26. Renal and Bladder Tumours Flashcards
What are the benign tumours of the kidney?
Adenoma
Angioma
Angiomyolipoma
What are the malignant tumours of the kidney?
Nephroblastoma
Renal cell carcinoma (adeno)
Trasitional cell carcinoma
Squamous cell of renal pelvis
What are the risk factors for RCC?
Tobacco African descent Cystic disease, haemodialysis Nutrition, obesity, hypertension Asbestos
What is the most important prognostic indicator in RCC?
TNM staging
Where does RCC spread?
Directly into adrenals
renal vein
Hilar and para-aortic nodes
Mets: lung, bone, liver
What is the appearance of an RCC in the lung on chest x ray?
‘Cannonball’
What are the genetic causes of von Hippel Lindau syndrome?
Loss of VHL tumour suppressor gene
Upregulation of VEG-F
What chromosome is associated with von Hippel Lindau?
3
What chromosome is associated with Hereditary Papillary RCC?
7
What chromosome is associated with Birt-Hogg-Dubé syndrome?
17
What chromosome is associated with Hereditary Leiomyoma RCC?
1
What are the T stages in staging RCC?
T1: <7cm
T2: >7cm
T3: advanced within Gerota’s fascia
T4: Beyond Gerota’s fascia
What is the histiological classification of RCC?
Clear cell Papillary Chromophobe Collecting duct Medullary cell
What is the presentation of RCC?
1/2 incidental
Pain, mass, haematuria
Bone pain, haemoptysis
What paraneoplastic syndromes are associated with RCC?
Polycythaemia, iron deficiency anaemia Hypertension (increased renin) High calcium (PTHrP) Cushing's syndrome Stauffer's syndrome
What is Stauffer’s syndrome?
Hepatic dysfunction
Fever
Anorexia
What investigations should be done into renal tumours?
FBC, ESR, U&E, LFT
Initially Ultrasound or triphasic CT
Then CT, MRI, angio
What is a triphasic CT?
Images taken without contract, directly after contrast and then delayed
Tumour appears bright: >20 Hounsfield units mean most likely malignant, 15-20 take biopsy
What treatment options are available for renal tumours in T1-3?
Radical nephrectomy in T1-3
Nephron sparing/ partial nephrectomy in T1
Thermal ablation if tumour is small
Active surveillance
What treatment option is available for T4 renal cancers?
Immunotherapy
Interferon a or interleukin 2
What are the risk factors for bladder cancer?
Industrial carcinogens: dyes, petrol, hairdressers Pharmaceutical compounds Cigarettes Schistosomiasis Cyclophosphamide
What tumours can be found in the bladder?
Transitional cell
Squamous cell (schistosomiasis)
Adenocarcinoma
What is the presentation of bladder cancer?
Gross painless haematuria
What investigations can be done into bladder cancer?
Urinary cytology
Cystoscopy
Biopsy
CT urogram
What is the management for low grade bladder cancer?
Transurethral Resection of Bladder Tumour (ie scrape it off)
Surveillance
What is the treatment for high grade bladder cancer?
Radical cystoprostatectomy
Chemo and radio
What is the treatment for carcinoma in situ of the bladder?
BCG vaccine into the bladder
