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A - MSRA Cancer Care [1] > [36] Bladder and Renal Cancer > Flashcards

[36] Bladder and Renal Cancer Flashcards

1
Q

What % of new cancer diagnoses are bladder cancer in the UK?

A

5% for men

2% for women

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2
Q

What is the male to female ratio of bladder cancer?

A

3:1

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3
Q

At what age is the peak incidence of bladder cancer?

A

65

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4
Q

What % of adult malignancies does renal cancer account for?

A

3% in men

1% in women

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5
Q

What age group do adult renal cancers occur in?

A

Most patients are over 50 years of age

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6
Q

What is the most common risk factor for bladder cancer worldwide?

A

Chronic bladder infection from parasites such as schistosomiasis

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7
Q

What are the risk factors for bladder cancer in the Western world?

A

Environmental exposure to inflammation from smoking, arylamines, and rubber processing

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8
Q

Where might a person become exposed to arylamines?

A

In the dye industry

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9
Q

What genetic changes increase the risk of bladder cancer?

A
  • Mutations on chromosome 9, particularly the TP53 gene

- Overexpression of EGFR

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10
Q

What kind of bladder cancer is of increased risk in patients with mutations in chromosome 9?

A

Transitional cell cancer

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11
Q

What % of cases of bladder cancer have over-expression of EGFR?

A

40%

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12
Q

What does over-expression of EGFR correlate with in bladder cancer?

A

Poor prognosis

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13
Q

Who is adult renal cell cancer more common in?

A
  • Men

- Those who smoke

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14
Q

What conditions can adult renal cell cancer be seen in?

A
  • Von Hippel-Lindau disease

- Familial papillary renal carcinoma syndrome

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15
Q

What is Von Hippel-Lindau disease?

A

An autosomal dominant condition with mutations on chromosome 3

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16
Q

What does familial papillary renal carcinoma syndrome occur due to?

A

Mutation of MET oncogene on chromosome 7q31

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17
Q

What cancers can renal metastasis arise from?

A
  • Lung or breast cancers
  • Melanoma
  • Lymphoma
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18
Q

What are transitional cells?

A

Stem cells

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19
Q

Where are transitional cells found?

A

Adjacent to the basement membrane of the epithelial surface that line the renal tract, from the renal papillae to the proximal urethra

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20
Q

What kind of epithelium lines the distal urethra?

A

Squamous epithelium

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21
Q

Where do most transitional cell tumours arise?

A

In the bladder

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22
Q

Why do most transitional cell tumours arise in the bladder?

A

As this is an area of polyclonal field change most susceptible to malignant change

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23
Q

What do many bladder cancers start out as?

A

Papillary tumours

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24
Q

Are papillary tumours of the bladder unifocal or multifocal?

A

They can be multifocal across the surface area of the bladder

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25
Q

What % of patients with bladder cancer will ave superficial papillary disease at diagnosis?

A

70%

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26
Q

What % of patients with bladder cancer will have an invasive tumour at diagnosis?

A

30%

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27
Q

What % of bladder TCC start as carcinoma in situ?

A

10%

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28
Q

Describe bladder carcinoma in situ

A

Flat, non-invasive, high-grade bladder cancer that spread over the surface of the bladder

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29
Q

How can bladder carcinoma in situ progress?

A

It can become invasive and penetrate the bladder muscle, then metastasise

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30
Q

What % of bladder tumours are TCC?

A

Up to 95%

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31
Q

What % of bladder tumours are squamous cell carcinoma?

A

5%

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32
Q

What do bladder squamous cell carcinomas usually result from?

A

Chronic inflammation

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33
Q

What are the rarer types of bladder tumours?

A
  • Rhabdomyosarcoma

- Leiomyosarcoma

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34
Q

What % of renal tumours arise in the cortex?

A

90%

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35
Q

What cells do cortical renal tumours arise from?

A

Probably the cells of the PCT

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36
Q

What are the synonymous names of cortical renal tumours?

A
  • Renal cell carcinoma
  • Renal adenocarcinoma
  • Clear cell carcinoma
  • Hypernephroma
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37
Q

What % of renal tumours arise from the renal pelvis?

A

10%

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38
Q

What kind of tumours are those that arise in the renal pelvis?

A

Transitional cell tumours

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39
Q

What do tumours of the renal pelvis resemble?

A

Tumours of the ureter, bladder, and urethra

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40
Q

What can tumour cells of the renal pelvis produce?

A

Excess hormones, such as erythropoietin, renin, or PTH-related polypeptide

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41
Q

What can excess erythropoietin produced by renal pelvis tumours cause?

A

Polycythaemia

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42
Q

What can excess renin produced by renal pelvis tumours cause?

A

Hypertension

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43
Q

What can excess PTH-related polypeptide produced by renal pelvis tumours cause?

A

Hypercalcaemia

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44
Q

What is the most common presenting complaint of bladder cancer?

A

Painless haematuria

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45
Q

What % of patients with bladder cancer present with painless haematuria?

A

80-90%

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46
Q

What may be palpable in bladder cancer?

A

A bladder mass or obstructed kidney

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47
Q

What % of patients presenting with bladder cancer have distant metastases?

A

5%

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48
Q

What are the other presentations of bladder cancer?

A
  • Symptoms of infection, such as urgercy and dysuria

- Sterile pyuria

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49
Q

What presenting complaint is most commonly associated with renal cancer?

A

Loin, back, or abdominal pain

50
Q

What are the other presentations of renal cancer?

A
  • Haematuria
  • Varicoceles
  • Metastases and systemic effects
  • Incidental finding
51
Q

Where does renal cancer spread to via the lymphatics?

A
  • Renal hilum
  • Retroperitoneum
  • Para-aortic lymph nodes
52
Q

When can renal cancer produce varicoceles?

A

In male patients with occlusion of the right or left testicular veins

53
Q

What does the right testicular vein drain into?

A

The IVC

54
Q

What does the left testicular vein drain into?

A

The left renal vein

55
Q

Where do metastases from renal cell cancer typically present?

A
  • Lung
  • Liver
  • Bones
  • Brain
56
Q

What systemic effects can result from renal cell cancer?

A
  • Fever
  • Weight loss
  • Gynaecomastia
  • Night sweats
  • Cushing’s syndrome
  • Polymyositis
  • Dermatomyositis
  • Malaise
  • Anaemia
57
Q

How can renal tumours be found incidentally?

A

Following abdominal imaging for other reasons

58
Q

What investigations should be given to all patients presenting with painless haematuria?

A
  • Urinanalysis
  • Urine cytology
  • Consider cystoscopy
59
Q

What is the purpose of cystoscopy in patients presenting with painless haematuria?

A

Visualisation of bladder mucosa and urethra

60
Q

What investigation should be offered to patients with positive cytology but normal cystoscopy?

A
  • Examination of the upper tracts

- Prostate examination for men

61
Q

How is a definitive diagnosis of bladder cancer made?

A

Only by cystoscopy and biopsy

62
Q

What is the purpose of CT abdo pelvis imaging in bladder and renal cancer?

A

It can detect local extension and lymph node involvement

63
Q

What is the purpose of imaging of the chest in bladder and renal cancer?

A

Screen for pulmonary metastasis

64
Q

When is a bone scan recommended in bladder and renal cancer?

A

Any patient with bone pain or raised alkaline phosphatase

65
Q

What blood tests should be done in bladder and renal cancer?

A
  • Renal and liver function
  • Prothrombin time
  • Calcium
66
Q

Are there any specific tumour markers for bladder and renal cancer?

A

No

67
Q

What staging system is used for bladder cancer?

A

TNM

68
Q

What is Tis in bladder cancer?

A

Carcinoma in situ - malignant cells not invading the basement membrane

69
Q

What is Ta in bladder cancer?

A

Non-invasive papillary carcinoma

70
Q

What is T1 in bladder cancer?

A

Superficial tumour, not invading beyond the lamina propria

71
Q

What is T2a in bladder cancer?

A

Tumour invading into the inner half of the muscle layer

72
Q

What is T2b in bladder cancer?

A

Tumour invading the outer half of the muscle layer

73
Q

What is T3a in bladder cancer?

A

Microscopic tumour involving the serosal surface of the bladder

74
Q

What is T3b in bladder cancer?

A

Macroscopic tumour involving the serosal surface of the bladder

75
Q

What is T4a in bladder cancer?

A

Tumour spread to the stroma of the prostate (in men), or to uterus and/or vagina (in women)

76
Q

What is T4b in bladder cancer?

A

Tumour spread to the pelvic wall or the abdominal wall

77
Q

What is N0 in bladder cancer?

A

No lymph node involvement

78
Q

What is N1 in bladder cancer?

A

One affected lymph node in the true pelvis

79
Q

What is N2 in bladder cancer?

A

Two or more affected lymph nodes in the true pelvis

80
Q

What is N3 in bladder cancer?

A

Involved lymph nodes along the common iliac artery

81
Q

What is M0 in bladder cancer?

A

No metastases

82
Q

What is M1 in bladder cancer?

A

Distant metastases

83
Q

What is T0 in renal cancer?

A

No evidence of primary tumour

84
Q

What is T1 in renal cancer?

A

<7cm and limited to the kidney

85
Q

What is T2 in renal cancer?

A

> 7cm limited to kidney

86
Q

What is T3 in renal cancer?

A

Tumour extension to major veins, adrenal glands, or perinephric tissue, but not beyond Gerota’s fascia

87
Q

What is T3a in renal cancer?

A

Tumour invades adrenal gland or perinephric tissue

88
Q

What is T3b in renal cancer?

A

Tumour invasion to renal veins and inferior vena cava below diaphragm

89
Q

What is T3c in renal cancer?

A

Tumour invasion into inferior vena cava above the diaphragm

90
Q

What is T4 in renal cancer?

A

Tumour invasion beyond Gerota’s fascia, and involvement of more than one regional lymph node

91
Q

What is N0 in renal cancer?

A

No regional lymph node metastases

92
Q

What is N1 in renal cancer?

A

Metastases in a single regional lymph node

93
Q

What is N2 in renal cancer?

A

Metastases in more than one regional lymph node

94
Q

What is M0 in renal cancer?

A

No distant metastases

95
Q

What is M1 in renal cancer?

A

Distant metastases

96
Q

How is superficial bladder cancer treated?

A

Transurethral resection (TURBT)

97
Q

What features increase the risk of relapse of superficial bladder cancer?

A
  • High-grade histology
  • Incomplete resection
  • Multifocal disease
  • Carcinoma in situ
98
Q

What should patients with superficial bladder cancer that is of high risk of relapse be considered for?

A

Adjuvant intravesical BCG therapy

99
Q

What are the treatment options for muscle invasive bladder cancer?

A
  • TURBT
  • Radical cystectomy
  • Radical radiotherapy
100
Q

What does the treatment for muscle invasive bladder cancer depend on?

A

Age and performance status of the patient

101
Q

What have recent advances in radiotherapy from improved CT simulation lead to?

A

More accurate treatment, with improved outcome results and reduced side effects

102
Q

How can metastatic bladder cancer be treated?

A

Combination chemotherapy

103
Q

What agents are used in combination chemotherapy for metastatic bladder cancer?

A
  • Gemcitabine

- Cisplatin

104
Q

Who is chemotherapy for metastatic bladder cancer suitable for?

A

Patients with good functional status

105
Q

What is the limitation of chemotherapy for metastatic bladder cancer?

A

Complete remissions are rare

106
Q

What should be undertaken for early stage renal cancer if possible?

A

Radical nephrectomy

107
Q

Can radical nephrectomy be curative in early stage renal cancer?

A

Yes

108
Q

What is the purpose of surgery for renal cancer in advanced disease?

A
  • Palliative symptoms of pain and haematuria in patients with locally advanced disease
  • Improve duration of survival in patients with metastatic disease subsequently treated with immunotherapy
109
Q

Can spontaneous regression of metastases of renal cancer following nephrectomy occur?

A

It is recognised, but extremely rare

110
Q

Does adjuvant therapy improve survival in renal cancer?

A

No

111
Q

Is standard chemotherapy effective in renal cancer?

A

No, it has little effect

112
Q

Is biological therapy effective in renal cancer?

A

Yes, can produce improvements in disease control and survival

113
Q

What biological therapies are used in renal cancer?

A

Anti-angiogenesis inhibitors such as everolimus, temsirolimus, sorafenib, and axitinib

114
Q

What can immunotherapy be used for in renal cancer?

A

Management of metastatic disease

115
Q

What immunotherapy can be used in renal cancer?

A
  • Inferferon

- Interleukin-2

116
Q

How effective is immunotherapy in renal cancer?

A

It can induce complete remissions or durable partial remissions in approx 10-15% of patients

117
Q

What does the prognosis of bladder cancer correlate with?

A

The degree of invasion at diagnosis

118
Q

What are the other prognostic determinants of bladder cancer?

A
  • Age
  • Performance status
  • Gender
  • Histological grade of tumour
  • Size and extent of tumour sprad
119
Q

What is the 5 year survival for superficial bladder cancers?

A

80-90%

120
Q

What is the 5 year survival for invasive bladder cancers?

A

30-40%

121
Q

What is the 5 year survival for renal cell cancer?

A

45%

A - MSRA Cancer Care [1] (47 decks)

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