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Cancer care (Y4) > 6- Urological cancer (2/2) > Flashcards

6- Urological cancer (2/2) Flashcards

1
Q

Testis cancer
Background

A

Most common cancer in males aged 20-40 yo

Categorisation
- Germ cell tumours (95%) (usually malignant)
- Non- germ cell tumours (5%) (usually benign)

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2
Q

germ cell tumours

A

seminomas
non-seminomatous -GCT

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3
Q

seminomas

A

germ cell tumour
* Remain localised until late and have good prognosis

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4
Q

non-seminomatous GCT

A

metastasise early and worse prognosis
* Yolk sac tumours
* Choriocarcinoma
* Embryonal carcinoma
* Teratomas (mostly)

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5
Q

where to testicular cancers metastasise

A

Metastasis
* Lymphatics
* Lungs
* Liver
* Brain

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6
Q

RF testicular cancer

A

Risk factors
* Undescended testes (cryptorchidism)
* Previous testicular malignancy
* Male infertility
* Family history
* Increased height

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7
Q

presentation of testciular cancer

A
  • Unilateral painless lump (occasionally pain)
    o Arising from testicle
    o Hard
    o Irregular
    o Non fluctuant
    o No transillumination
  • Rarely gynaecomastia- Leydig cell tumour
  • Evidence of metastasis may present with weight loss, back pain (from retroperitoneal metastases), or dyspnoea (secondary to lung metastases).
    *Lymphatic drainage of the testes is to the para-aortic nodes, therefore localised lymphadenopathy may not be present, even in cases of metastatic disease
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8
Q

investigations for testis cancer

A
  • Scrotal US
  • Tumour markers (diagnostic and prognostic)
  • Staging CT CAP with contrast
  • Trans-scrotal percutaneous bipsy should not be performed -> can cause seeding of cancer
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9
Q

tumour markers for testicular cancer

A

both diagnostic and prognostic
AFP (Alpha-fetoprotein)
- NSGCT e.g. teratomas
- Not in pure seminomas

BHCG (Beta-hCG)
- NSGCT e.g. teratomas and choriocarcinoma
- Seminomas (5)

LDH (Lactate dehydrogenase)
- Marker for tumour volume and necrosis
- Response to oncological treatment

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10
Q

AFP (Alpha-fetoprotein)

A
  • NSGCT e.g. teratomas
  • Not in pure seminomas
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11
Q

BHCG (Beta-hCG)

A
  • NSGCT e.g. teratomas and choriocarcinoma
  • Seminomas
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12
Q

LDH (Lactate dehydrogenase)

A
  • Marker for tumour volume and necrosis
  • Response to oncological treatment
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13
Q

Staging system of testicular cancer
R

A

Royal Marsden
* Stage 1 – isolated to the testicle
* Stage 2 – spread to the retroperitoneal lymph nodes
* Stage 3 – spread to the lymph nodes above the diaphragm
* Stage 4 – metastasised to other organs

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14
Q

management of testicular cancer

A
  • Surgery to remove the affected testicle (inguinal radical orchidectomy) – a prosthesis can be inserted
  • Chemotherapy
  • Radiotherapy
  • Sperm banking to save sperm for future use, as treatment may cause infertility
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15
Q

Long term side effects of testicular cancer treatment are

A

particularly significant, as most patients are young and expected to live many years after treatment of testicular cancer. Side effects include:

  • Infertility
  • Hypogonadism (testosterone replacement may be required)
  • Peripheral neuropathy
  • Hearing loss
  • Lasting kidney, liver or heart damage
  • Increased risk of cancer in the future
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16
Q

testicular cnacer prognosis

A

Prognosis
- Overall high rate of remission

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17
Q

management of Stage 1 NSGCTs

A

Will require orchidectomy , then further managed dependent on their risk score.
- Low risk patients without any evidence of vascular invasion can routinely enter just surveillance
- Whilst high risk patients (including embryonal cancer >50% or proliferation rate >70%) or those with vascular invasion require adjuvant chemotherapy, and then surveillance, including regular examination, surveillance CT imaging and plain film chest radiographs (CXRs), and tumour markers.

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18
Q

management of metastastic 1 NSGCTs

A

NSGCTs management is also dependent on risk scoring.
o Cases with intermediate prognosis should be treated with chemotherapy,
o whilst those with poor prognosis should be treated with one cycle of chemotherapy before reassessment (those with marker decline should have continued chemotherapy cycles,
o whilst those with unfavourable decline should have their chemotherapy intensified).

19
Q

management stage 1 seminoma

A

often be managed with orchidectomy alone and surveillance monitoring.
- Patients with a high relapse risk are often considered for adjuvant chemotherapy.
- Histological factors which indicate higher risk for relapse are invasion of rete testis and tumour size >4cm.
- Surveillance for stage 1 seminoma includes twice yearly including regular examination, surveillance CT imaging, and tumour markers. Beyond 5 years, surveillance can be transferred to the GP, with regular examination and tumour markers alone.

20
Q

management of metastatic seminoma

A

Stage IIA can be treated with either radiotherapy or chemotherapy, whilst higher stage disease will require chemotherapy alone and treated similar to metastatic NSGCTs (as above).

21
Q

Penile cancer background

A

Most common is squamous cell carcinoma, arising from the epithelium of the inner prepuce or the glans- Rare

22
Q

risk factors for penile cancer

A

Risk factors
- HPV 16,18
- Phimosis - smegma build up
- Smoking
- Lichen sclerosis
- Untreated HIV infection

Protective- circumcision

23
Q

risk factors for penile cancer

A

Risk factors
- HPV 16,18
- Phimosis - smegma build up
- Smoking
- Lichen sclerosis
- Untreated HIV infection

Protective- circumcision

24
Q

presentation of penile cancer

A
  • Palpable/ ulcerating lesions on the penis usually located on the glans
  • Painless
  • May discharge or bleed
  • Inguinal lymphadenopathy (30-60%)
  • Distant mets uncommon
25
Q

DD for penile cancer

A
  • Herpes or syphilis
  • Psoriasis
  • Lichen planus
  • Balanitis
  • Premalignant -condyloma acuminatum (genital warts)
26
Q

investigations for penile cancer

A

Investigations
- Penile biopsy to confirm diagnosis
- PET-CT imaging to determine inguinal involvement
o If inguinal involvement- CT CAP

27
Q

staging for penile cancer

A

TNM

28
Q

Aim of penile cancer management

A

complete tumour removal and oncological control and organ preservation

29
Q

management of penile cancer

A

combination: surgery, radiotherapy, chemotherapy

30
Q

penile cancer surgery

A

(2cm tumour-free margin for resection)

Organ sparing treatment
* Local excision
* Partial glansectomy
* Total glansectomy with reconstruction
* Radical circumcision if only foreskin tumours

Invasive penile cancer
* Partial amputation with reconstruction
* Total penectomy

If inguinal lymph node involvement- radical inguinal lymphadenectomy, neoadjuvant chemo or radio

31
Q

Glands resurfacing after penile cancer surgery

A

consisting of complete removal of the glandular epithelium down to the corpus spongiosum, followed by reconstruction with a split skin or buccal mucosa graft

32
Q

Vulval
Background
-

A

Very rare
- Pre malignant condition (VIN)
- Elderly patients
- Usually SCC
- Caused by HPV and chronic skin disease

33
Q

Risk factors for vulval cancer

A
  • HPV 16 and 18
  • Herpes simples virus type 2
  • Smoking
  • Immunosuppression
  • Chronic vulvar irritation
  • Conditions such as Lichen sclerosis
34
Q

Presentation of vulval cancer

A

Vulval cancer may present with symptoms of:
* Vulval lump
* Ulceration
* Bleeding
* Pain
* Itching
* Lymphadenopathy in the groin

Vulval cancer most frequently affects the labia majora, giving an appearance of:
* Irregular mass
* Fungating lesion
* Ulceration
* Bleeding

35
Q

referral if suspected vulval cancer

A
  • 2 week wait if suspected
36
Q

Investigation for vulval cancer

A
  • Biopsy of the lesion
  • Sentinel node biopsy to demonstrate lymph node spread
  • Further imaging for staging (e.g. CT abdomen and pelvis)
37
Q

staging of vuval cancer

A

Staging
- FIGO

38
Q

management of vulval cancer

A
  • Surgery- vulvectomy (wide local excision)
  • Lymph node dissection
  • Radiotherapy
  • Chemoradiotherapy
39
Q

malignant condition related to vulval cancer

A

Vulval intraepithelial neoplasia (VIN)

  • Pre malignant condition
  • Involves squamous epithelium
  • Can resolve spontaneously
  • Can progress to vulval cancer
40
Q

Vulval intraepithelial neoplasia (VIN)
types (2)

A

1) High grade squamous intraepithelial lesion
* HPV

2) Differentiated VIN
* Lichen sclerosis

41
Q

presentation of VIN

A
  • Can be asymptomatic
  • Can present with itching/burning/pain
42
Q

investigation for VIN

A

biopsy

43
Q

management of VIN

A
  • Conservative: Antihistamine
  • Medical: Imiquimod
  • Surgical: Wide local excision

Cancer care (Y4) (30 decks)

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