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Renal SB > Bladder and Prostate Cancer > Flashcards

Bladder and Prostate Cancer Flashcards

1
Q

what are the 3 zones of the prostate

A

transitional zone
- gives rise to BPH

central zone

peripheral zone
- origin of up to 70% of prostate adenocarcinoma

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2
Q

clinical presentation of prostate cancer

A
  • gross majority asymptomatic
  • lower urinary tract symptoms e.g. hesitancy, nocturia, poor stream
  • hematuria/hematospermia
  • bone pain, anorexia, weight loss
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3
Q

how is asymptomatic prostate cancer picked up

A

PSA tests
Abnormal Rectal exam
- asymmetry, nodule, fixed craggy mass

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4
Q

why is PSA not very specific for diagnosing prostate cancer

A

can be elevated by other reasons

  • BPH
  • prostatitis/UTIs
  • retention
  • cathererisation
  • DRE
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5
Q

Ix for prostate cancer

A

Trans-rectal USS guided prostate biopsy

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6
Q

when is Trans-rectal USS indicated

A

men with an abnormal DRE, an elevated PSA
Previous biopsies showing PIN or ASAP
Previous normal biopsies but rising PSA trends

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7
Q

what are the majority of prostate cancers

A

multifocal adenocarcinomas

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8
Q

where are the most common sites for mets of prostate cancer and why are they unique

A

pelvic lymph nodes and the skeleton

are Sclerotic lesions i.e. form bones

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9
Q

what is used as a way to predict prognosis

A

Gleason’s score

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10
Q

what is used to stage cancers

A

TNM

T - primary tumour
N - regional lymph nodes
M - distant mets

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11
Q

what are the classifications of prostate cancer

A

Organ-Confined disease
T1-2 N0 M0

Locally advanced Disease
T3-4 N0 M0

Metastatic Disease
N+, M+

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12
Q

Mx of organ confined disease

A

Watchful waiting

Surgery
- Radical prostatectomy

Radical Radiotherapy

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13
Q

possible complications of radical prostatectomy

A

erectile dysfunction
incontinence
bladder neck stenosis

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14
Q

possible complications of radial radiotherapy

A 
Irritative lower urinary tract symptoms 
Hematuria
GI symptoms 
Erectile dysfunction
Incontinence
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15
Q

Mx of locally advanced disease

A

radiotherapy with neo-adjucant hormonal therapy

hormonal therapy

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16
Q

Mx of metastatic disease

A

Androgen Deprivation Therapy

  • Hormonal therapy (Anti-Androgens, Anti-LNRH)
  • Bilareal subcapsular orchidectomy
  • maximal androgen blockade

Diethylstilbesterol/steroids

Cytotoxic chemotherapy

17
Q

what is the growth of prostate cancer cells under the influence of

A

testosterone

dihydrotestosterone

18
Q

how can apoptosis in prostate cancer cells be stimulated

A

deprived of androgenic stimulation

19
Q

what happens after chronic exposure to LNRH agonists as part of hormonal therapy

A

down-regulation of LHRH-receptors, with subsequent suppression of pituitary LH and FSH secretion and testosterone production

20
Q

side effects of LNRH agonists

A 
Loss of libido,ED
Hot flushes and sweats
Weight gain
Gynaecomastia
Anaemia
Cognitive changes,
Osteoporosis
21
Q

why is an anti-androgen given 1-2 weeks before an LNRH agonists is started

A

LHRH analogues initially stimulate pituitary LHRH receptors, inducing a transient rise in LH and FSH release, and consequently elevate testosterone production

22
Q

how do anti-androgens work

A

compete with testosterone and DHT binding on receptor in the prostate cell nucleus

promote apoptosis and inhibit cancer growth

23
Q

examples of anti-androgens

A

steroidal - cyproterone acetate

non-steroidal - nilutamide, flutamide

24
Q

side effects of steroidal anti-androgens

A

loss of libido and erectile dysfunction
gynaecomastia
cardiovascular toxicity hepatotoxicity

25
Q

side effects of non-steroidal anti-androgens

A

Sexual interest and libido maintained

gynaecomastia, breast pain and hot flashes, hepatotoxicity

26
Q

what is the most common type of bladder cancer in UK

A

transitional cell carcinoma

27
Q

what type of bladder cancer is associated with schistosomiasis

A

SCC

28
Q

Sx of bladder cancer

A

painless haematuria
recurrent UTIs
Voiding irritability

29
Q

Risk factors for bladder cancer

A

smoking
rubber/dye
schistosomiasis

30
Q

Ix of bladder cancer

A

Cystoscopy with biopsy (diagnostic)
Urine culture
CT urogram (diagnostic + staging)

31
Q

what unusual result can bladder cancer have on a urine culture

A

sterile pyuria

32
Q

what are the two subtypes of TCC of the Uroepithelial tract

A 
Papillary type (80% - 50% malignant)
Non-papillary type (20% - all malignant)
33
Q

where can TCC occur

A

in the bladder, ureter or renal pelvis

34
Q

Ix for uroepithelial tumours

A 
excretory urogram
sonography
retrograde pyelogram
computed tomography
angiography
35
Q

what do papillary TCC often look like

A

stippled appearance

36
Q

what will 50% of patients with ureter or pelvis cancer develop

A

bladder cancer

37
Q

what can be sign is seen on imaging of urinary bladder carcinomas

A

halo sign

Renal SB (15 decks)

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