30. carcinoma of the kidney and bladder

Question 1

Where does RCC occur?

Answer 1

In the parenchyma of the kidney

Question 2

Where does TCC occur?

Answer 2

Anywhere from calyx to bladder

Question 3

What type of carcinoma are the majority of renal malignant tumours in adults?

Answer 3

Renal cell carcinoma

Question 4

Where does rcc arise from?

Answer 4

Arise from tubular epithelium

Question 5

Who are RCC common and rare in?

Answer 5

• Rare in children. Peak incidence in 60-70 year olds.

* Male:female ratio is 3:1

Question 6

What are the risk factors for RCC?

Answer 6

• Dialysis
• Smoking
• Obesity

Question 7

What can happen in the final stages of RCC?

Answer 7

metastases to other organs via vasculature or lymph

Question 8

What is the presentation of RCC?

Answer 8

• ~90% with hematuria or incidental finding e.g. ultrasound or CT undertaken for another reason
• Non specific symptoms include fatigue, weight loss and fever. May be mass in the loin.
• RCCs often metastasize before local symptoms develop
• If advanced:
• A small number can secrete hormone like substances such as PTH-rP (pts present with hypercalcemia)
• Large varicocele may be present

Question 9

What are the investigations for RCC?

Answer 9

• Radiology - Ultrasound or CT scan
• Endoscopy - Flexible cystoscopy
• Urine - Cystology

Question 10

What is the treatment for small localised RCC with no effect on renal function?

Answer 10

surveillance

Question 11

What is the treatment for increasingly small RCC?

Answer 11

removed with partial nephrectomy to preserve some renal function

Question 12

What is the treatment for large RCC with no distant metastases?

Answer 12

radical nephrectomy with removal of the associated adrenal gland, perinephric fat, upper ureter and the
para -aortic lymph nodes.

Question 13

What is the treatment for metastatic RCC?

Answer 13

• Little effective treatment for metastatic disease
• Chemotherapy and radiotherapy resistant
• Palliative treatment - Target angiogenesis - reduce spread of tumour

Question 14

What is the presentation of TCC?

Answer 14

• Haematuria
• Incidental finding on imaging
(ultrasound or CT)
• Weight loss, loss of appetite
• Signs/symptoms of obstruction

Question 15

What can cause bladder TCC?

Answer 15

• Analgesic misuse
• Exposure to aniline dyes used in the industrial manufacture of dyes, rubber and plastics
• Smoking

Question 16

who are bladder TCC more common in, males or females?

Answer 16

Male:female ratio is 3:1

Question 17

What can be used to diagnose and treat bladder TCC?

Answer 17

transurethral resection of bladder tumor (TURBT) - can visualise and remove any tumours(if small)

Question 18

Describe the staging of TCC?

Answer 18

• 75 % are superficial
• 5% are Tis this is carcinoma in situ (CIS) or ‘flat tumour
• 20% are muscle-invasive
• Tumours are also graded

Question 19

How is TCC investigated?

Answer 19

Investigation via cystoscopy and biopsy allows histological examination and staging.

Question 20

How is TCC diagnosed?

Answer 20

• Diagnosis based on cytological examination of the urine to check for the presence of malignant cells and cystoscopy of the lower urinary tract

Question 21

What is the treatment for low risk non-muscle invasive TCC?

Answer 21

Treated with TURBT +/- intravesical chemotherapy to bladder

Question 22

What is the treatment for High risk non muscle invasive TCC?

Answer 22

TURBT + intravesical chemotherapy, intravesical BCG treatment, cystectomy

Question 23

What is the treatment for Muscle invasive TCC?

Answer 23

Cystectomy + radiotherapy (with radiosensitiser) or palliative care

Question 24

What is the prevalence of upper urinary tract malignancies?

Answer 24

• Only 5% of all malignancies affect upper urinary tract

* Patients have a 40% chance of developing bladder cancer

Question 25

What is the presentation of upper urinary tract malignancies?

Answer 25

• Presentation with haematuria or obstruction occurs early, because the renal pelvis projects directly into the pelvicalyceal cavity.

Question 26

What is the treatment for upper urinary tract malignancies?

Answer 26

Treated with nephro-ureterectomy

kidney, fat, ureter, cuff of bladder