Bladder and Renal Cancer

Question 1

Where is the most common site for urothelial cancers?

Answer 1

Bladder (90%)

Question 2

What is the most common type of bladder cancer?

Answer 2

Transitional Cell carcinoma

Question 3

If schistosomiasis is the cause of the bladder cancer what is the most common tumour type found?

Answer 3

Squamous cell carcinoma

Question 4

What are the risk factors for TCC?

Answer 4

Smoking (accounts for 40% of cases)
Aromatic amines
Non-hereditary genetic abnormalities (e.g. TSG incl. p53 and Rb)

Question 5

What are the risk factors for SCC?

Answer 5

Schistosomiasis (S. haematobium only)
Chronic cystitis (e.g. recurrent UTI, long term catheter, bladder stone)
Cyclophosphamide therapy
Pelvic radiotherapy

Question 6

What are the presenting features of bladder cancer?

Answer 6

Painless haematuria (micro or frank)
Recurrent UTI
Storage bladder symptoms
Dysuria, frequency, nocturia, urgency +/- urge Incontinence
Bladder pain

Question 7

What are the symptoms of Upper urinary tract TCC?

Answer 7

Frank haematuria
Unilateral ureteric obstruction
Flank or loin pain
Symptoms of nodal or metastatic disease 
-Bone pain
-Hypercalcaemia
-Lung
-Brain

Question 8

What investigations should be done in UTT TCC?

Answer 8

CT-IVU or IVU
Urine cytology
Ureteroscopy and biopsy

Question 9

What are two types of benign renal tumours?

Answer 9

Oncocytoma

Angiomyolipoma

Question 10

What are the four histological subtypes of renal adenocarcinoma?

Answer 10

Clear cell
Papillary
Chromophobe
Bellini type ductal carcinoma

Question 11

What are the risk factors for renal carcinoma?

Answer 11

Family history (autosomal dominant e.g. vHL, familial clear cell RCC, hereditary papillary RCC; can be bilateral and/or multifocal)
Smoking
Anti-hypertensive medication
Obesity
End-stage renal failure
Acquired renal cystic disease

Question 12

What is the presentation for renal cell carcinoma?

Answer 12

Asymptomatic
‘Classic triad’ of flank pain, mass and haematuria
Paraneoplastic syndrome
Anorexia, cachexia and pyrexia
Hypertension, hypercalcaemia and abnormal LFTs
Anaemia, polycythaemia and raised ESR
Metastatic disease-bone, brain, lungs, liver

Question 13

What investigations should be done for renal cell carcinoma?

Answer 13

CT scan (triple phase) of abdomen and chest is mandatory
Bloods : U&E, FBC
Ultrasound differentiates tumour from cyst
DMSA or MAG-3 renogram to assess split renal function if doubts about contralateral kidney

Question 14

What is the treatment for RCC?

Answer 14

Radical nephrectomy

RCC is chemo and radioresistant so need to use Tyrosine kinase inhibitors instead for metastases