Bladder and Renal Cancer

Question 1

Urgent referral:

Age>45 - what would trigger urgent referral?

Age>60 - what would trigger urgent referral?

Answer 1

Unexplained visible haematuria

Unexplained microhaematuria and (dysuria/WBC on a blood test)

Question 2

Non-urgent referral:

Age>60 - what would trigger a referral?

Answer 2

Recurrent or persistent unexplained UTI

Question 3

Bladder Cancer:

S+S:

• Main sign?
• It is usually painless. What other symptom can they get?

Investigations:

Bloods:
- Why may FBC be low?

Diagnosis:
- A test is done to look for cancer in urine. What is this called?
A biopsy is done after!

What imaging is used for staging?

Why is it important to ask about a chronic schistomsomiasis infection from abroad (SYM: diarrhoea, abdomen pain and malaise)?

What is another big lifestyle factor that could increase your risk of cancer?

Transitional cell carcinoma is the most common bladder cancer in the UK. What occupational exposures increase the risk of this?

Answer 3

Macro/microscopic haematuria

Dysuria

Low Hb from haematuria

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Urine cytology

CT CAP
Upper urinary tract imaging - CT urogram

It can cause bladder cancer (SCC) years later - important to ask if they have had haematuria before in a country abroad.

Smoking

Aromatic amines and aniline dyes

Question 4

Bladder Cancer:

Normal chemo/radiotherapy and surgery is done.

What may be done if the bladder has to be completely removed?

What is complete removal of the bladder, which is commonly the main Rx, called?

A transurethral resection of a bladder tumour (TURBT) can also be done.

They can get bleeding as a complication of this Rx. What can this lead to?

What is the Rx for this?

Answer 4

Urostomy

Radical cyctsectomy 2

Clot retention - 3 way catheter is needed

Question 5

Renal cell carcinoma:

Often asymptomatic. How are they usually found?

The classic triad of symptoms?

Investigations - Bloods:

• Why is FBC done? - 2
• What are some good prognostic markers?

What imaging is used?

Answer 5

Incidental detection on unrelated abo US or CT

Macro/microscopic haematuria
Flank pain
Abdo mass

Low Hb in chronic disease
Raised RBC due to increased EPO production

Raised calcium due to increased PTH production

CT KUB with IV contrast
USS

Question 6

Renal cell carcinoma:

Management:

What surgery can be done?

Answer 6

Nephrectomy