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Year 2 - Renal > Bladder + renal cancer > Flashcards

Bladder + renal cancer Flashcards

1
Q

Urothelial carcinoma aka

+ affects what organ the most

A

transitional cell carcinoma (TCC)

affects BLADDER (90%) but technically speaking can affect anywhere from renal calyces to tip of urethra as transitional epithelium is all along the tract

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2
Q

2 types of bladder cancer + which more common

A

Transitional cell carcinoma - 90%

Squamous cell carcinoma

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3
Q

Squamous cell carcinoma of the the bladder is less common and is mostly caused by

A

Schistosomiasis infection by S. haematobium

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4
Q

Risk factors of TCC of the bladder (3)

A

Smoking - MAIN
Occupational exposure to chemical carcinogens - aromatic amines
Age >55, male

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5
Q

Risk factors of SCC of the bladder (3)

A

Schistosomiasis infection
Chronic cystitis (from recurrent UTIs, stones)
Systemic chemotherapy - e/g/ cyclophosphamide

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6
Q

Main symptom of bladder cancer +

symptoms/signs of bladder carcinoma in situ (superficial but aggressive high grade form)

A

Painless frank haematuria

If carcinoma in situ (aggressive)

  • dysuria
  • frequency
  • urgency
  • bladder pain
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7
Q

Investigations of bladder cancer

  • biochem (2)
  • imaging (2)
  • definitive diagnosis
A

Urinalysis - microscopy etc
Urine cytology

Imaging

  • CT urogram
  • renal and bladder USS

CYSTOSCOPY + BIOPSY
-cystoscopy itself good for low grade cancers but high grade less visible as their cells are flatter

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8
Q

Painless frank haematuria itself suggests what diagnosis whereas painful haematuria suggests what

A

Painless - bladder cancer

Painful - UTI

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9
Q

IV urogram is not used as much anymore to investigate TCCs - why?

A

Small bladder tumours are often not visible, good for upper urinary tract but still can miss out tumours

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10
Q

Definitive diagnostic investigation of TCCs of the bladder

A

Cystoscopy guided biopsy

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11
Q

Staging investigations of TCCs of the bladder

A

CT
MRI
Bone scan - to see bone metastases

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12
Q

Treatment of bladder TCC

  • if low grade superficial (2)
  • if high grade superficial/CIS (3)
  • if muscle invasive (T2 onwards) (2)
A

If non-muscle invasive (superficial)
-transurethral resection of a bladder tumour (TURBT) via cystoscopy
AND
-immediate post op intravesical chemotherapy

If high grade superficial/CIS
-above
AND
-2 weeks post op intravesical BCG vaccine

If muscle invasive

  • radical cystectomy + pelvic lymph node dissection
  • neoadjuvant chemo +/- adjuvant
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13
Q

Grading of tumours is different to staging, describe the 3 grades of bladder tumours

A

G1 = Well diff. - commonly non-invasive

G2 = Mod. diff. - often non-invasive

G3 = Poorly diff. - often invasive + metastatic

Carcinoma in situ (CIS) - non muscle invasive (so still superficial) but very AGGRESSIVE

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14
Q

What are the different stages of bladder cancer (NOT GRADE) (4)

A

Carcinoma in situ (CIS) - non muscle invasive but very AGGRESSIVE

Ta - superficial

T1 - superficial

T2 onwards - muscle invasive

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15
Q

Although carcinoma in situ is superficial, what grade is it

A

high grade because very aggressive

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16
Q

Non-invasive low-grade (TaG1) bladder tumours have a low risk of stage progression but recurrence…

A

is still high post resection so need follow up cystoscopy 3 months later

17
Q

TCCs of the upper urinary tract mostly affect

A

renal pelvis or calyces; not so much the ureter

18
Q

Symptoms (1) /signs (2) of upper urinary tract TCC (i.e. affecting renal pelvis/calyces/ureter)

A

Flank/loin pain

Frank haematuria
Unilateral obstruction –> unilateral hydronephrosis

19
Q

Investigations of an upper urinary tract TCC (affecting renal pelvis/calyces/ureter)

  • urine (2)
  • imaging (2)
A

Urinalysis - microscopy
Urine cytology

CT urogram - tumour shows as filling defect
Ureteroscopy + biopsy

20
Q

Treatment of upper urinary tract TCCs (affecting renal pelvis/calyces/ureter)

A

Nephro-ureterectomy

If unfit for this or disease is only low grade
-endoscopic ablation

21
Q

Benign tumours of the kidney (2)

A

Oncocytoma

Angiomyolipoma

22
Q

Malignant tumours of the kidney (2)

A

Renal cell adenocarcinoma aka renal cell carcinoma (NOT THE SAME AS CLEAR CELL CARCINOMA; clear cell is a subtype of renal cell carcinoma)

TCC of kidney

23
Q

Histological subtypes of renal adenocarcinoma/ renal cell carcinoma (4)

A

Clear cell - MOST COMMON
Papillary
Chromophobe
Bellini type ductal carcinoma

24
Q

Renal cell carcinoma (RCC) is renal malignancy arising from the renal parenchyma/cortex, and accounts for about 85% of renal cancers, much more common than what cancer of the kidney

A

TCC of the kidney

25
Q

Commonest renal cell carcinoma

A

Clear cell renal cell carcinoma

26
Q

Risk factors of renal cell carcinoma (aka renal cell adenocarcinoma) (6)

A 
Smoking
Male
Age >55
Obesity
Hypertension
Family history of RCC
Polycystic kidneys
27
Q

Symptoms/signs of renal cell carcinoma

  • 50% cases people are
  • single presentation
  • classic triad in <10% (suggests local advanced)
A

50% actually asymptomatic and only found INCIDENTALLY on imaging of something else

Haematuria alone

Classic triad

  • flank pain
  • palpable mass
  • haematuria
28
Q

Some renal cell carcinomas present as paraneoplastic syndromes

What are some of the symptoms/signs presented here

A

Systemic symptoms
-fever, weight loss, night sweats, cachexia (weakness + wasting)

Ectopic secretions

  • erythropoetin –> polycythemia (high RBCs)
  • renin –> hypertension
  • PTH –> hypercalcaemia
  • ACTH –> Cushing’s syndrome
29
Q

Renal cell carcinoma metastases to what places (4)

A

Bone
Brain
Lungs
Liver

30
Q

What stage of renal cell carcinoma indicates it has extended outwith the fibrous capsule of the kidney

A

T3 and onwards

T1 and T2 - still confined in capsule

31
Q

Routes renal cell carcinoma can spread (3)

A 
Direct spread (local invasion through fibrous capsule)
-e.g. into renal vein/IVC

Via blood

Via lymph
-to paracaval lymph nodes

32
Q

Investigations of renal cell carcinoma (6)

-imaging (2)

A

FBC - may show anaemia or polycythaemia (from EPO secreting paraneoplastic syndrome)
U+Es - may be high creatinine if low GFR
LFTs - abnormal enzymes may indicate liver metastases
Urinalysis - microscopy (for haematuria)

CT abdo/pelvis - DEFINITIVE DIAGNOSIS
CT chest - to look for metastases

33
Q

Treatment of renal cell carcinoma

  • if localised mass (stage 1/2)
  • if spread outwith capsule (stage 3) (1)
  • if stage 4 (metastatic) (2)
A

Chemotherapy/radiotherapy RESISTANT

Surgery

  • tumour resection/local ablation if just stage 1/2 (localised)
  • radical nephrectomy if stage 3

Metastastic

  • targeted molecular therapy (TYROSINE KINASE RECEPTOR INHIBITORS)
  • immunotherapy
34
Q

Renal cell carcinoma is resistant to what treatment

A

Chemotherapy/radiotherapy

Year 2 - Renal (21 decks)

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