30. carcinoma of the kidney and bladder Flashcards
Where does RCC occur?
In the parenchyma of the kidney
Where does TCC occur?
Anywhere from calyx to bladder
What type of carcinoma are the majority of renal malignant tumours in adults?
Renal cell carcinoma
Where does rcc arise from?
Arise from tubular epithelium
Who are RCC common and rare in?
- Rare in children. Peak incidence in 60-70 year olds.
* Male:female ratio is 3:1
What are the risk factors for RCC?
- Dialysis
- Smoking
- Obesity
What can happen in the final stages of RCC?
metastases to other organs via vasculature or lymph
What is the presentation of RCC?
- ~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
What are the investigations for RCC?
- Radiology - Ultrasound or CT scan
- Endoscopy - Flexible cystoscopy
- Urine - Cystology
What is the treatment for small localised RCC with no effect on renal function?
surveillance
What is the treatment for increasingly small RCC?
removed with partial nephrectomy to preserve some renal function
What is the treatment for large RCC with no distant metastases?
radical nephrectomy with removal of the associated adrenal gland, perinephric fat, upper ureter and the
para -aortic lymph nodes.
What is the treatment for metastatic RCC?
- Little effective treatment for metastatic disease
- Chemotherapy and radiotherapy resistant
- Palliative treatment - Target angiogenesis - reduce spread of tumour
What is the presentation of TCC?
• Haematuria • Incidental finding on imaging (ultrasound or CT) • Weight loss, loss of appetite • Signs/symptoms of obstruction
What can cause bladder TCC?
- Analgesic misuse
- Exposure to aniline dyes used in the industrial manufacture of dyes, rubber and plastics
- Smoking
who are bladder TCC more common in, males or females?
Male:female ratio is 3:1
What can be used to diagnose and treat bladder TCC?
transurethral resection of bladder tumor (TURBT) - can visualise and remove any tumours(if small)
Describe the staging of TCC?
- 75 % are superficial
- 5% are Tis this is carcinoma in situ (CIS) or ‘flat tumour
- 20% are muscle-invasive
- Tumours are also graded
How is TCC investigated?
Investigation via cystoscopy and biopsy allows histological examination and staging.
How is TCC diagnosed?
• Diagnosis based on cytological examination of the urine to check for the presence of malignant cells and cystoscopy of the lower urinary tract
What is the treatment for low risk non-muscle invasive TCC?
Treated with TURBT +/- intravesical chemotherapy to bladder
What is the treatment for High risk non muscle invasive TCC?
TURBT + intravesical chemotherapy, intravesical BCG treatment, cystectomy
What is the treatment for Muscle invasive TCC?
Cystectomy + radiotherapy (with radiosensitiser) or palliative care
What is the prevalence of upper urinary tract malignancies?
- Only 5% of all malignancies affect upper urinary tract
* Patients have a 40% chance of developing bladder cancer
What is the presentation of upper urinary tract malignancies?
• Presentation with haematuria or obstruction occurs early, because the renal pelvis projects directly into the pelvicalyceal cavity.
What is the treatment for upper urinary tract malignancies?
Treated with nephro-ureterectomy
kidney, fat, ureter, cuff of bladder
