Cancer

Question 1

risk factors for bladder SCC?

Answer 1

schistosomiasis

smoking

Question 2

T/F: benign bladder tumours are common

Answer 2

false - uncommon

Question 3

> 90% of bladder malignancies are what subtype?

Answer 3

TCC

Question 4

presentation of bladder cancer?

Answer 4

painless macroscopic haematuria

Question 5

investigation for histological diagnosis and staging of bladder cancer?

Answer 5

cystoscopy and biopsy or TURBT

Question 6

Ix in bladder cancer for

1) determining locoregional spread
2) distance disease
3) investigating nodes of uncertain significance

Answer 6

1) MRI
2) CT
3) PET CT

Question 7

risk factors for transitional cell carcinoma of the bladder?

Answer 7

smoking
alanine dyes e.g. 2-naphthylamine and benzidine
rubber manufacture
cyclophosphamide

Question 8

commonest cancer in adult males in the UK?

Answer 8

prostate

Question 9

risk factors for prostate cancer?

Answer 9

age
afro-carribean ethnicity
obesity
FH

Question 10

presentation of prostate cancer?

Answer 10

Early: few symptoms (periphery affected)

bladder outlet obstruction: hesitancy, urinary retention
haematuria, haematospermia
pain: back, perineal or testicular

Question 11

PR exam in prostate cancer?

Answer 11

asymmetrical, hard, nodular enlargement with loss of median sulcus

Question 12

1st line investigation for suspected prostate cancer?

Answer 12

multiparametric MRI

Question 13

complications of TRUS biopsy?

Answer 13

sepsis
pain
fever
haematuria and rectal bleeding

Question 14

treatment of metastatic prostate cancer?

Answer 14

GnRH agonist e.g. Goserelin (Zoladex)
Anti-androgen e.g. cyproterone acetate
Orchidectomy

Question 15

when starting treatment with Goserelin in prostate cancer, what drug do you need to cover with at first?

Answer 15

anti-androgen (to prevent rise in testosterone - ‘flare’)

Question 16

T/F: a prostate cancer screening program exists within the UK

Answer 16

false - men allowed to make informed choice

Question 17

around ___% of men with prostate cancer have a normal PSA

Answer 17

20

Question 18

causes of raised PSA?

Answer 18

prostate cancer
BPH
prostatitis and UTI
ejaculation in prev 48hr
vigorous exercise in prev 48hr
urinary retention
instrumentation in the urinary tract 
?PR exam

Question 19

commonest type of primary renal neoplasm?

Answer 19

RCC (hypernephroma)

Question 20

commonest histological subtype of RCC?

Answer 20

clear cell

Question 21

RCC associations

1) more common in what demographic?
2) lifestyle factor?
3) __ ___ syndrome
4) tuberous ____

Answer 21

1) middle-aged males
2) smoking
3) von Hippel-Lindau
4) sclerosis

Question 22

Presentation of RCC? (inc classical triad)

Answer 22

Triad: haematuria, loin pain, abdominal mass
Pyrexia
Left varicocele
Endocrine effects: EPO, PTH, renin, ACTH

Question 23

RCC may present with varicocele on which side? why?

Answer 23

left sided- occlusion of left testicular vein

Question 24

__% of RCC patient’s have metastases at presentation

Answer 24

25

Question 25

What is Stauffer syndrome? who does it occur in?

Answer 25

RCC paraneoplastic hepatic dysfunction syndrome- cholestasis/ hepatosplenomegaly.

Question 26

commonest malignancy in men aged 20-30?

Answer 26

testicular cancer

Question 27

around 95% of testicular cancers are what subtypes?

Answer 27

Germ cell

Question 28

sub-divisions of germ cell tumours?

Answer 28

Seminoma | Non-seminoma: embryonal, teratoma, yolk sac, choriocarcinoma

Question 29

Non germ-cell testicular tumours?

Answer 29

Leydig cell tumour | sarcoma

Question 30

risk factors for germ cell tumours?

Answer 30

``` infertility cryptorchidism family history Klinefelter's syndrome mumps orchitis ```

Question 31

presentation of testicular cancer?

Answer 31

painless testicular lump hydrocele gynaecomastia

Question 32

___ is elevated in around 60% of germ cell tumours ___ is elevated in around 40%

Answer 32

AFP LDH

Question 33

seminoma: ___ may be elevated in around 20%

Answer 33

HCG

Question 34

first line investigation for testicular cancer?

Answer 34

testicular USS

Question 35

T/F: prognosis is generally poor in testicular cancer

Answer 35

false- excellent

Question 36

PSA test should be postponed how long following prostatitis/ UTI

Answer 36

1 month

Question 37

why might gynaecomastia occur in testicular tumours?

Answer 37

increased oestrogren:androgen ratio Germ-cell tumours → hCG → Leydig cell dysfunction → relative increase in oestradiol production Leydig cell tumours → directly secrete more oestradiol and convert additional androgen precursors to oestrogens