Bladder and Renal Cancer Flashcards
1
Q
What % of new cancer diagnoses are bladder cancer in the UK?
A
5% for men
2% for women
2
Q
What is the male to female ratio of bladder cancer?
A
3:1
3
Q
At what age is the peak incidence of bladder cancer?
A
65
4
Q
What % of adult malignancies does renal cancer account for?
A
3% in men
1% in women
5
Q
What age group do adult renal cancers occur in?
A
Most patients are over 50 years of age
6
Q
What is the most common risk factor for bladder cancer worldwide?
A
Chronic bladder infection from parasites such as schistosomiasis
7
Q
What are the risk factors for bladder cancer in the Western world?
A
Environmental exposure to inflammation from smoking, arylamines, and rubber processing
8
Q
Where might a person become exposed to arylamines?
A
In the dye industry
9
Q
What genetic changes increase the risk of bladder cancer?
A
- Mutations on chromosome 9, particularly the TP53 gene
- Overexpression of EGFR
10
Q
What kind of bladder cancer is of increased risk in patients with mutations in chromosome 9?
A
Transitional cell cancer
11
Q
What % of cases of bladder cancer have over-expression of EGFR?
A
40%
12
Q
What does over-expression of EGFR correlate with in bladder cancer?
A
Poor prognosis
13
Q
Who is adult renal cell cancer more common in?
A
- Men
- Those who smoke
14
Q
What conditions can adult renal cell cancer be seen in?
A
- Von Hippel-Lindau disease
- Familial papillary renal carcinoma syndrome
15
Q
What is Von Hippel-Lindau disease?
A
An autosomal dominant condition with mutations on chromosome 3
16
Q
What does familial papillary renal carcinoma syndrome occur due to?
A
Mutation of MET oncogene on chromosome 7q31
17
Q
What cancers can renal metastasis arise from?
A
- Lung or breast cancers
- Melanoma
- Lymphoma
18
Q
What are transitional cells?
A
Stem cells
19
Q
Where are transitional cells found?
A
Adjacent to the basement membrane of the epithelial surface that line the renal tract, from the renal papillae to the proximal urethra
20
Q
What kind of epithelium lines the distal urethra?
A
Squamous epithelium
21
Q
Where do most transitional cell tumours arise?
A
In the bladder
22
Q
Why do most transitional cell tumours arise in the bladder?
A
As this is an area of polyclonal field change most susceptible to malignant change
23
Q
What do many bladder cancers start out as?
A
Papillary tumours
24
Q
Are papillary tumours of the bladder unifocal or multifocal?
A
They can be multifocal across the surface area of the bladder
25
What % of patients with bladder cancer will ave superficial papillary disease at diagnosis?
70%
26
What % of patients with bladder cancer will have an invasive tumour at diagnosis?
30%
27
What % of bladder TCC start as carcinoma in situ?
10%
28
Describe bladder carcinoma in situ
Flat, non-invasive, high-grade bladder cancer that spread over the surface of the bladder
29
How can bladder carcinoma in situ progress?
It can become invasive and penetrate the bladder muscle, then metastasise
30
What % of bladder tumours are TCC?
Up to 95%
31
What % of bladder tumours are squamous cell carcinoma?
5%
32
What do bladder squamous cell carcinomas usually result from?
Chronic inflammation
33
What are the rarer types of bladder tumours?
- Rhabdomyosarcoma
| - Leiomyosarcoma
34
What % of renal tumours arise in the cortex?
90%
35
What cells do cortical renal tumours arise from?
Probably the cells of the PCT
36
What are the synonymous names of cortical renal tumours?
- Renal cell carcinoma
- Renal adenocarcinoma
- Clear cell carcinoma
- Hypernephroma
37
What % of renal tumours arise from the renal pelvis?
10%
38
What kind of tumours are those that arise in the renal pelvis?
Transitional cell tumours
39
What do tumours of the renal pelvis resemble?
Tumours of the ureter, bladder, and urethra
40
What can tumour cells of the renal pelvis produce?
Excess hormones, such as erythropoietin, renin, or PTH-related polypeptide
41
What can excess erythropoietin produced by renal pelvis tumours cause?
Polycythaemia
42
What can excess renin produced by renal pelvis tumours cause?
Hypertension
43
What can excess PTH-related polypeptide produced by renal pelvis tumours cause?
Hypercalcaemia
44
What is the most common presenting complaint of bladder cancer?
Painless haematuria
45
What % of patients with bladder cancer present with painless haematuria?
80-90%
46
What may be palpable in bladder cancer?
A bladder mass or obstructed kidney
47
What % of patients presenting with bladder cancer have distant metastases?
5%
48
What are the other presentations of bladder cancer?
- Symptoms of infection, such as urgercy and dysuria
| - Sterile pyuria
49
What presenting complaint is most commonly associated with renal cancer?
Loin, back, or abdominal pain
50
What are the other presentations of renal cancer?
- Haematuria
- Varicoceles
- Metastases and systemic effects
- Incidental finding
51
Where does renal cancer spread to via the lymphatics?
- Renal hilum
- Retroperitoneum
- Para-aortic lymph nodes
52
When can renal cancer produce varicoceles?
In male patients with occlusion of the right or left testicular veins
53
What does the right testicular vein drain into?
The IVC
54
What does the left testicular vein drain into?
The left renal vein
55
Where do metastases from renal cell cancer typically present?
- Lung
- Liver
- Bones
- Brain
56
What systemic effects can result from renal cell cancer?
- Fever
- Weight loss
- Gynaecomastia
- Night sweats
- Cushing's syndrome
- Polymyositis
- Dermatomyositis
- Malaise
- Anaemia
57
How can renal tumours be found incidentally?
Following abdominal imaging for other reasons
58
What investigations should be given to all patients presenting with painless haematuria?
- Urinanalysis
- Urine cytology
- Consider cystoscopy
59
What is the purpose of cystoscopy in patients presenting with painless haematuria?
Visualisation of bladder mucosa and urethra
60
What investigation should be offered to patients with positive cytology but normal cystoscopy?
- Examination of the upper tracts
| - Prostate examination for men
61
How is a definitive diagnosis of bladder cancer made?
Only by cystoscopy and biopsy
62
What is the purpose of CT abdo pelvis imaging in bladder and renal cancer?
It can detect local extension and lymph node involvement
63
What is the purpose of imaging of the chest in bladder and renal cancer?
Screen for pulmonary metastasis
64
When is a bone scan recommended in bladder and renal cancer?
Any patient with bone pain or raised alkaline phosphatase
65
What blood tests should be done in bladder and renal cancer?
- Renal and liver function
- Prothrombin time
- Calcium
66
Are there any specific tumour markers for bladder and renal cancer?
No
67
What staging system is used for bladder cancer?
TNM
68
What is Tis in bladder cancer?
Carcinoma in situ - malignant cells not invading the basement membrane
69
What is Ta in bladder cancer?
Non-invasive papillary carcinoma
70
What is T1 in bladder cancer?
Superficial tumour, not invading beyond the lamina propria
71
What is T2a in bladder cancer?
Tumour invading into the inner half of the muscle layer
72
What is T2b in bladder cancer?
Tumour invading the outer half of the muscle layer
73
What is T3a in bladder cancer?
Microscopic tumour involving the serosal surface of the bladder
74
What is T3b in bladder cancer?
Macroscopic tumour involving the serosal surface of the bladder
75
What is T4a in bladder cancer?
Tumour spread to the stroma of the prostate (in men), or to uterus and/or vagina (in women)
76
What is T4b in bladder cancer?
Tumour spread to the pelvic wall or the abdominal wall
77
What is N0 in bladder cancer?
No lymph node involvement
78
What is N1 in bladder cancer?
One affected lymph node in the true pelvis
79
What is N2 in bladder cancer?
Two or more affected lymph nodes in the true pelvis
80
What is N3 in bladder cancer?
Involved lymph nodes along the common iliac artery
81
What is M0 in bladder cancer?
No metastases
82
What is M1 in bladder cancer?
Distant metastases
83
What is T0 in renal cancer?
No evidence of primary tumour
84
What is T1 in renal cancer?
<7cm and limited to the kidney
85
What is T2 in renal cancer?
>7cm limited to kidney
86
What is T3 in renal cancer?
Tumour extension to major veins, adrenal glands, or perinephric tissue, but not beyond Gerota's fascia
87
What is T3a in renal cancer?
Tumour invades adrenal gland or perinephric tissue
88
What is T3b in renal cancer?
Tumour invasion to renal veins and inferior vena cava below diaphragm
89
What is T3c in renal cancer?
Tumour invasion into inferior vena cava above the diaphragm
90
What is T4 in renal cancer?
Tumour invasion beyond Gerota's fascia, and involvement of more than one regional lymph node
91
What is N0 in renal cancer?
No regional lymph node metastases
92
What is N1 in renal cancer?
Metastases in a single regional lymph node
93
What is N2 in renal cancer?
Metastases in more than one regional lymph node
94
What is M0 in renal cancer?
No distant metastases
95
What is M1 in renal cancer?
Distant metastases
96
How is superficial bladder cancer treated?
Transurethral resection (TURBT)
97
What features increase the risk of relapse of superficial bladder cancer?
- High-grade histology
- Incomplete resection
- Multifocal disease
- Carcinoma in situ
98
What should patients with superficial bladder cancer that is of high risk of relapse be considered for?
Adjuvant intravesical BCG therapy
99
What are the treatment options for muscle invasive bladder cancer?
- TURBT
- Radical cystectomy
- Radical radiotherapy
100
What does the treatment for muscle invasive bladder cancer depend on?
Age and performance status of the patient
101
What have recent advances in radiotherapy from improved CT simulation lead to?
More accurate treatment, with improved outcome results and reduced side effects
102
How can metastatic bladder cancer be treated?
Combination chemotherapy
103
What agents are used in combination chemotherapy for metastatic bladder cancer?
- Gemcitabine
| - Cisplatin
104
Who is chemotherapy for metastatic bladder cancer suitable for?
Patients with good functional status
105
What is the limitation of chemotherapy for metastatic bladder cancer?
Complete remissions are rare
106
What should be undertaken for early stage renal cancer if possible?
Radical nephrectomy
107
Can radical nephrectomy be curative in early stage renal cancer?
Yes
108
What is the purpose of surgery for renal cancer in advanced disease?
- Palliative symptoms of pain and haematuria in patients with locally advanced disease
- Improve duration of survival in patients with metastatic disease subsequently treated with immunotherapy
109
Can spontaneous regression of metastases of renal cancer following nephrectomy occur?
It is recognised, but extremely rare
110
Does adjuvant therapy improve survival in renal cancer?
No
111
Is standard chemotherapy effective in renal cancer?
No, it has little effect
112
Is biological therapy effective in renal cancer?
Yes, can produce improvements in disease control and survival
113
What biological therapies are used in renal cancer?
Anti-angiogenesis inhibitors such as everolimus, temsirolimus, sorafenib, and axitinib
114
What can immunotherapy be used for in renal cancer?
Management of metastatic disease
115
What immunotherapy can be used in renal cancer?
- Inferferon
| - Interleukin-2
116
How effective is immunotherapy in renal cancer?
It can induce complete remissions or durable partial remissions in approx 10-15% of patients
117
What does the prognosis of bladder cancer correlate with?
The degree of invasion at diagnosis
118
What are the other prognostic determinants of bladder cancer?
- Age
- Performance status
- Gender
- Histological grade of tumour
- Size and extent of tumour sprad
119
What is the 5 year survival for superficial bladder cancers?
80-90%
120
What is the 5 year survival for invasive bladder cancers?
30-40%
121
What is the 5 year survival for renal cell cancer?
45%
