26. Renal and Bladder Tumours

Question 1

What are the benign tumours of the kidney?

Answer 1

Adenoma
Angioma
Angiomyolipoma

Question 2

What are the malignant tumours of the kidney?

Answer 2

Nephroblastoma
Renal cell carcinoma (adeno)
Trasitional cell carcinoma
Squamous cell of renal pelvis

Question 3

What are the risk factors for RCC?

Answer 3

Tobacco
African descent
Cystic disease, haemodialysis
Nutrition, obesity, hypertension
Asbestos

Question 4

What is the most important prognostic indicator in RCC?

Answer 4

TNM staging

Question 5

Where does RCC spread?

Answer 5

Directly into adrenals
renal vein
Hilar and para-aortic nodes
Mets: lung, bone, liver

Question 6

What is the appearance of an RCC in the lung on chest x ray?

Answer 6

‘Cannonball’

Question 7

What are the genetic causes of von Hippel Lindau syndrome?

Answer 7

Loss of VHL tumour suppressor gene

Upregulation of VEG-F

Question 8

What chromosome is associated with von Hippel Lindau?

Answer 8

3

Question 9

What chromosome is associated with Hereditary Papillary RCC?

Answer 9

7

Question 10

What chromosome is associated with Birt-Hogg-Dubé syndrome?

Answer 10

17

Question 11

What chromosome is associated with Hereditary Leiomyoma RCC?

Answer 11

1

Question 12

What are the T stages in staging RCC?

Answer 12

T1: <7cm
T2: >7cm
T3: advanced within Gerota’s fascia
T4: Beyond Gerota’s fascia

Question 13

What is the histiological classification of RCC?

Answer 13

Clear cell
Papillary
Chromophobe
Collecting duct
Medullary cell

Question 14

What is the presentation of RCC?

Answer 14

1/2 incidental
Pain, mass, haematuria
Bone pain, haemoptysis

Question 15

What paraneoplastic syndromes are associated with RCC?

Answer 15

Polycythaemia, iron deficiency anaemia
Hypertension (increased renin)
High calcium (PTHrP)
Cushing's syndrome
Stauffer's syndrome

Question 16

What is Stauffer’s syndrome?

Answer 16

Hepatic dysfunction
Fever
Anorexia

Question 17

What investigations should be done into renal tumours?

Answer 17

FBC, ESR, U&E, LFT
Initially Ultrasound or triphasic CT
Then CT, MRI, angio

Question 18

What is a triphasic CT?

Answer 18

Images taken without contract, directly after contrast and then delayed
Tumour appears bright: >20 Hounsfield units mean most likely malignant, 15-20 take biopsy

Question 19

What treatment options are available for renal tumours in T1-3?

Answer 19

Radical nephrectomy in T1-3
Nephron sparing/ partial nephrectomy in T1
Thermal ablation if tumour is small
Active surveillance

Question 20

What treatment option is available for T4 renal cancers?

Answer 20

Immunotherapy

Interferon a or interleukin 2

Question 21

What are the risk factors for bladder cancer?

Answer 21

Industrial carcinogens: dyes, petrol, hairdressers
Pharmaceutical compounds
Cigarettes
Schistosomiasis
Cyclophosphamide

Question 22

What tumours can be found in the bladder?

Answer 22

Transitional cell
Squamous cell (schistosomiasis)
Adenocarcinoma

Question 23

What is the presentation of bladder cancer?

Answer 23

Gross painless haematuria

Question 24

What investigations can be done into bladder cancer?

Answer 24

Urinary cytology
Cystoscopy
Biopsy
CT urogram

Question 25

What is the management for low grade bladder cancer?

Answer 25

Transurethral Resection of Bladder Tumour (ie scrape it off)

Surveillance

Question 26

What is the treatment for high grade bladder cancer?

Answer 26

Radical cystoprostatectomy

Chemo and radio

Question 27

What is the treatment for carcinoma in situ of the bladder?

Answer 27

BCG vaccine into the bladder