Cancer - Renal and 2WW criteria

Question 1

How do renal cancers present?

Answer 1

• Often asymptomatic
• Haematuria
• Vague loin pain
• Non-specific symptoms of cancer: weight loss, fatigue, anorexia, night sweats

Question 2

TCC- Upper urinary tract: epidemiology and risk factors

Answer 2

• 5% (rare)
• Risk factors (similar to bladder cancer): smoking, aniline dies, cyclophosmide, phenacetin, bladder TCC (5% risk of spread), Von Hippel-Lindau disease

Question 3

TCC upper renal tract: what investigations would you perform? What is the treatment for localised and metastatic disease?

Answer 3

• USS (hydronephrosis)
• CT urogram (filling defect or stricture)
• Ureteroscopy + biopsy
• Treatment
  
  • Localised disease: nephro-ureterectomy - kidney, fat, ureter and cuff of bladder removed
  • Metastatic disease: systemic chemotherapy (cisplatin based) or immunotherapy (as with TCC of bladder)

Question 4

RCC: Epidemiology, Presentation and Aetiology

Answer 4

• 95% are all upper urinary tract tumours (especially in parenchyma of kidney)
• Increasing incidence and mortality
• M:F is 3:2
• White > non-white
• Presentation: haematuria, incidental finding on imaging, palpable mass (rare), 30% have mets on presentation (RCCs cause canonball mets to lung - associated sx)
• Aetiology: smoking (2x increase), obesity, dialysis

Question 5

What are the 2ww referral criteria for renal cancer?

Answer 5

• Aged 45 and over with:
  
  • Unexplained visible haematuria without UTI
  • Visible haematuria that persists/recurs after treatment for UTI

Question 6

What is the treatment for localised RCC?

Answer 6

• Surveillance
• Excision (MDT based decision)
  
  • Radical nephrectomy: open or lap
  • Partial nephrectomy: open or robotic

Question 7

What is the treatment for metastatic RCC?

Answer 7

• Tend to be radio and chemo-resistant
• Biological therapies targeting angiogenesis are 1^st choice: Sunitinib, Sorafenib, pazopanib (tyrosine kinase inhibitors)

Question 8

Name some paraneoplastic features of RCC

Answer 8

• Polycythaemia: RCCs secrete unregulated erythropoietin
• Hypercalcaemia: PTHrP

Question 9

What are the 2WW referral criteria for prostate cancer?

Answer 9

• Prostate feels malignant on DRE
• PSA is above age-specific range
• Consider DRE and PSA in men who:
  
  • LUTS symptoms: nocturia, frequency, urgency, hesitancy, retention
  • Erectile dysfunction
  • Visible haematuria

Question 10

What are the 2WW referral criteria for bladder cancer?

Answer 10

• Age 45 and over with:
  
  • Unexplained visible haematuria without UTI
  • Visible haematuria that persists/recurs after UTI treatment
• Age over 60 and have unexplained non-visible haematuria with either
  
  • Dysuria
  • Raised WC count

Question 11

What are the 2WW referral criteria for testicular cancer?

Answer 11

• Non painful enlargement or change of shape or texture of the testis
• Consider direct access scan for men with unexplained/persistent testicular symptoms

Question 12

What are the 2WW referral criteria for penile cancer?

Answer 12

• Penile mass or ulceration where STI has been excluded
• Persistent penile ulceration after a course of treatment for STI has been completed