8.8 Renal Tumours & Prostate Cancer

Question 1

3 most common benign renal tumours

Answer 1

1. Oncocytoma
- benign variant of renal cell ca
- indistinguishable on imaging

Adenoma
- precursor to RCC

Angiomyolipoma (AML)
- hamartoma containing fat, muscle and blood vessels
- associated with tuberous sclerosis
- can rupture if enlarges (preg)

Question 2

Etiology of RCC (renal cell ca)

Answer 2

• hypertension
• obesity
• acquired renal cystic disease
• von-hippel-lindua disease - familial syn (autosomal dominant)
• renal adenoma
• smoking

Question 3

RCC pathology

Answer 3

• arises form proximal tubular epithelium

Primary types
- clear cell
- papillary (type 1&2)
- chromophobe
- collecting duct
- sarcomatoid

Question 4

RCC spread of cancer

Answer 4

Local spread
- anatomical planes
- perinephric fat & fascia
- adrenal gland
- posterior abdominal wall
- can form tumour thrombus along veins: renal vein -> IVC -> Right atrium
- surrounding organs (rare)

Lymphatic spread
- hilar
- para-aortic
- mediastinal
- supraclaviclar

Haematgenous
- lungs
- liver
- bone
- brain

Question 5

Unique pathological features of RCC

Answer 5

• thrombus forming tumour
• can get very big before metastasising
• produce toxins & hormones (para-neoplastic syn)
• can metastasise to unorthodox sites (vagina, bladder, parotid glands)

Question 6

What is the mortality : incidence ratio of prostate cancer in Africa

Answer 6

71%
7 out of 10 men diagnosed will die
- we diagnose it too late

Question 7

Risk factors for prostate cancer

Answer 7

Age
- ⬆️ age (>70) : ⬆️ incidence

Black ethnicity
- earlier onset
- increase incidence
- more aggressive

Family history
- first degree relative (male/female)
- prostate, breast, cervix (BRCA 2 gene)

Question 8

Natural progression of prostate cancer

Answer 8

1. Early-stage
- 5 year survival rate for Stage 1&@ men is 90%
- 10 year survival rate >65%

2. Advanced tumours
- have already spread (lymph / blood)
- controlled by ADT (androgen deprivation therapy) {testosterone stim tumour growth and ADT stops testosterone}
- limit or relive sec sym
- prolong rime to clinical prgress

3. Resistant tumours
- hormonal - and castration resistant

Question 9

Prostate cancer pathology

Answer 9

• adenoca
• Starts: peripheral zone (malignant)
• slow growing
• Benign prostate cancer more from transitional zone

Question 10

Grading for prostate cancer
Gleason criteria

Answer 10

looks at gland (architecture and differentiation)

1. Small, uniform glands
2. More stroma between glands
3. Distinctly infiltrative margins
4. Irregular masses of neoplastic glands
5. Only occasional gland formation

• two scores given (sum of theses scores)

predominant primary pattern + second most predominant pattern (secondary)

The lower the better

Question 11

Spreading pattern of prostate cancer

Answer 11

• local (urethra, bladder neck, trigone, sv, urethral orifice)
• lymphatic (iliacs -> para-aortic)
• hematogenous (bone & lungs)

Question 12

PSA (Prostate specific antigen)

Answer 12

• in lumens of prostatic glands
• disruption of barriers between gland lumens and capillaries cause serum PSA levels to rise
• half life in circulation is ± 3.2 days
• PSA in serum = prostatic disease (not cancer specifically)

Factors influencing PSA
- medication
- catheterization (⬇️)
- ejaculation
- acute prostatitis
- subclinical or chronic prostatitis
- urinary retention
- needle biopsies of prostate