1b// Urological Cancer Flashcards
What are the 2 types of haematuria?
non-visible and visible (micro and macroscopic)
What does haematuria suggest?
disease or cancer
Describe the process of diagnosis and management of incidentally discovered microscopic haematuria.
do imaging for top end of urinary system and cystoscopy for bottom end
What are the types of kidney cancer?
85% of kidney cancer is Renal Cell carcinoma(adenocarcinoma),
10% transitional cell carcinoma,
Sarcoma/Wilms tumour/other types(5%)
What is the aetiology of kidney cancer?
smoking
obesity
high blood pressure
genetic
treatment for kidney failure
What are the clinical features of kidney cancer?
Painless haematuria/persistent microscopic haematuria can is a red flag symptom and can reflect any of these urological malignancies
What are additional features of renal cell cancer?
Additional Features of renal cell cancer include:
- Loin pain
- Palpable mass
- Metastatic disease symptoms (cough, weight loss, etc.)
–bone pain, haemoptysis
What are the main types of renal cell carcinoma/ cancer? (3)
clear cell
papillary
chromophobe
Why can there be peripheral oedema and swelling with kidney cancer?
because when the tumour gets bigger it can press on the inferior vena cava
What are the risk factors for kidney cancer?
older age
smoking (risk decreases after quitting)
obesity
high bp
hepatitis C
exposure to certain dyes, asbestos, cadmium (a metal), herbicides, solvents
Treatment of kidney failure
certain inherited syndromes
What are the symptoms for renal cancer?
blood in urine
back pain
unexplained weight loss/ loss of appetite
fatigue
intermittent fever
lump on belly
anaemic
night sweats
Fx of kidney disease
high levels of calcium
high bp
What changes what type of investigations you will perform for kidney cancer?
categorised…
painless visible haematuria
persistent non visible haematuria
suspected kidney cancer
What investigations do you do for painless visible haematuria?
flexible cystoscopy
CT urogram
renal function
What investigations do you do for persistent non-visible haematuria?
flexible cystoscopy
US KUB (Ultrasound of Kidney, ureters and bladder)
What investigations do you do for suspected kidney cancer?
CT renal triple phase
staging CT chest
bone scan if symptomatic
What is the staging and grading for kidney cancer?
What is the management for kidney cancer?
Patient specific (depends on the ASA status, comorbidities, classification of lesion)
Gold standard is excision either via:
- partial nephrectomy (single kidney, bilateral tumour, multifocal RCC in patients with VHL, T1 tumours up to 7cm)
- radical nephrectomy
What management do you do for patients with kidney cancer, but it is a small tumour and they are unfit for surgery?
cryosurgery
How do you manage a patient with kidney cancer and metastatic disease?
receptor tyrosine kinase inhibitors, immunotherapy
What are the types of bladder cancer?
> 90% of bladder cancer is transitional cell carcinoma,
1-7% squamous cell carcinoma (75% SCC where schistosomiasis is endemic),
Adenocarcinoma(2%)(2
What is the aetiology of bladder cancer?
smoking
radiation
catheterisation
What are the clinical features of bladder cancer?
Painless haematuria/persistent microscopic haematuria can is a red flag symptom and can reflect any of these urological malignancies
- Suprapubic pain
- Lower urinary tract symptoms and UTI
- Metastatic disease symptoms
–bone pain - lower limb swelling
- inability to pass urine
What are likely risk factors for bladder cancer?
What are the signs and symptoms of bladder cancer?
How are investigations for bladder cancer classified?
painless visible haematuria
persistent microscopic haematuria
If biopsy proven muscle invasive then staging investigations
What are the investigations for bladder cancer with visible haematuria?
- Flexible cystoscopy
- CT urogram
- Renal function
What are the investigations for bladder cancer with microscopic haematuria?
- Flexible cystoscopy
- USKUB
What is the staging and grading for bladder cancer?
T2=> invasive when invades muscle layer
Can you see the cancers in the bladder?
Y/ N
How can bladder cancers be treated/ seen?
Cystoscopy + transurethral resection of bladder lesion
What is Cystoscopy + transurethral resection of bladder lesion?
A transurethral resection of bladder lesion uses heat to cut out all visible bladder tumour.
This provides histology and also can be curative.
What is the management protocol for bladder cancer categorised by?
non muscle invasive
muscle invasive
What is the management for non muscle invasive bladder cancer?
If low grade and no CIS then consideration of cystoscopic surveillance +/- intravesicular chemotherapy/BCG
What is the management for muscle invasive bladder cancer?
- Cystectomy
- Radiotherapy
- +/- chemotherapy
- Palliative treatment
What is ureteric TCC?
ureteric transitional cell carcinoma
can occur anywhere in ureter
use a ureteroscope to check
blocking the ureter can lead to renal function failure
when elderly it’s hard to remove kidney and ureter
What is the overall management for bladder cancer?
important= urine cytology in select patients
What is the type of prostate cancer?
adenocarcinoma
What are the risk factors for prostate cancer?
Increasing age, Western nations (Scandinavia ncountries), Ethnicity (African Americans)
What are the clinical features of prostate cancer?
Usually asymptomatic unless metastatic
What is PSA?
an enzyme (serine protease) normally produced by the glandular tissue of the prostate
it is produced at detectable levels only by prostate tissue
PSA may be increased by trauma to the prostate (such as after biopsy or cystoscopy), infecting, benign enlargement, or prostate cancer
- therefore high PSA doesn’t necessarily mean prostate cancer
OSA tends to increase with prostatic enlargement
Prostatic enlargement tends to occur with age
if PSA is 40-50 you may be able to feel cancer
What are the investigations for prostate cancer?
Blood tests
MRI
Trans perineal prostate biopsy
What is the prostate cancer staging and grading?
Give more detail about Tumour staging?
Describe the N and M of staging and grading?
Does this Gleason grading make sense?
Y/ N
What is the management for prostate cancer?
What are the side effects of prostate cancer treatment?
The prostate contains the proximal sphincter
Prostatectomy removes the proximal urethral sphincter and changes urethral length.
Risk of damage to cavernous nerves ( innervation to bladder and urethra)
Damage to cavernous nerves causes ED.
What is the major red flag symptom?
painless visible haematuria
- all patients should undergo cystoscopy and imaging
What should cancer management take into account?
Cancer management should take account stage and grade of cancer and patients comorbidities
What enzyme may suggest prostate cancer?
PSA
What should patients with suspected prostate cancer undergo?
MRI imaging
