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Renal > Cancer > Flashcards

Cancer Flashcards

1
Q

how much does a young healthy prostate weigh

A

20g

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2
Q

where is the base of prostate?

A

at the top of the prostate

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3
Q

and where is the apex of prostate

A

inferior portion of prostate

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4
Q

what kind of epithelium is the prostatic urethra covered in?

A

transitional epithelium

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5
Q

what is the verumontanum a landmark of

A

seminal vesicles

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6
Q

what is the transitional zone of the prostate

A

surrounds prostatic urethra proximal to verumontanum

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7
Q

what percentage of prostate tumours arise from the transitional zone

A

20%

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8
Q

what does the transitional zone give rise to?

A

benign prostatic hyperplasia

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9
Q

what is the central zone?

A

cone shaped region that surrounds ejaculatory duct

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10
Q

what percentage of cancers raised from the central zone

A

1-5%

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11
Q

what is th peripheral zone

A

majority of the glandular tissue.

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12
Q

where does most of the carcinomas arise and what type are they?

A

peripheral zone and they are adenocarcinomas

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13
Q

what age are most patients who’d develop prostate cancers

A

> 65

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14
Q

are black or caucasians at more risk of prostate cancer?

A

black

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15
Q

is there a familial link in prostatic cancer?

A

yes

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16
Q

how re most prostatic cancers picked up?

A

by PSA screening tests

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17
Q

what symptoms would present with prostatic cancers?

A

lower urinary tract symptoms, haematuria/ haematospermia, bone pain, anorexia, weight loss

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18
Q

what would you note on palpation of a possible prostate tumour?

A

craggy, asymmetry and nodular

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19
Q

what happens to serum PSA in those with prostatic cancer?

A

serum levels increase

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20
Q

what are other conditions that raise the PSA

A

benign prostatic hyperplasia, prostatitis/ UTIs, retention, catheterisation,

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21
Q

when would you use a trans- rectal USS guided prostate biopsy

A

abnormal rectal examination, elevated PSA

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22
Q

where is the most common sites for metastatic prostate tumour?

A

pelvic lymph nodes and skeleton

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23
Q

what is the pattern of growth of the prostate tumour

A

through urethra, bladder base, seminal vesicles, perineurial invasion and autonomic nerves

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24
Q

what type of lesions are seen in prostate tumours

A

sclerotic

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25
Q

what is th scoring method used for prostates

A

grading- gleasons scoring (1-5, 5 being the worst)

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26
Q

what is the initial feature of malignancy in prostate cancer?

A

loss of basement membrane

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27
Q

what imaging modality is used for staging?

A

bone scan, CT, MRI

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28
Q

what treatment options are available for prostate cancer

A

organ confined- watch and wait until further symptoms present, active monitoring, radical surgery, radical radiotherapy,

locally advanced disease- radiotherapy with neo adjuvant hormonal therapy, watchful waiting, hormonal therapy (non curative)

Metastatic disease- androgen deprivation therapy (LHRH, anti-androgens, bilateral sub scapular orchidectomy, maximal androgen blockade), cytotoxic chemotherapy, steroids

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29
Q

what hormones control the prostate cancer cells

A

testosterone and dihydrotestosterone

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30
Q

where does the majority of testosterone come from?

A

testis and adrenal gland

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31
Q

does testosterone exert a positive or negative effect on hypothalamic LH secretion

A

negative

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32
Q

what happens to the prostate cells if they are deprived of androgenic stimulation

A

apoptosis

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33
Q

how do LHRH agonists work?

A

down regulation of LHRH receptors with suppression of LH and FSH and testosterone secretion

34
Q

what is given along with LHRH agonists to prevent suppression of spinal cord compression?

A

anti androgen cover for 1 week prior to LHRH injection and 2 weeks after first dose

35
Q

what are side effects of LHRH agonists

A

loss of libido, hot flushes and sweats, weight gain, gynaecomastia

36
Q

what do anti androgens do

A

compete with testosterone for binding sites on receptors thus promoting apoptosis and inhibiting prostate cancer growth

37
Q

what do you use to diagnose bladder cancer

A

CT, Xray angiography, sonography, excretory urogram

38
Q

what is the most common type of uroepithelial tumour?

A

transitional cell tumour

39
Q

what are the two types of transitional cell carcinoma?

A

papillary, nonpapillary

40
Q

what is the commonest type of transitional cell carcinoma?

A

papillary (80%)

41
Q

which is the more malignant type of transitional cell carcinoma

A

non papillary

42
Q

what does transitional cell tumours look like on imaging studies?

A

single lesion/ multiple discrete lesions/ diffuse and confluent lesions

43
Q

what cancers are commonly linked with bladder cancer?

A

pelvis and ureter

44
Q

what age group is bladder cancer most common?

A

50 yo>

45
Q

what is the main difference between squamous and transitional cell carcinoma

A

calcified in squamous cell

46
Q

what are benign renal tumours

A

renal cysts, oncocytoma, angiomyolipoma

47
Q

where is majority of transitional cell carcinoma seen?

A

bladder

48
Q

how are lesions identified in kidneys?

A

US - CT

49
Q

are renal cysts bad?

A

most are benign- USS to examine fluid filled cysts

50
Q

what is angiomyolipoma

A

blood vessels, muscles and fat tumour- in wrong proportions

51
Q

what is oncocytoma

A

bening tumour- excessive mitochondria resulting in a granular cytoplasm

52
Q

what is the best imaging for oncocytoma

A

central scar on CT

53
Q

how is oncocytoma diagnosed?

A

difficult to tell, usually only diagnosed at nephrectomy

54
Q

what is the presentation of renal cell carcinoma

A

triad: loin pain, renal mass, haematuria

usually incidental on imaging

paraneoplastic syndromes- anaemia, hypertension, WL, hypercalcaemia

55
Q

what age does RCC commonly affect

A

65-75

56
Q

what is a renal cell carcinoma?

A

adenocarcinoma - epithelial in origin

57
Q

how to diagnosis RCC

A

CT scan- solid lesion take up contrast that is enhancing

58
Q

where are most renal cell carcinomas confined to?

A

capsule

59
Q

how is RCC spread

A

lymph, haematogenous spread

60
Q

where is RCC commonly spread tp

A

lung liver bone and brain

61
Q

what is the RCC treatment?

A

radical nephrectomy (standard treatment-laparscopically), partial nephrectomy, radiofrequency ablation, cryoablation

62
Q

what is standard practice involving the removal of adrenal gland in RCC nephrectomy

A

do not remove- unless it is involved

63
Q

why is partial nephrectomy good?

A

doesn’t get rid of all the nephrons

64
Q

what can you give to patients with metastatic disease

A

ECOG performance studies (best), (IL2, Interferon alpha- very rarely used) TKI- sunitinib- progression free survival by reducing neo vascularisation

65
Q

what is the survival for people with Stage 1 RCC

A

75%

66
Q

what is the most common type of penile carcinoma

A

squamous cell carcinoma

67
Q

what is balanitis xerotica obliterates (BXO)

A

causes tight foreskin in men. Causes fissuring in men, need a circumcision to fix this.

68
Q

is there a predisposition of BXO to malignancy?

A

not really that high

69
Q

what does squamous cell carcinoma look like

A

red velvety patches on glans of penis - check if not inflammation

70
Q

how would you treat carcinoma in situ

A

topical 5 flourouracil

71
Q

how would invasive squamous carcinoma occur?

A

older men, do not tell people about, late presentation, HPV infection

72
Q

how would squamous carcinoma present on penis?

A

red raised areas, foul smelling, phimosis (hygiene) and fun gating mass

73
Q

how do we diagnose squamous carcinoma of penis

A

USSa nd MRI

74
Q

what is the treatment of squamous cell carcinoma of penis

A

surgery- total or partial penectomy, inguinal node therapy, radiotherapy can be used palliatively

75
Q

what is the symptoms of testicular tumours

A

painless, insensitive testicular swelling- usually hard

76
Q

what imaging is used for testicular tumours

A

USS, CXR for metastasis ‘cannonball’ risk

77
Q

when is CT scan done for tsticaulr tumours?

A

CT abdomen thorax after surgery has occured

78
Q

what are the markers for testicualr tumour

A

AFP- never raised in seminoma , HCG, LDH,

79
Q

what is orchidectomy?

A

inguinal operation- must clamp vessels before going to scrotum

80
Q

what extra letter is included in testicular tumours?

A

s- serum

Renal (18 decks)

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