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(C) - Urinary > 20 - RCC, TCC and Prostate Cancer > Flashcards

20 - RCC, TCC and Prostate Cancer Flashcards

1
Q

How does renal cell carcinoma present?

A

- Haematuria

  • May be incidental on imaging (25%)
  • If advance varicocele, weight loss, hypercalcaemia or PE
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2
Q

How does transitional cell carcinoma present?

A
  • Haematuria
  • Incidental on imaging
  • DVT, lymphoedema and weight loss if advanced
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3
Q

What are some differentials if a person presents with haematuria?

A
  • Painless and frank it is TCC or RCC until proven otherwise
  • Stones
  • Infection
  • Prostate cancer
  • Infection
  • Inflammation
  • GN
  • BPH
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4
Q

If a patient presents with haematuria what are some further questions in the history and some immediate examinations you can do?

A
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5
Q

What are some imaging techniques that may be used to investigate haematuria?

A
  • Flexible cystoscopy
  • Ultrasound/CT
  • Urine culture/cytology
  • Bloods
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6
Q

What is the rate of RCC and what is the prognosis?

A
  • 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%
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7
Q

What are some risk factors for developing RCC?

A
  • Smoking
  • Obesity
  • Dialysis
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8
Q

What are some ways that RCC metastasises?

A
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9
Q

How do we treat RCC?

A

Localised

  • Surveillance
  • Nephrectomy full or partial
  • Ablation

Advance Metastatic

  • Palliative with biological therapies targeting angiogenesis as chemo and radio resistant
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10
Q

What is the most common neoplasm of the bladder?

A

Risk factors:

  • Smoking
  • Occupational exposure in dye industry to arylamines
  • Handling crude oil
  • White male
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11
Q

Why may bladder TCC present with flank pain?

A
  • Tumour may be at vesicoureteric junction so obstruction and hydronephrosis
  • This can also lead to urinary retention if tumour at urethral orifice
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12
Q

How do we diagnose and stage bladder TCC?

A

- TURBT which also removes the cancer

  • Cystoscopy and full thickness biopsy
  • 75% are superficial T1 and 20% are muscle invasive
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13
Q

How can we treat bladder TCC?

A

Depends on staging

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14
Q

How can we treat muscle invasive bladder TCC?

A
  • Curative: radical cystectomy then reconstruct, and chemo

- Palliative: chemo/radio

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15
Q

How common is renal TCC and what is the risk factors?

A
  • 5% of renal malignancies
  • In epithelial cells lining renal calyces and renal pelvis
  • Smoking
  • Phenacetin abuse
  • Balkan’s nephropathy
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16
Q

How do we investigate for the suspicion of renal TCC after a patient has presented with haematuria?

A
17
Q

How do we treat renal TCC?

A
  • Nephro-ureterctomy
  • Systemic chemotherapy or biological therapys like atezolizumab if malignant
18
Q

What is the epidemiology and risk factors of prostate cancer?

A
  • Commonest cancer in men, rare <50 but 1 in 8 will have in a lifetime
  • Age
  • Family history and BRCA2 gene
  • Black>White>Asian
19
Q

What is the issue with using PSA for screening for prostate cancer?

A
  • 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
20
Q

How may a man with prostate cancer present?

A
  • 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
21
Q

How do we diagnose prostate cancer?

A

- Lower urinary tract symptoms (symptomatic): TURP

- Abnormal DRE or PSA (non-symptomatic): TRUS guided biopsy

22
Q

What factors decide how you are going to treat a prostate cancer?

A
  • Age
  • DRE showing T1/2 etc
  • PSA level
  • Biopsy and Gleason Grade
  • MRI/Bone scan for hot spot osteoblastic metastases
23
Q

How do we treat localised prostate cancer?

A
  • Surveillance every 6 months with DRE and PSA
  • Robotic radical prostatectomy
  • Radiotherapy
24
Q

How do we treat metastatic prostate cancer?

A

- 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
25
Q

What are the different zones of the prostate and where does prostate cancer mainly occur?

A
  • 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
26
Q

What hormone affects the prostates growth and function?

A

Testosterone from the testicles

27
Q

What part of the nephron does RCC mainly form in?

A

PCT

28
Q

What is the classic triad presentation of RCC?

A
  • Pain
  • Haematuria
  • Palbable mass
29
Q

What part of the kidney nephron is most likely to develop clear cell renal cell carcinoma?

A

PCT

30
Q

What is the most common cancer of the bladder and when might you develop another type?

A
  • TCC
  • Can get SCC with Schistomiasis due to the chronic irritation changing the cells to squamous
31
Q

What is a Wilms tumour?

A

Childhood neoplasm with good prognosis (nephroblastoma)

32
Q

If there is a tumour on the anterior aspect of the bladder, what type of tumour might you suspect?

A
  • Urachal cancer
  • Adenocarcinoma
33
Q

What are some of the paraneoplastic syndromes found in RCC?

A
34
Q

What is a urothelial cancer?

A

Carcinomas of the bladder, ureters, and renal pelvis, which occur at a ratio of 50:3:1

(C) - Urinary (21 decks)

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