bladder cancer

Question 1

What is the most common kidney cancer in adults?

Answer 1

Renal cell carcinoma (80% of neoplasms arising from the kidney)

Question 2

What is the gender bias in renal cancer?

Answer 2

male:female → 1.5:1

Question 3

What are risk factors for the development of renal cancere?

Answer 3

Risk factors include lifestyle, smoking (!!), obesity and hypertension

Other risk factors include long-term renal dialysis, tuberous sclerosis, renal transplant recipients and acquired renal cystic disease.

Question 4

You know renal cell carcinoma, what other renal cancers exist?

Answer 4

Transitional cell carcinoma.
Renal oncocytoma.
Wilms’ tumour (most common in children)

Question 5

How do renal cancers present?

Answer 5

Classic triad:

1. Haematuria
2. Loin pain
3. Potential loin mass

Other presentations include fatigue, weight loss, macroscopic haematuria, palpable mass, varicocele, bilateral ankle oedema, pyrexia of unknown origin and hypertension.

Question 6

Where do renal cancers often spread to?

Answer 6

The lungs are the most common site of metastases. It is one of the carcinomas to metastasise to bone where it produces osteolytic lesions.

To the adrenal glands, liver, spleen, colon or pancreas.

Local lymph nodes are often involved.

Question 7

How would you stage renal cancer?

Answer 7

CT scan

Question 8

Considering renal cancer, how many patients have metastases at presentation?

Answer 8

20-30%

Question 9

How would you manage localised renal cancer?

Answer 9

Partial nephrectomy is considered first-line (with or without adjuvant therapy)

Radical nephrectomy is no longer the gold standard curative therapy for patients with localised RCC

Question 10

How would you manage advanced renal cancer?

Answer 10

Tumour nephrectomy is recommended in otherwise fit patients with metastatic disease, combined with interferon alfa (IFN-α).

Sunitinib (a tyrosine kinase inhibitor) is recommended by NICE as first-line treatment for advanced or metastatic RCC in patients who are suitable for immunotherap

Question 11

What are complications from renal cancer?

Answer 11

Paraneoplastic syndromes may develop and include:

1. Polycythaemia due to erythropoietin production.
2. Hypercalcaemia due to production of a parathormone-like hormone.

Question 12

What is the five year survival for renal cancer?

Answer 12

56%

Question 13

What age is the most common to present with renal cell carcinoma?

Answer 13

60-70s

Question 14

What is the most common bladder cancer?

Answer 14

Transitional cell carcinoma (90%)

Question 15

What is the gender bias in bladder cancer?

Answer 15

male:female → 3:1

Question 16

What is the most common age group for bladder cancer?

Answer 16

75+

Question 17

What is the main risk factor for bladder cancer?

Answer 17

Increasing age

About half of bladder cancers are caused by smoking. Tobacco smoke contains aromatic amines and polycyclic aromatic hydrocarbons, which are renally excreted.

Occupational exposure to aromatic amines, polycyclic aromatic hydrocarbons and chlorinated hydrocarbons is the second most important risk factor

Question 18

By how much does smoking increase your risk of bladder cancer?

Answer 18

The risk of developing bladder cancer is 2-6 times greater in smokers than in non-smokers

Question 19

What are the main symptoms flor bladder cancer?

Answer 19

The presenting feature is painless haematuria that is gross in 80-90%

Advanced disease may cause voiding symptoms, although these can even be produced by carcinoma in situ (CIS).

Question 20

When would you refer someone with suspected bladder cancer?

Answer 20

Adults over 45 years who have unexplained visible haematuria without urinary tract infection.

Adults over 45 years with visible haematuria that persists or recurs after successful treatment of urinary tract infection.

Adults aged 60 and over who have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test.

Question 21

How would you diagnose bladder cancer?

Answer 21

The diagnosis mainly depends on the cystoscopic examination of the bladder, biopsy and urine cytology:

1. Urinalysis including culture should be performed to exclude infection.
2. Urine cytology is important in the diagnosis

CT or MRI for staging

Question 22

What type of cancer are ureteral cancers normally?

Answer 22

Transitional cell carcinoma

Question 23

Where do transitional carcinomas arise?

Answer 23

Transitional epithelium