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Y3(S) - Urology > Cancer/Haematuria > Flashcards

Cancer/Haematuria Flashcards

1
Q

What is considered non-visible/microscopic Haematuria?

A

Anything more than a trace of blood on dipstick

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2
Q

What substances are measured on urine dipstick?

A

Nitrites
Leukocytes
Protein
PH
Glucose
Bilirubin
Ketones
Urobiliogen
Specific gravity

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3
Q

What are some important features to ask about in terms of a history of haematuria?

A

Duration
Where in stream
Clots
Associated symptoms (fever, weight loss, dysuria)
Smoking
Dye industry
Travel
Anticoagulation
Past urological investigataions

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4
Q

What would you like to examine in a patient with haematuria?

A

Abdominal exam
External genitalia
Hernial orifices
DRE (male)

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5
Q

What investigations are done for a patient with haematuria?

A

1.) urine dipstick
2.) Ultrasound KUB
3.) Cystoscopy
4.) ?? CT Urogram

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6
Q

When is a CT urogram done for a patient with haematuria?

A

If the ultrasound KUB and flexible cystoscopy both come up negative

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7
Q

What is an Ultrasound KUB looking for in a patient with haematuria?

A

Renal masses (RCC)
Hydronephrosis
Hydroureter
Urinary retention
Bladder masses

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8
Q

What are Ultrasound KUBs not good at detecting?

A

Upper urinary tract TCC (Transitional Cell Carcinomas)

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9
Q

What is a CT urogram?

A

CT KUB with no contrast with a delayed post contrast phase

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10
Q

What are the 4 main locations from where haematuria can originate?

A

Ureters
Bladder
Prostate
Urethra

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11
Q

What are some causes of haematuria from the ureters?

A

Cancer (TCC)
Trauma (iatrogenic)
Urolithiasis (stones)
Uretritis (radiological diagnoses from ascending infection)

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12
Q

What are some causes of haematuria from the bladder?

A

Cancer (normally TCC)
Trauma (cystoscopy, pelvic fractures, drunk driving on full bladder)
Bladder stones

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13
Q

How are bladder stones formed?

A

Urinary stasis (BPH or neurogenic causes)

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14
Q

What are some causes of haematuria from the prostate?

A

BPH
Prostate cancer
Prostate stones
Prostatitis
Trauma (catheterisation)

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15
Q

How do prostate stones form?

A

Glandular secretions of the prostate get stuck forming stones

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16
Q

What are some causes of haematuria from the urethra?

A

Cancer (mainly TCC, can be SCC if at very end)
Trauma (catheterisation)
Stones
Urethritis (STIs)

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17
Q

So generally, what are the main causes of haematuria?

A

Cancer
Trauma
Infection
Stones

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18
Q

What is the most common type of renal cell carcinoma?

A

Clear cell renal carcinoma

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19
Q

What is the grading system for renal cysts/renal cell carcinoma?

A

Bosniaks grading system

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20
Q

What syndrome is clear cell renal carcinoma associated with?

A

Von-hippel lindau syndrome

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21
Q

How may a patient with renal cell carcinoma present?

A

Haematuria
Loin pain
Palpable mass
Weight loss
Night sweats

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22
Q

What are the risk factors for renal cell carcinoma?

A

Obesity
Smoking
HTN
Family history/genetics
Dialysis

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23
Q

What type of tumour is a typical renal cell carcinoma?

A

Adenocarcinoma

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24
Q

Where do renal cell carcinomas form?

A

Renal parenchyma typically from PCT in renal cortex

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25
Q

What imaging is done for patients with suspected renal cell carcinoma?

A

US KUB initially

Then GOLD standard CT abdo-pelvis IV contrast

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26
Q

How is localised renal cell carcinoma treated?

A

Surveillance if small

Partial nephrectomy if possible (preserve as much renal function as possible)

May require radical nephrectomy y

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27
Q

What is removed in a radical nephrectomy?

A

Kidney
Perinephric fat
Local lymph nodes

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28
Q

What is the treatment for a patient with metastatic renal cell carcinoma?

A

CHEMO NOT EFFECTIVE

Immunotherapy
Biologics
Metastectomy

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29
Q

What is a paraneoplastic syndrome?

A

Syndromes associated with the malignant disease which are not directly related to the physical effects of the primary or metastatic Tumor

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30
Q

What are some paraneoplastic syndromes associated with renal cell carcinomas?

A

Polycythaemia/anaemia
Hypercalcaemia
Hypertension
Pyrexia
Cushings
Amenorrhea

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31
Q

What is upper tract Transitional Cell Carcinoma?

A

Malignancy of the renal pelvis/collecting system

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32
Q

What is upper tract Transitional Cell Carcinoma?

A

Malignancy of the renal pelvis/collecting system

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33
Q

How does upper tract transitional cell carcinoma present?

A

Visible haematuria
Weight loss

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34
Q

What is the gold standard imaging method for Upper tract transitional cell carcinoma?

A

CT urogram

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35
Q

What is the treatment of an upper tract transitional cell carcinoma?

A

Nephrouretectomy with bladder cuff(ureteric orifices)

Sometimes laser ablation is viable

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36
Q

What is the main difference between a CT urogram and a CT non contrast KUB?

A

CT urogram uses contrast and pictures in detail the entire urinary system

CT non contrast KUB used to quickly image and see if theres stones/obstruction

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37
Q

What is the most common renal cancer of children?

A

Wilms tumour (nephroblastoma)

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38
Q

How may a patient with bladder cancer present?

A

Haematuria
Storage symptoms (frequency, urgency)
Recurrent UTIs
Weight loss
Fatigue

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39
Q

What Investigations are done on a patient with:

Haematuria
Storage symptoms (frequency, urgency)
Recurrent UTIs
Weight loss
Fatigue

Suspecting bladder cancer

A

US KUB
Flexible cystoscopy
CT abdo pelvis contrast

Then a TURBT would be done after flexible cystoscopy identifies bladder mass

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40
Q

What is the importance of a TURBT for a bladder mass?

A

Determines histology of bladder cancer (TCC, squamous cell or adenocarcinoma)

Determines grade/stage of cancer so guides treatment approach

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41
Q

What is the grading of bladder cancer?

A

G1 - low grade
G2 - medium (low/high)
G3 - high grade

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42
Q

How is bladder cancer staged?

A

Ta
T1
T2
T3
T4

43
Q

What does bladder cancer stage Ta mean?

A

Cancer invades bladder mucosa

44
Q

What does bladder cancer stage T1 mean?

A

Cancer invades through LAMINA PROPRIA (mucosa -> Lamina propria)

45
Q

What does bladder cancer stage T2 mean?

A

Cancer invades through the detrusor muscle (bladder mucosa -> lamina propria -> detrusor muscle)

46
Q

What does bladder cancer stage T3 mean?

A

Cancer invades the fat around the bladder (bladder mucosa ->lamina propria ->detrusor muscle -> fat around bladder)

47
Q

What does stage T4 bladder cancer mean?

A

Cancer invades surrounding organs (bladder mucosa ->lamina propria ->detrusor muscle -> fat around bladder -> surrounding organs)

48
Q

What is the main histological type of bladder cancer?

A

Transitional cell carcinoma

49
Q

What are the 2 types of managements for bladder cancer?

A

Intravesicular treatment

Surgery

50
Q

What type of bladder cancer can receive intravesicualr treatment?

What stages are these?

A

Non muscle invasive bladder cancer includes Ta and T1

51
Q

What is the treatment for non muscle invasive (Ta/T1) bladder cancer that is low grade / medium grade (G1/G2)?

A

Mitomycin injection

52
Q

What is the treatment for non muscle invasive (Ta/T1) bladder cancer that is high grade (G3)?

A

BCG injections

53
Q

What are some side effects of using BCG injections to treat non muscle invasive bladder cancer?

A

Systemic BCGosis (never inject after traumatic catheterisation)
Dysuria
Frequency
Urgency
UTI
Haematuria

54
Q

What is the treatment for muscle invasive transitional cell bladder cancer?

A

Neoadjuvant chemotherapy + RADICAL CYSTECTOMY

55
Q

What is a radical cystectomy in men for TCC (bladder)?

A

Bladder + prostate removal

Then will need an ileal conduit

56
Q

What is a radical cystectomy in women for TCC (Bladder)?

A

Bladder + Ovaries + uterus + fallopian tubes

Ileal conduit will be needed

57
Q

What is an ileal conduit and why iis it needed after a radical cystectomy?

A

When ureters connected to the ileum so urine can drain via a stoma

Ureters dont have bladder to drain into

58
Q

What are the main risk factors for bladder cancers?

A

Smoking
Aniline dyes
Recurrent catheters
Schistosomiasis

59
Q

What is squamous cell carcinoma of the bladder caused by on a basic level?

A

Chronic inflammation

60
Q

What are some risk factors for developing squamous cell carcinoma of the bladder?

A

Recurrent catheters
Recurrent UTIs
Schistosomiasis

Anything that causes inflammation of bladder

61
Q

Why can you get adenocarcinoma of the bladder?

A

Urachus in development links the urinary tract to GI tract which is heavily glandular

62
Q

What is nutcracker syndrome?

A

Left renal vein impinged between SMA and abdominal aorta imparing blood flow to kidney

63
Q

What is the likely diagnosis?

LUTS
Frequency
Urgency
Poor stream
Hesitancy
Terminal dribble
Bone pain
Weight loss

A

Prostate cancer

64
Q

What are the risk factors for prostate cancer?

A

Older age
Family history
Genetics (BRCA,HPC1)
Afrfocarribean

65
Q

What constitutes a family history for prostate cancer?

A

Brother or father dead of prostate cancer under 65y/o

66
Q

What Ix do you do when suspecting prostate cancer?

A

PSA
DRE
MRI prostate
CT CAP for staging
CT PET for staging
Biopsy (transperineal or transrerctal ultrasound guided)

67
Q

What is the issue with measuring PSA?

A

Elevated PSA is not indicative of prostate cancer, it can be elevated inn many circumstances

68
Q

When should men be offered a PSA test?

A

Have FHx of prostate cancer
Are afrocarribean

69
Q

Why may PSA be elevated ?

A

Urinary retention
UTI
Instrumentation
BPH
Prostate cancer

70
Q

What is the type of cancer for prostate cancer?

A

Adenocarcinoma

71
Q

What is the grading system for prostate cancer?

A

Gleasons grading system

72
Q

How does the gleasons grading system work?

A

Scored with 2 numbers
First score indicates the aggressiveness of the most common cancer pattern and other score the less common pattern

Scores are either 3,4 or 5

Eg score 5 + 3

73
Q

What is a low grade gleasons?

A

3 + 3 =6

74
Q

What is an intermediate gleasons score?

A

3 + 4 = 7

75
Q

What is a high grade gleasons score?

A

4 + 3 = 7 and 8,9,10

76
Q

Which gleasons grade is worse:

3 + 4
4 + 3

A

Gleasons 4 + 3 = 7 is worse since the more common cancer sequence has a higher grade

77
Q

What is the management for low risk prostate cancer (Gleasons 6 (3+3))?

A

Active surveillance = PSA + DRE every 6 months

78
Q

What is the difference between active surveillance and watchful waiting?

A

Active surveillance = treatment initiation is dependent on disease progression

Watchful waiting = treatment initiation is dependant on symptoms

79
Q

What are the 2 main managements of localised prostate cancer?

A

Radical prostatectomy

External beam radiotherapy + hormones

80
Q

What are the complications of radical prostatectomy?

A

Urinary incontinence
ED
Bowel damage
Bladder neck stenosis.

81
Q

What are the complications of external beam radiotherapy + hormones?

A

ED
Bowel damage
Bladder damage
Scaring

82
Q

What are the 2 main methods in treating metastatic prostate cancer?

A

Androgen deprivation therapy

Chemotherapy

83
Q

What are the 2 medications that are androgen. Deprivation therapies for prostate cancer?

A

Degarelix

Bicalutamide

84
Q

What is the mechanism of action of degarelix in treating metastatic prostate cancer?

A

LHRH antagonist

85
Q

What is the mechanism of action of bicalutamide in treating metastatic prostate cancer?

A

Testosterone receptor antagonist

86
Q

What chemotherapeutic against cancer be used to treat metastatic prostate cancer?

A

Docetaxel

87
Q

What drugs do you use to treat castrate resistant prostate cancer?

A

Docetaxel + dexamethasone + bicalutamide

88
Q

What are the 2 categories of testicular cancer?

A

Seminoma
Non-seminoma

89
Q

Patient presents with lump in groin that’s inseparable from testis, what Ix do you do?

A

Uss testis
CT CAP staging

90
Q

What are important tumour markers for testicular cancer?

A

AFP
bHCG
LDH

91
Q

What is elevated AFP indicative of?

A

Non seminomatous germ cell tumours (its specific to them)

92
Q

What does elevated bHCG suggest with a testicular lump?

A

Likely a non seminomatous germ cell tumour but could be germ cell

93
Q

What does elevated LDH indicate with a testicular lump?

A

Larger tumour bulk

94
Q

What lymph nodes do the testis drain to?

A

Para-aortic lymph nodes

95
Q

What is the management of testicular cancer?

A

Inguinal orchidectomy (with sperm banking if under 55) for local disease

Chemotherapy for metastatic disease or prophylactic when local disease

96
Q

When do the para aortic lymph nodes need diseecting with testicular cancer?

A

Following chemotherapy after non seminomatous germ cell tumours

97
Q

What type of cell is penile cancer?

A

Squamous cell carcinoma

98
Q

Where does penile cancer metastasise to?

A

Inguinal lymph nodes

99
Q

What is the treatment for penile cancer?

A

Excise tumour
Circumcsiion
Glansectomy
Partial or total penectomy

100
Q

What drains to the superficialis Inguinal lymph nodes?

A

Scrotum
Vulva

101
Q

What drains to the deep inguinal lymph nodes?

A

Glans penis
Glans clitoris

102
Q

What drains to the para aortic lymph nodes?

A

Testis
Ovaries

103
Q

What drains to the external + internal iliac lymph nodes?

A

Inferior bladder

Y3(S) - Urology (5 decks)

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