Bladder and Kidney Cancer

Question 1

What are the main risk factors of bladder cancer?

Answer 1

PeeSAC
Chronic cystitis
Long term catheter
Pelvic radiotherapy

Question 2

What does PeeSAC stand for in terms of bladder cancer risk factors?

Answer 2

Phenacitin
Smoking (#1 risk factor)
Analine
Cyclophosphamide

Question 3

What is the most common type of bladder cancer?

Answer 3

Transitional cell carcinoma

Question 4

What are the two main types of bladder cancer?

Answer 4

Urothelial

Non-urothelial

Question 5

Non-urothelial consists of what types of bladder cancer?

Answer 5

Adenocarcinoma

Squamous cell carcinoma

Question 6

What defines a low grade urothelial carcinoma?

Answer 6

Non muscle invasive

Question 7

What are the major presenting features of bladder cancer?

Answer 7

Haematuria (visible/invisible)

Weight loss/loss of appetite

Question 8

What are the two types of renal cancer?

Answer 8

Renal carcinoma

Urothelial cancer

Question 9

What are the different types of renal carcinoma?

Answer 9

Clear cell
Papillary type 1 & 2
Chromophobe
Collecting duct
Renal medullary

Question 10

What is the meant by urothelium?

Answer 10

Special type of transitional epithelium of the bladder.

Question 11

What step precedes squamous cell carcinoma?

Answer 11

Squamous cell metaplasia

Question 12

Squamous cell carcinoma of the bladder is commonly caused by what?

Answer 12

Chronic irritation e.g urinary tract infection or kidney stones.
Schistosoma parasitic infection

Question 13

How does schistosoma parasitic infection cause squamous cell carcinoma?

Answer 13

Schistosoma causes chronic inflammation of the bladder.

Question 14

Primary adenocarcinomas of the bladder are commonly derived from where?

Answer 14

Glandular tissue (therefore produce mucins)

Question 15

What is the allantois?

Answer 15

Allowed urine to flow from the fetal bladder to the amniotic sac.

Question 16

What is the urachus?

Answer 16

The embryological remnant of the allantois.

Question 17

What are the two main types of urothelial carcinomas?

Answer 17

p53 dependant

p53 independant

Question 18

What is characteristic of p53 dependant urothelial carcinomas?

Answer 18

Invasive

Flat tumour

Question 19

What is characteristic of p53 independant urothelial carcinomas?

Answer 19

Less aggressive

Papillary tumour

Question 20

What is the most common type of kidney cancer?

Answer 20

Renal cell carcinoma aka adenocarcinoma

Question 21

Where do renal cell carcinomas form from?

Answer 21

Epithelial cells in the proximal convoluted tubule.

Question 22

What are the main symptoms of renal cell carcinomas?

Answer 22

Flank pain or near hip
Palpable mass
Haematuria
Inflammation
Paraneoplastic syndromes

Question 23

What is a paraneoplastic syndrome?

Answer 23

The tumour cells generate a hormone which causes it’s own set of symptoms.

Question 24

What effect can renal paraneoplastic syndromes have.

Answer 24

Excessive EPO production can lead to polycythemia.
Excessive renin increasing bp.
Excessive PTHrP leading to hypercalcemia.
Excessive ACTH which can lead to cushings.

Question 25

How can a large renal cell carcinoma affect the left renal vein and what symptoms may be seen?

Answer 25

Can occlude the left renal vein, which can then impede the venous drainage of the left testes. This can lead to a varicocele (dilated veins in the tests bag of worms).

Question 26

Why does a large renal cell carcinoma not affect the right testes in the same way?

Answer 26

The right testicular vein drains directly into the right vena cava, and thus will not form a varicocele.

Question 27

What does TNM stand for in the TNM cancer staging system?

Answer 27

T - size of the tumour and whether it has grown into nearby areas. N - degree of spread to reteroperitoneal lymph nodes. M - Degree of metastasis.

Question 28

What cells make up Willm's tumour?

Answer 28

Metanephric blastemal cells (cells evolved in kidney development).

Question 29

Amongst which population is Willm's tumour seen?

Answer 29

Children

Question 30

What is the presentation of Willm's tumour?

Answer 30

Large flank mass (palpable, unilateral) Haematuria Hypertension (caused by excess renin)

Question 31

Willm's tumour aka

Answer 31

Triphasic nephroblastoma

Question 32

What are the general risk factors of kidney cancers?

Answer 32

``` Obesity Smoking Previous thyroid cancer Chronic renal failure - dialysis Hypertension ```

Question 33

What is the "classic triad" of presenting features in renal cancers?

Answer 33

Haematuria Loin pain Mass

Question 34

Presentation of bone pain with renal cancer suggests what?

Answer 34

Metastisis

Question 35

What are the main investigations carried out in renal cancers?

Answer 35

Urine test Blood test US/MRI/CT scan

Question 36

Renal cell carcinomas arise from where?

Answer 36

Renal cell carcinomas (RCCs) arise from proximal tubular epithelium.

Question 37

Storage symptoms

Answer 37

The collective term for symptoms including urgency, frequency and nocturia.