20 - RCC, TCC and Prostate Cancer Flashcards
How does renal cell carcinoma present?
- Haematuria
- May be incidental on imaging (25%)
- If advance varicocele, weight loss, hypercalcaemia or PE
How does transitional cell carcinoma present?
- Haematuria
- Incidental on imaging
- DVT, lymphoedema and weight loss if advanced
What are some differentials if a person presents with haematuria?
- Painless and frank it is TCC or RCC until proven otherwise
- Stones
- Infection
- Prostate cancer
- Infection
- Inflammation
- GN
- BPH
If a patient presents with haematuria what are some further questions in the history and some immediate examinations you can do?
What are some imaging techniques that may be used to investigate haematuria?
- Flexible cystoscopy
- Ultrasound/CT
- Urine culture/cytology
- Bloods
What is the rate of RCC and what is the prognosis?
- 7th most commoin cancer
- 95% of all upper urinary tract tumours
- More common in white males
- 30% metastasised at presentation
- Most lethal urological malignancy and high recurrence rate 90-95%
What are some risk factors for developing RCC?
- Smoking
- Obesity
- Dialysis
What are some ways that RCC metastasises?
How do we treat RCC?
Localised
- Surveillance
- Nephrectomy full or partial
- Ablation
Advance Metastatic
- Palliative with biological therapies targeting angiogenesis as chemo and radio resistant
What is the most common neoplasm of the bladder?
Risk factors:
- Smoking
- Occupational exposure in dye industry to arylamines
- Handling crude oil
- White male
Why may bladder TCC present with flank pain?
- Tumour may be at vesicoureteric junction so obstruction and hydronephrosis
- This can also lead to urinary retention if tumour at urethral orifice
How do we diagnose and stage bladder TCC?
- TURBT which also removes the cancer
- Cystoscopy and full thickness biopsy
- 75% are superficial T1 and 20% are muscle invasive
How can we treat bladder TCC?
Depends on staging
How can we treat muscle invasive bladder TCC?
- Curative: radical cystectomy then reconstruct, and chemo
- Palliative: chemo/radio
How common is renal TCC and what is the risk factors?
- 5% of renal malignancies
- In epithelial cells lining renal calyces and renal pelvis
- Smoking
- Phenacetin abuse
- Balkan’s nephropathy
How do we investigate for the suspicion of renal TCC after a patient has presented with haematuria?
How do we treat renal TCC?
- Nephro-ureterctomy
- Systemic chemotherapy or biological therapys like atezolizumab if malignant
What is the epidemiology and risk factors of prostate cancer?
- Commonest cancer in men, rare <50 but 1 in 8 will have in a lifetime
- Age
- Family history and BRCA2 gene
- Black>White>Asian
What is the issue with using PSA for screening for prostate cancer?
- Over diagnosis and treatment
- Not cost effective
- Will be raised up to 6 weeks after a UTI
- Inflammation and large prostate will raise it e.g BPH
- Urinary retention will alter it
- Ejaculation will alter it
- May have normal PSA but abnormal DRE
How may a man with prostate cancer present?
- Urinary symptoms due to wrapping around urethra e.g hesistancy
- Bone pain as osteosclerotic metastases
- Had PSA checked
- DRE for other reason found it
- Incidental on TURP
How do we diagnose prostate cancer?
- Lower urinary tract symptoms (symptomatic): TURP
- Abnormal DRE or PSA (non-symptomatic): TRUS guided biopsy
What factors decide how you are going to treat a prostate cancer?
- Age
- DRE showing T1/2 etc
- PSA level
- Biopsy and Gleason Grade
- MRI/Bone scan for hot spot osteoblastic metastases
How do we treat localised prostate cancer?
- Surveillance every 6 months with DRE and PSA
- Robotic radical prostatectomy
- Radiotherapy
How do we treat metastatic prostate cancer?
- Surgical castration
- Hormone castration with LHRH agonists to exhaust the pituitary and lower testosterone levels but will be tumour flare at first
- Chemotherapy
- If palliative can give single dose radiotherapy, chemotherapy and pain relief
What are the different zones of the prostate and where does prostate cancer mainly occur?
- Cancer in peripheral zones which is next to rectum so found on DRE and if presents with urinary symptoms will mean it is late stage
- BPH is in transitional zone which is central. Happens to most men by age of 80
What hormone affects the prostates growth and function?
Testosterone from the testicles
What part of the nephron does RCC mainly form in?
PCT
What is the classic triad presentation of RCC?
- Pain
- Haematuria
- Palbable mass
What part of the kidney nephron is most likely to develop clear cell renal cell carcinoma?
PCT
What is the most common cancer of the bladder and when might you develop another type?
- TCC
- Can get SCC with Schistomiasis due to the chronic irritation changing the cells to squamous
What is a Wilms tumour?
Childhood neoplasm with good prognosis (nephroblastoma)
If there is a tumour on the anterior aspect of the bladder, what type of tumour might you suspect?
- Urachal cancer
- Adenocarcinoma
What are some of the paraneoplastic syndromes found in RCC?
What is a urothelial cancer?
Carcinomas of the bladder, ureters, and renal pelvis, which occur at a ratio of 50:3:1
