2: Kidney & Bladder Cancer Flashcards
where does renal cell carcinoma present
in the parenchyma of the kidney
- affects tissue made from metanephric blastema
- renal cortex, mainly from PCTs and often appearing in the upper pole of the kidney
where does transitional cell carcinoma (TCC) present
from calyx to the bladder
- affects tissue from ureteric blood
how is RCC staged
- 1 : < 7cm
- 2: > 7cm
- 3 : Gerota’s fascia
- 4 : lymph nodes
describe the epidemiology of RCC
- ~90% of renal malignant rumours in adults are RCCs
- arise from tubular epithelium
- rare in children
- peak incidence in 60-70
- male:female is 3:1
describe the prognosis of RCC
prognosis is poor
- 30% of patients have metastatic disease at diagnosis
- 5 year survival is estimated at 12%
what are risk factors of RCC
- SMOKING
- industrial exposure e.g. cadmium lead
- dialysis
- HTN
- obesity
- anatomical abnormalities e.g. PKD and horshoe kidney
- genetic disorders e.g. von Hippel-Lindau, BAP, Birt-Hogg-Dube
how does RCC present
- 90% with haematuria or incidental finding
- non specific: fatigue, weight loss and fever
- may present with mass in the loin
- RCCs often metastaise before local symptoms develop
how might advanced RCC present
- small number can secrete hormone like substances e.g. PTH-rP so the pt presents w hypercalcaemia
- large varicocele
why might varicocele be present in RCC
tumour grows along renal vein and compresses gonadal vein so it cant drain and fluid collects in the scrotum (only on left as right drains into IVC)
what investigations are carried out in RCC (3)
- radiology: US or ⭐️ CT abdo pelvis pre and post IV contrast
- endoscopy: flexible cystoscopy
- urine: cytology
how is localised RCC treated
- surveillance
- increasingly small tumours are removed with partial nephrectomy to preserve some renal function
- large tumours w no distant metastases: radical nephrectomy with removal of the associated adrenal gland, perinephric fat, upper ureter and para-aortic lymph nodes
what treatment is available for metastatic RCC
- little effective treatment for metastatic disease as it is chemo and radiotherapy resistant
- palliative treatment: target angiogenesis
- biological agents e.g. Sunitinib and Pazopanib (tyrosine kinase inhibitors)
- metastectomy where disease is resectable and patient is otherwise well
how does urothelial cell carcinoma present
- painless haematuria
- incidental finding on imaging (US or CT)
- weight loss, loss of appetite
- signs/symptoms of obstruction
what is bladder cancer caused by
- analgesic misuse
- exposure to aniline dyes used in the industrial manufacturing of dyes, rubber and plastics
- smoking
how is bladder cancer diagnosed (3)
- CT or MRI
- CXR
- cystoscopy or ureteroscopy
are most cancers of the bladder superficial or muscle invasive
75% superficial
5% carcinoma in situ
20% muscle invasive
how is bladder cancer investigated
cytoscopy and biopsy which allows histological examination and staging
how is TCC diagnosed
based on cytological examination of the urine to check for the presence of malignant cells and cystoscopy of the LUT
how is low risk non-muscle invasive TCC treated
TURBT +/- intraveseical (directly inside the bladder) chemotherapy