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Renal > Cancer > Flashcards

Cancer Flashcards

1
Q

What is the most common malignancy affecting men in the UK?

A

Prostate cancer

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2
Q

Most prostate cancers are?

A

adenocarcinomas

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3
Q

4 risk factors for prostate cancer?

A

Increasing age (by 80 80% of men have malignant foci)
Family history
Hormonal factors
Black men > caucasians

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4
Q

Presentation of prostate cancer?

A

Majority are asymptomatic and picked up by PSA tests or abnormal DRE findings
May have lower urinary tract symptoms
Haematuria
Haematospermia
If metastasised: bone pain, anorexia, weight loss

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5
Q

75% of prostate cancers arise in what zone?

A

Peripheral zone

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6
Q

What zone of the prostate contains the majority of prostatic glandular tissue?

A

Peripheral zone

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7
Q

Describe the four zones of the prostate?

A

Transitional zone: around urethra
Anterior zone: at the front
Peripheral zone: at the back
Central zone: around the seminal vesicles

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8
Q

Abnormal Prostate on DRE?

A

Asymmetry, nodule, fixed craggy mass

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9
Q

PSA is produced by ______

Serum levels ______ with prostate cancer

A

secretory epithelial cells of the prostate

increase

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10
Q

Describe sensitivity and specificity of PSA testing?

A

Sensitivity of PSA in detecting prostate cancer is very high at 90% but specificity is very low at 40%
Basically those with cancer are identified using the test but majority of people that are positive in testing don’t actually have cancer

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11
Q

Describe 6 conditions other than cancer that can cause a rise in the PSA?

A 
benign prostatic hyperplasia
prostatitis
UTIs
Retention 
Catherisation
DRE
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12
Q

If want to test asymptomatic patients PSA what must you do?

A

Give counselling about poor specificity.
Cancer identified in less than 5%
Biopsy to get further info if PSA raised is uncomfortable with risk of significant bleeding and sepsis

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13
Q

Indications for a trans rectal USS guided prostate biopsy?

A

Men with abnormal DRE
Elevated PSA (4ng/mL)
Previous biopsies showing PIN and ASAP
Rising PSA trend despite previous normal biopsies

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14
Q

4 complications of trans rectal USS guided prostate biopsy?

A

Sepsis
PR bleeding
Vasovagal fainting
Haematuria and haematospermia for 2-3 weeks after

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15
Q

Characteristic skeletal metastasis for prostate cancer is ____

A

sclerotic

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16
Q

Describe spread of prostate cancer

A

Local extension through prostatic capsule to urethra, bladder and seminal vesicle with perineurial invasion along autonomic nerve.
Most common sites of metastatic deposit are the pelvic lymph nodes and skeleton

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17
Q

What system is used to grade prostate cancer how does it work?

A

Gleason system has grades 2-10 and indicates degree of differentiation from well 2 to aggressive 10. Grading correlates well with prognosis

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18
Q

In organ confined prostate cancer disease describe 4 treatment strategies?

A 
Watchful waiting (palliative at end)
Active surveillance (curative at end)
Radical surgery (prostatectomy to remove disease- complications though)
Radical radiotherapy (curative but complications)
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19
Q

In locally advanced prostate cancer describe 3 treatment strategies?

A

Radiotherapy with neo adjuvant hormonal therapy
Watchful waiting > well differentiated and life expectancy less than 10 yrs or in those who don’t want treatment complications
Hormonal therapy - symptomatic patients that can’t be cured but need palliation

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20
Q

Describe treatment options for metastatic prostate cancer?

A

Hormonal therapy - if you deprive prostate cells of androgenic stimulation (testosterone) they will undergo apoptosis
LHRH analogues
Anti androgens
Bilateral sub capsular orchidectomy to remove testes
Maximal androgen blockage
Diethylstibesterol (synthetic oestrogen)
Cytotoxic chemotherapy

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21
Q

Side effects of prostate cancer hormonal therapy?

A 
Loss of libido and ED
Hot flushes and sweats
Weight gain
Gynaecomastia
Osteoporosis
Anaemia
Cognitive changes
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22
Q

Describe the main types of bladder cancer?

A

90% are transitional cell carcinomas, 9% are squamous, 1% everything else (adenocarcinomas, urachal carcinoma etc)

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23
Q

Where do transitional cell carcinomas occur?

A

Bladder most common by far
Also the calyces, renal pelvis, ureter, or urethra
anywhere lined in transitional epithelium

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24
Q

Risk factors for bladder cancer?

A

Risk increases with age
Cigarette smoking (strong association)
Exposure to industrial carcinogens e.g. B-naphthylamine and benzidine
Exposure to certain drugs e.g. cyclophosphamide
Chronic inflammation in schistosomiasis (usually squamous)

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25
Q

Transitional cell carcinoma can be ____________

A

papillary or solid in growth patterns

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26
Q

Squamous cell carcinomas arise from ____________

A

metaplastic change due to persistent inflammation

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27
Q

Urachal carcinoma comes from _______

A

the urachis- fetal remnant that drained the bladder into the umbilical cord

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28
Q

Most common presentation of bladder cancer is?

A

painless haematuria

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29
Q

Presentation of bladder cancer?

A

painless haematuria most commonly
Pain can occur however if clot retention
Symptoms may be suggestive of UTI but significant bacteraemia is absent
Presenting symptoms may be pain from local nerve involvement or metastases
Flank pain if lesion causes ureteric obstruction

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30
Q

Investigations for bladder cancer?

A 
Urine cytology for malignant cells
Cytoscopy (camera/ lens into urethra)
Urinary tumour markers
CT or MRI of pelvis
Excretory urography
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31
Q

Describe management of bladder cancers?

A

Depends on staging and grading
Superficial can do transurethral resection or local diathermy
Radical cystectomy or radiotherapy if muscle invasive cancer
Can do systemic chemo and then resection to preserve bladder
In metastatic disease can do chemo

32
Q

What tumour is being described:

A benign renal tumour with a central stellate scar on CT?

A

An oncocytoma

33
Q

Pathology of an oncocytoma?

A

Small, oval and well circumscribed
Mahogony brown with a central stellate scar
Microscopically very pink and granular cytoplasm

34
Q

Treatment of oncocytoma?

A

Nephrectomy
Often can’t actually tell if it is oncocytoma or RCC until removed whole kidney anyway
Needs removed whether benign or malignant due to local effects

35
Q

Name 2 benign renal tumours?

A

Oncocytoma

Angiomyolipoma

36
Q

What is an angiomyolipoma?

A

Benign renal tumour of the blood vessels, fat and muscle

37
Q

Angiomyolipoma may occur ____ or ______

A

sporadically or in tuberous sclerosis

38
Q

What is the important complication in angiomyolipoma?

A

Risk of haemorrhage as tumour has fragile blood vessels but the kidneys are a very vascular organ so lots of blood flows through the fragile vessels
Wunderlichs syndrome > non traumatic renal haemorrhage

39
Q

What is being described:

Non traumatic renal haemorrhage?

A

Wunderlichs syndrome

40
Q

Renal cell carcinoma is ______ and thought to arise from _________

A

adenocarcinoma thought to arise from tubular epithelium

41
Q

4 histological variants of RCC in order of most common to least common?

A

1) clear cell
2) Papillary
3) chromophobe
4) collecting duct

42
Q

What is the most aggressive histological variant of RCC?

A

Collecting duct

43
Q

Risk factors/ associations for renal cell carcinoma?

A

Cigarette smoking, obesity, cystic changes in patients on haemodialysis, genetic predisposition e.g. VHL

44
Q

Describe vhl?

A

Von Hippel Lindau Disease
Results from a mutation on tumour suppressor gene and associated with haemangioblastomas, phaeochromocytoma, pancreatic cyst and renal cell carcinoma. If RCC is multifocal or bilateral this condition should be ruled out.

45
Q

If RCC is multifocal or bilateral what should be ruled out?

A

VHL

46
Q

Presentation of renal cell carcinoma?

A

Often asymptomatic and discovered incidentally
Haematuria, loin pain and mass in flank is classic triad
Can present with paraneoplastic symptoms of hypercalcaemia (secretion of PTHrp), hypertension (secretion of renin) or anaemia (depression of erythropoietin)
General symptoms of weight loss, anorexia and malaise

47
Q

Who tends to get RCC?

A

More in men than women

Age 65-75 yo

48
Q

Describe investigations in RCC?

A

US may demonstrate a solid lesion
CT scanning used to identify renal lesion and involvement of renal vein or IVC
Biopsy may or may not play a role in diagnosis

49
Q

Describe management of small tumours < 3cm in renal cell carcinoma?

A

surveillance in elderly unfit patients
ablation techniques in elderly fit patients
Ablation in selected younger patients

50
Q

Describe management of tumours > 3cm in RCC?

A

Partial nephrectomy or radical nephrectomy

Partial preserves function if younger person

51
Q

Describe management of large tumours in RCC?

A

Radical nephrectomy is done laparoscopically

52
Q

Describe treatment of metastatic disease in RCC?

A

Tyrosine kinase inhibitors prolong survival and work by reducing neo-vascularisation. Removing primary tumour improves effectiveness of medication.

53
Q

What is lichen sclerosus/ balantitis xerotica obliteratans?

A

Inflammatory skin condition that can effect the penis

54
Q

One of the main causes of tight foreskin in older men is

A

lichen sclerosus / BXO

55
Q

Presentation of BXO / LS

A

white patches, fissuring, bleeding and scarring

Can make foreskin too tight to pass urine

56
Q

Treatment of BXO / LS?

A

Circumcision to remove foreskin usually relieves symptoms and reduces risk of malignant transformation

57
Q

Describe malignant transformation risk in BXO/ LS?

A

v low to begin with but is a risk

Circumcision basically eliminates risk

58
Q

Carcinoma in situ refers to

A

full thickness dysplasia of the epidermis

59
Q

SCC in situ of the penis may also be referred to as?

A

Bowens disease

60
Q

SCC of the penis affects what age group?

A

elderly men, peak incidence 80yo

61
Q

Risk factors for SCC penis?

A

HPV 16 and 18

Poor penile hygiene (not cleaning under foreskin) - v rare in circumcised men

62
Q

Presentation of SCC penis?

A

Often late

Red raised area on penis, fungating mass, foul smelling, phimosis (inability to retract foreskin)

63
Q

2 germ cell tumours of the testes?

A

Seminoma and teratoma

64
Q

Seminomas arise from

A

the germinal epithelium or the seminiferous tubules

65
Q

Teratomas arise from

A

totipotent germ cells capable of differentiating into derivates of ectoderm, endoderm and mesoderm.

66
Q

Describe difference between totipotent, multipoint and pluripotent?

A

Pluripotent- stem cells can differentiate into almost anything
Multipotent- stem cells restricted into differentiating into cell types from the organ they are found
Totipotent- similar to pluripotent but can give rise to embryo and placenta

67
Q

Presentation of testicular cancer?

A

Painless, insensitive, testicular swelling, hard stony mass

68
Q

Diagnosis of testicular cancers?

A

95% sensitivity and specificity on US

69
Q

If a patient has a hard testicular lump

A

need US that day

70
Q

3 markers of testicular cancer? When are they used?

A

AFP, HCG, LDH

Diagnostic and to evaluate if treatment working (ie would hope to see a reduction in successful treatment)

71
Q

Treatment of testicular cancer?

A

Orchidectomy performed

72
Q

Higher risk of testicular cancer in ______

A

those with undescended testes

73
Q

Spread of testicular cancer?

A

Retroperitoneal lymph nodes

Haematogenous spread to the lungs

74
Q

Describe secondary tumours and the testes?

A

Leukaemias often involve the testes
Lymphomas
Metastatic prostate or gastric cancer

75
Q

What on contrast CT would make you suspicious of bladder cancer?

A

Irregular margin in CT contrast signifies bladder filling defect

Renal (19 decks)

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