

Cystoscopy +/- intravesical chemotherapy

30
Q

What treatment is there for muscle invasive bladder cancer?

A

Neoadjuvant chemo + radical cystectomy or radiotherapy

or Palliative chemo/radiotherapy

31
Q

What is a radical cystectomy?

A

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

32
Q

What cancer causes most upper urinary tract tumours?

A

Renal cell carcinoma

33
Q

What are risk factors for RCC?

A

Smoking, obesity, dialysis

34
Q

Where can RCC spread?

A

Perinephric fat
Lymph node
IVS to right atrium

35
Q

What treatment is there for localised RCC?

A

Surveillance
Radical or partial nephrectomy
Ablation - erosive process removing tumour

36
Q

What is a radical nephrectomy?

A

Removal of kidney, adrenal, surrounding fat and upper ureter

37
Q

What treatment is there for metastatic RCC?

A

Palliative - molecular therapies targeting angiogenesis

38
Q

What is the other causes of upper urinary tract malignancy?

A

Upper tract transitional cell carcinoma

39
Q

What are risk factors for upper tract TCC?

A

Smoking, phenacetin abuse, Balkan’s nephropathy

40
Q

What percentage of UUT cancers spread up from bladder?

A

5%

41
Q

What percentage of UUT cancers spread to bladder?

A

40%

42
Q

What investigations can you use in upper tract TCC?

A

Ultrasound - hydronephrosis
CT urogram
Retrograde pyelogram
Ureteroscopy - biopsy

43
Q

What treatment is there for upper tract TCC?

A

Nephro-ureterctomy - removal of kidney, fat, ureter and cuff of bladder

44
Q

What is hydronephrosis?

A

Swelling of kidney due to urine back up

Urinary System (10 decks)

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