9: Urological malignancies Flashcards
Which tumours can be found in the renal pelvis?
TCC (urothelium)
What is an embryonic renal tumour found in children?
Nephroblastoma
What incidental scan often picks up renal tumours?
Ultrasound
What benign tumour is extremely common?
Renal cysts
What scans are used to view renal cysts?
Ultrasound
CT scan
When may benign renal cysts be treated?
Symptomatic - if they are causing pain
What are benign tumours associated with tuberous sclerosis?
Angiomyolipomas
What are angiomyolipomas made up of?
Blood vessels and fat
What is the main investigation for angiomyolipomas?
Why?
CT
Fat content is very distinctive on CT
What is a life-threatening complication of angiomyolipomas?
Haemorrhage
How are ruptured angiomyolipomas treated?
Embolisation
What benign renal tumour presents with a distinctive central scar?
Oncocytoma
What do
a) renal cysts
b) angiomyolipomas
c) oncocytomas
look like on imaging?
a) Fluid filled
b) Fatty
c) Centrally scarred
What is the classic triad of symptoms seen in malignant renal tumours?
Loin pain
Abdominal mass
Haematuria
What paraneoplastic symptoms are seen alongside RCC?
Weight loss
Anaemia
Hypertension
Hypercalcaemia
(Males / females) tend to get RCC.
Males
What are the two appearances of RCC?
Clear cell
Papillary
What genetic syndrome causes loads of cysts in different organs?
Von-Hippel Lindau syndrome
What is the mode of inheritance of VHL syndrome?
Autosomal dominant
In a young person with renal cell carcinoma, suspect what?
Von Hippel Lindau syndrome
How is RCC investigated?
Ultrasound
CT scan +/- contrast
Renal biopsy
Why do renal tumours cause bleeding?
Angiogenesis produces crap vessels
What staging system is used for RCC?
Robson score
Where do RCCs tend to spread?
Renal veins
Depending on the stage of the tumour, how is RCC treated?
Full nephrectomy (adrenal left unless it is affected) for advanced tumours
Partial nephrectomy for local tumours
Thermal ablation for tiny tumours or patients with one kidney or patients who can’t withstand surgery
How are small renal masses usually picked up?
Incidental finding on USS
Many surgeries are carried out for renal tumours which turn out to be ___.
benign
How are patients with metastatic renal cancer managed?
Supportively
+/- adjuvant drugs like tyrosine kinase inhibitors
As the stage of a cancer increases, its prognosis ___.
decreases
What is the most common pre-malignant lesion of the penis?
Balanitis xerotica obliterans
What does balanitis xerotic obliterans look like?
Scarring of the foreskin
How is BXO treated?
Circumcision
and/or Dorsal slit
What can BXO spread to affect?
Urethra
Glans
so management may require work on these two
What is the malignant tumour which affects the penis?
Squamous cell carcinoma
What names are given to squamous cell carcinoma-in situ of the penis?
Erythroplasia of Queryat (glans, shaft)
Bowen’s disease (everything else)
chronic inflammation of the squamous epithelium
What are the
a) pre-malignant
b) in-situ
c) invasive forms of penile cancer?
a) BXO
b) Erythroplasia of Queryat, Bowen’s disease
c) Squamous cell carcinoma
What does squamous cell carcinoma of the penis look like?
Red, raised, fungating mass
Which virus strains are involved in SCC of the penis?
HPV types 16 and 18
How is SCC of the penis staged?
TNM staging
Apart from the local parts of the penis and scrotum, where else can penile cancer spread?
Inguinal lymph nodes
How is penile cancer treated?
Surgery (penectomy)
Inguinal lymphadenectomy
or Palliative (e.g radiotherapy for those with advanced cancer, those who can’t withstand surgery)
What is the difference between a total and partial penectomy?
Partial - external urethral orifice preserved
Total - patient has to void through a stoma
What are the most common testicular tumours?
Germ cell tumours
What are the two important types of germ cell tumour?
Seminoma
Teratoma
How do testicular tumours present?
Are they painful?
Testicular swelling
Painless
How does metastatic testicular cancer present?
Signs of systemic invasion
SOB
Lymphadenopathy
What is the gold standard investigation for testicular cancer?
USS
What are some markers of testicular cancer?
AFP
HCG
LDH
Which marker is not produced by seminomas?
AFP
Which tumours produce AFP, hCG and LDH?
a) Teratomas
b) Seminomas and teratomas
c) Seminomas and teratomas
So AFP seems to be the way to tell them apart
How is testicular cancer treated?
Orchidectomy
removal of testicle
some cancers also respond to radiotherapy
Where is the testicle removed in orchidectomy?
From the groin
so you can look at lymphatics simultaneously
What congenital problem massively increases your chances of developing testicular cancer?
Undescended testes
Men of what age tend to get testicular cancer?
20 - 35 years old
Each type of testicular cancer has a different ___ in case of metastasis.
treatment
Which lymph nodes do testicular cancers spread to?
Lumbar nodes
In the abdomen, due to the embryological origin of testes
Which specialty deals with the treatment of metastatic testicular cancer?
Oncology
