21 Urological Cancers 1 (Renal Cell Carcinoma and Transitional Cell Carcinoma)

Question 1

Where are renal cell carcinomas likely to be located and where are trasitional cell carcinomas likely to be located?

Answer 1

• RCC: kidney tubules
• TCC: renal pelvis, ureter, bladder

Question 2

How might a localised renal cell carcinoma present?

Answer 2

Unsymptomatic (incidental finding on imaging eg ultrasound/CT)

Haematuria

Palpable mass (rare)

Question 3

How might an advanced renal cell carcinoma present?

Answer 3

Unsymptomatic (incidental finding on imaging eg ultrasound/CT)

Haematuria

Palpable mass (rare)

+

Large varicocele (most common in left)

Weight loss, appetite loss (symptoms of metastasis)

Hypercalcaemia

Question 4

How might a localised transitional cell carcinoma present?

Answer 4

Unsymptomatic (incidental finding on imaging eg ultrasound/CT)

Haematuria

Question 5

How might an advanced transitional cell carcinoma present?

Answer 5

Unsymptomatic (incidental finding on imaging eg ultrasound/CT)

Haematuria

+

Weight loss, appetite loss (symptoms of metastases)

DVT

Lymphodema

Question 6

How can we classify haematuria?

Answer 6

Question 7

A patient presents with haematuria. What are the differential diagnoses?

Answer 7

Question 8

If a patient presents with haematuria, what is examined for urologically ?

Answer 8

• BP
• Abdominal mass
• Varicocele
• Leg swelling
• Assess prostate by digital rectal examination (DRE)
  
  • Size
  • Texture

Question 9

What are the 3 common sites of spread of a renal cell carcinoma?

Answer 9

Question 10

How is a renal cell carcinoma treated?

Answer 10

1. Surveillance
2. Excision
   
   1. Radical nephrectomy- open or laproscopic
   2. Partial nephrectomy- open or robotic
3. Ablation (basically burning tumour off)

Question 11

How is metastatic (advanced) renal cell carcinoma treated?

Answer 11

Palliative

Can use therapies to slow down cancer:

• Biological therapies
• Targeted therapies- eg targeting angiogenesis

Question 12

What % of bladder cancers are transitional cell carcinomas?

Answer 12

90%

Question 13

Give 3 factors that increase your risk of developing renal cell carcinoma.

Answer 13

Smoking

Obesity

Dialysis

Question 14

Give 2 risk factors that increase your risk of developing bladder transitional cell carcinoma.

Answer 14

Smoking

Occupational exposure

Rubber/plastic manufacture

Handling carbon/crude oil etc

Question 15

How should muscle-invasive Bladder transitional cell carcinoma be treated? (think curative and not curative)

Answer 15

Question 16

Why is the ileum used to form a ‘bladder’ following a radical cystectomy?

Answer 16

If ureter used - would stenose and urine on skin=irritant

Question 17

Give 3 risk factors for developing upper urinary tract transitional cell carcinoma.

Answer 17

1. Smoking
2. Phenacetin abuse (pain-relieving and fever-reducing drug)
3. Balkan’s nephropathy (chronic dietary exposure to low concentrations of a toxin called aristolochic acid)

Question 18

If you have a upper urinary tract transitional cell carcinoma, what is your chance of going on to have a bladder tumour?

Answer 18

40% chance

Question 19

What investigations can be done for a suspected upper urinary tract transitional cell carcinoma?

Answer 19

Question 20

What is the standard treatment for an upper urinary tract transitional carcinoma?

Answer 20

Question 21

What treatment options are available for metastatic transitional cell carcinoma of the bladder or the upper urinary tract?

Answer 21