Bladder and Renal Cancer

Question 1

Risk factors for transitional cell carcinoma of the bladder

Answer 1

Smoking, aromatic amines, cyclophosphamide

Question 2

Risk factors for squamous cell carcinoma of the bladder

Answer 2

Schistomiasis infection, long term catheterisation (>10 years)

Question 3

Risk factors for adenocarcinoma and small cell cancer of the bladder

Answer 3

Other types of bladder cancer and local bowel cancer (adenocarcinoma only)

Question 4

Features of bladder cancer

Answer 4

Visible painless haematuria, UTI, hydronephrosis, neuropathic pain on medial thigh (invasion of obturator nerve), weight loss, night sweats

Question 5

Common metastatic sites of bladder cancer

Answer 5

Lungs, liver and bone

Question 6

Investigations into bladder cancer

Answer 6

UT urogram, flexible cytoscopy then rigid cystoscopy to take biopsy

Question 7

Treatments of non-muscle invasive bladder cancer

Answer 7

Transurethral resection of bladder tumour (GOLD) with addition of chemotherapy or immunotherapy

Question 8

Treatment of muscle invasive bladder cancer

Answer 8

Cystectomy with urinary diversion (GOLD), without metastatic disease or significant co-morbidities

Question 9

Types of bladder diversions

Answer 9

Ileal conduit, neo-bladder or mitrofanoff

Question 10

What is renal cell carcinoma

Answer 10

Adenocarcinoma of the renal cortex arising from PCT

Question 11

Features of renal cell carcinoma

Answer 11

Macroscopically well circumsised with high fat and glycogen content. Often areas of haemorrhage and necrosis (85%)

Question 12

Features of transitional cell carcinoma in renal pelvis

Answer 12

Macroscopically papillary or flat, squamous differentiation and excessive keratinisation

Question 13

Risk factors for renal cancer

Answer 13

North American and European. Obesity, smoking, HTN, diet with low vitamins

Question 14

Presentation of renal cell carcinoma

Answer 14

Haematuria (50%), loin pain (40%), flank mass (30%), metastatic disease (10%), left sided varocoele

Question 15

INvestigations into renal cancer

Answer 15

US, CT, MRI, IV urogram, flexible cystoscopy,, often picked up incidentally, biopsies not routine

Question 16

Treatment of renal cell carcinoma

Answer 16

Relatively insensitive to chemotherapy and radiotherapy. Surgery depends on stage and function of other kidney - partial or radical nephrectomy

Question 17

Treatment of transitional cell carcinoma of the renal pelvises

Answer 17

Radical nephroureterectomy involving removal of kidney and ureter. Offered if not distant disease. Chemotherapy or laser therapy used