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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
What imaging is done for patients with suspected renal cell carcinoma?
US KUB initially Then GOLD standard CT abdo-pelvis IV contrast
26
How is localised renal cell carcinoma treated?
Surveillance if small Partial nephrectomy if possible when T1/ <7cm (preserve as much renal function as possible) May require radical nephrectomy if > 7cm
27
What is removed in a radical nephrectomy?
Kidney Perinephric fat Local lymph nodes
28
What is the treatment for a patient with metastatic renal cell carcinoma?
CHEMO NOT EFFECTIVE Immunotherapy Biologics Metastectomy
29
What is a paraneoplastic syndrome?
Syndromes associated with the malignant disease which are not directly related to the physical effects of the primary or metastatic Tumor
30
What are some paraneoplastic syndromes associated with renal cell carcinomas?
Polycythaemia/anaemia Hypercalcaemia Hypertension Pyrexia Cushings Amenorrhea
31
What is upper tract Transitional Cell Carcinoma?
Malignancy of the renal pelvis/collecting system
32
What is upper tract Transitional Cell Carcinoma?
Malignancy of the renal pelvis/collecting system
33
How does upper tract transitional cell carcinoma present?
Visible haematuria Weight loss
34
What is the gold standard imaging method for Upper tract transitional cell carcinoma?
CT urogram/CT KUB non contrast
35
What is the treatment of an upper tract transitional cell carcinoma?
Nephrouretectomy with bladder cuff(ureteric orifices) Sometimes laser ablation is viable
36
What is the main difference between a CT urogram and a CT non contrast KUB?
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
37
What is the most common renal cancer of children?
Wilms tumour (nephroblastoma)
38
How may a patient with bladder cancer present?
Haematuria Storage symptoms (frequency, urgency) Recurrent UTIs Weight loss Fatigue
39
What Investigations are done on a patient with: Haematuria Storage symptoms (frequency, urgency) Recurrent UTIs Weight loss Fatigue Suspecting bladder cancer
US KUB Flexible cystoscopy CT abdo pelvis contrast Then a TURBT would be done after flexible cystoscopy identifies bladder mass
40
What is the importance of a TURBT for a bladder mass?
Determines histology of bladder cancer (TCC, squamous cell or adenocarcinoma) Determines grade/stage of cancer so guides treatment approach
41
What is the grading of bladder cancer?
G1 - low grade G2 - medium (low/high) G3 - high grade
42
How is bladder cancer staged?
Ta T1 T2 T3 T4
43
What does bladder cancer stage Ta mean?
Cancer invades bladder mucosa
44
What does bladder cancer stage T1 mean?
Cancer invades through LAMINA PROPRIA (mucosa -> Lamina propria)
45
What does bladder cancer stage T2 mean?
Cancer invades through the detrusor muscle (bladder mucosa -> lamina propria -> detrusor muscle)
46
What does bladder cancer stage T3 mean?
Cancer invades the fat around the bladder (bladder mucosa ->lamina propria ->detrusor muscle -> fat around bladder)
47
What does stage T4 bladder cancer mean?
Cancer invades surrounding organs (bladder mucosa ->lamina propria ->detrusor muscle -> fat around bladder -> surrounding organs)
48
What is the main histological type of bladder cancer?
Transitional cell carcinoma
49
What are the 2 types of managements for bladder cancer?
Intravesicular treatment Surgery
50
What type of bladder cancer can receive intravesicualr treatment? What stages are these?
Non muscle invasive bladder cancer includes Ta and T1
51
What is the treatment for non muscle invasive (Ta/T1) bladder cancer that is low grade / medium grade (G1/G2)?
Mitomycin injection
52
What is the treatment for non muscle invasive (Ta/T1) bladder cancer that is high grade (G3)?
BCG injections
53
What are some side effects of using BCG injections to treat non muscle invasive bladder cancer?
Systemic BCGosis (never inject after traumatic catheterisation) Dysuria Frequency Urgency UTI Haematuria
54
What is the treatment for muscle invasive transitional cell bladder cancer?
Neoadjuvant chemotherapy + RADICAL CYSTECTOMY
55
What is a radical cystectomy in men for TCC (bladder)?
Bladder + prostate removal Then will need an ileal conduit
56
What is a radical cystectomy in women for TCC (Bladder)?
Bladder + Ovaries + uterus + fallopian tubes Ileal conduit will be needed
57
What is an ileal conduit and why iis it needed after a radical cystectomy?
When ureters connected to the ileum so urine can drain via a stoma Ureters dont have bladder to drain into
58
What are the main risk factors for bladder cancers?
Smoking Aniline dyes Recurrent catheters Schistosomiasis
59
What is squamous cell carcinoma of the bladder caused by on a basic level?
Chronic inflammation
60
What are some risk factors for developing squamous cell carcinoma of the bladder?
Recurrent catheters Recurrent UTIs Schistosomiasis Anything that causes inflammation of bladder
61
Why can you get adenocarcinoma of the bladder?
Urachus in development links the urinary tract to GI tract which is heavily glandular
62
What is nutcracker syndrome?
Left renal vein impinged between SMA and abdominal aorta imparing blood flow to kidney
63
What is the likely diagnosis? LUTS Frequency Urgency Poor stream Hesitancy Terminal dribble Bone pain Weight loss
Prostate cancer
64
What are the risk factors for prostate cancer?
Older age Family history Genetics (BRCA,HPC1) Afrfocarribean
65
What constitutes a family history for prostate cancer?
Brother or father dead of prostate cancer under 65y/o
66
What Ix do you do when suspecting prostate cancer?
PSA DRE MRI prostate CT CAP for staging CT PET for staging Biopsy (transperineal or transrerctal ultrasound guided)
67
What is the issue with measuring PSA?
Elevated PSA is not indicative of prostate cancer, it can be elevated inn many circumstances
68
When should men be offered a PSA test?
Have FHx of prostate cancer Are afrocarribean
69
Why may PSA be elevated ?
Urinary retention UTI Instrumentation BPH Prostate cancer
70
What is the type of cancer for prostate cancer?
Adenocarcinoma
71
What is the grading system for prostate cancer?
Gleasons grading system
72
How does the gleasons grading system work?
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
What is a low grade gleasons?
3 + 3 =6
74
What is an intermediate gleasons score?
3 + 4 = 7
75
What is a high grade gleasons score?
4 + 3 = 7 and 8,9,10
76
Which gleasons grade is worse: 3 + 4 4 + 3
Gleasons 4 + 3 = 7 is worse since the more common cancer sequence has a higher grade
77
What is the management for low risk prostate cancer (Gleasons 6 (3+3))?
Active surveillance = PSA + DRE every 6 months
78
What is the difference between active surveillance and watchful waiting?
Active surveillance = treatment initiation is dependent on disease progression Watchful waiting = treatment initiation is dependant on symptoms
79
What are the 2 main managements of localised prostate cancer?
Radical prostatectomy External beam radiotherapy + hormones
80
What are the complications of radical prostatectomy?
Urinary incontinence ED Bowel damage Bladder neck stenosis.
81
What are the complications of external beam radiotherapy + hormones?
ED Bowel damage Bladder damage Scaring
82
What are the 2 main methods in treating metastatic prostate cancer?
Androgen deprivation therapy Chemotherapy
83
What are the 2 medications that are androgen. Deprivation therapies for prostate cancer?
Degarelix Bicalutamide
84
What is the mechanism of action of degarelix in treating metastatic prostate cancer?
LHRH antagonist
85
What is the mechanism of action of bicalutamide in treating metastatic prostate cancer?
Testosterone receptor antagonist
86
What chemotherapeutic against cancer be used to treat metastatic prostate cancer?
Docetaxel
87
What drugs do you use to treat castrate resistant prostate cancer?
Docetaxel + dexamethasone + bicalutamide
88
What are the 2 categories of testicular cancer?
Seminoma Non-seminoma
89
Patient presents with lump in groin that’s inseparable from testis, what Ix do you do?
Uss testis CT CAP staging
90
What are important tumour markers for testicular cancer?
AFP bHCG LDH
91
What is elevated AFP indicative of?
Non seminomatous germ cell tumours (its specific to them)
92
What does elevated bHCG suggest with a testicular lump?
Likely a non seminomatous germ cell tumour but could be germ cell
93
What does elevated LDH indicate with a testicular lump?
Larger tumour bulk
94
What lymph nodes do the testis drain to?
Para-aortic lymph nodes
95
What is the management of testicular cancer?
Inguinal orchidectomy (with sperm banking if under 55) for local disease Chemotherapy for metastatic disease or prophylactic when local disease
96
When do the para aortic lymph nodes need diseecting with testicular cancer?
Following chemotherapy after non seminomatous germ cell tumours
97
What type of cell is penile cancer?
Squamous cell carcinoma
98
Where does penile cancer metastasise to?
Inguinal lymph nodes
99
What is the treatment for penile cancer?
Excise tumour Circumcsiion Glansectomy Partial or total penectomy
100
What drains to the superficialis Inguinal lymph nodes?
Scrotum Vulva
101
What drains to the deep inguinal lymph nodes?
Glans penis Glans clitoris
102
What drains to the para aortic lymph nodes?
Testis Ovaries
103
What drains to the external + internal iliac lymph nodes?
Inferior bladder
104
What is the mechanism of action of Goserelin in treating prostate cancer?
GnRH agonist inhibiting LH production

Y3(S) - Urology (5 decks)

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