Cancer Flashcards
In which zone does prostate cancer usually occur
Peripheral zone of the prostate
In which zone does BPH usually occur
Transitional zone
Which part of the prostate makes up most of the tissue mass
Peripheral zone
What test could be used to screen for prostate cancer
Prostate Specific Antigen
Not very specific though - can be raised by BPH or infection etc
Prostate cancer is the most common cancer affecting men in the UK - true or false
True
How does prostate cancer present
usually asymptomatic - picked up by PSA Lower UT symptoms Haematuria Bone pain Weight loss Hard prostate
How do you biopsy the prostate
Trans-Rectal USS guided biopsy
Take 5 samples from either side of the prostate
What type of cancer is most common in the prostate
Multifocal adenocarcinoma
Where are the most common sites of metastasis for prostate cancer
Pelvic lymph nodes
Bone
How do you grade prostate cancer
Gleason score
Take the two most abundant cell patterns, score them each and add together to get final score
What is the TNM definition of organ-confined prostate cancer
T1 or 2
N0
M0
What is the TNM definition of locally advanced prostate cancer
T3 or 4
N0
M0
What is the TNM definition of metastatic prostate cancer
N+ and M+
How do you manage organ confined prostate cancer
Watchful waiting If not advanced
Radical surgery
Radical radiotherapy
How do you treat locally advanced prostate cancer
Radiotherapy with adjuvant hormone therapy
Watch and wait if asymptomatic
Hormone therapy alone if unit for radio
How do you manage metastatic prostate cancer
Androgen deprivation therapy
Steroids
Chemo
How does bladder cancer present
Painless haematuria
How do you diagnose bladder cancer
Flexible cystoscopy and CT scan
What is the main type of cancer to affect the bladder
Transitional cell cancer
List the most common benign renal tumours
Simple cysts
Angiomyolipoma
Oncocytoma
What is a angiomyolipoma
Benign tumour affecting the blood vessels, smooth muscle and fat
Seen in middle aged women
Which condition is angiomyolipoma associated with
tuberous sclerosis
How does angiomyolipoma present
Loin pain
Haematuria
Mass
Some may have a massive retroperitoneal bleed
How do you diagnose and treat angiomyolipoma
USS and CT
Treat if larger than 4cm with embolization or partial nephrectomy
Describe an oncocytoma a
Benign kidney tumour - doesn’t metastasize
Spherical, brown and has a central scar
Cells are packed with mitochondria
Can be hard to differentiate from Renal cell carcinoma
List the subtypes of renal cell carcinoma
Clear cell - most common Papillary cell Chromophobe Collecting Duct Medullary cell
What gene is responsible for clear cell renal carcinoma
VHL gene
Which group presents with medullary cell carcinoma
Sickle cell patients
Often present with mets
How does renal cell carcinoma present
Haematuria Loin pain Mass Pyrexia Varicocele - varicose veins around testicle
What investigations would you do for renal cell carcinoma
USS
CT of chest, abdomen, pelvis - look for mets
FBC and liver/renal functions
List some risk factors for renal cell carcinoma
Obesity
Smoking
Hypertension
Long term dialysis
How do you treat renal cell carcinoma
Monitor if small and patient is unfit Surgical removal (partial or total nephrectomy)
Which malignant cancers can affect the kidneys
Renal cell carcinoma
Transitional cell carcinoma
Lymphoma
Describe the epidemiology of testicular cancer
Most common solid cancer in men 20-45
Affects white Caucasians
Most curable cancer
What are some of the risk factors for testicular cancer
Previous testicular cancer - other side at risk
Undescended testes
Family history
HIV
What are the 2 main subtypes of testicular cancer
Seminoma
Non-seminomatous
How does testicular cancer present
Scrotal lump - hard, irregular
Delayed presentation - acute pain, bleeding, weight loss, neck lumps, chest or bone symptoms
What investigations would you do for testicular cancer
Serum tumour markers - alpha feto protein, B-HCG, LDH
FBC, LFT, renal function
USS testicle
CT chest and abdomen for staging
How do you treat urinary incontinence
Radical inguinal orchidectomy (remove testicle through inguinal region)
Offer sperm preservation
Re-check tumour markers 1-week post-op
CT scan
Follow up with oncology (given adjuvant chemo)
What type of cancer affects the penis
Squamous cell carcinoma (skin cancer) - ulcerating
Can invade into the tissue
HIV patients may get Kaposi’s sarcoma
List some risk factors for penile cancers
Being in 5th or 6th decade BXO Phimosis HPV Smoking Immunocompromise
Circumcision may have protective effect
Which part of the penis is most common
The glans
Then the prepuce (foreskin)
How does penis cancer present
Hard painless lump
Lots of delayed presentation though - urinary retention or groin mass
What investigations would you do for penile cancer
Examination of abdo, inguinal and genitalia
MRI scan
CT abdo, pelvis, chest
How do you treat penile cancer affecting the prepuce
Circumcision
Remove affected inguinal nodes
How do you treat penile cancer affecting the glans
Glans resurfacing or resection (depending on depth)
If disease is advanced you may need penile amputation
Remove affected inguinal nodes
Which neoplasia’s can affect the penis
PEiN - penile intraepithelial neoplasia
Differentiated type is not HPV related and dedifferentiated is
Describe the appearance of a seminoma of the testes
Potato tumour (when you cut it open it looks like a potato)
What is the more common testicular cancer subtype
Seminoma
What treatment is a seminoma sensitive to
Very radio-sensitive
What treatment is a non-seminomatous tumour sensitive to
Very chemo-sensitive
Though has quick local and vascular infiltration
How can you diagnose a trophoblast testicular tumour
Produces HCG so will give a positive pregnancy test
Embryonal testicular tumours are aggressive - true or false
True
Quick mets and high grade
What tumour marker is produced by yolk sca testicular tumours
alpha feto protein
