Cancers Flashcards
What is RCC
Arises from proximal renal tubular epithelium
Features of RCC
50% found incidentally Haematuria Loin pain Abdo masses Anorexia Malaise Weight loss PUO - pyrexia of unknown origin Rarely invasion of left renal vein impresses LFT testicular vein and causing a varicocele
Spread of RCC
Lymph
Direct to renal vein
Haematogenous bone liver lung
IX RCC
BP high from inc renin Blood FBC. Polycythemia due to inc EPO secretion ESR, U&E, ALP - boney met Urine dip MC&S Imagine USS - hydronephrosis, tumour CT/MRI stage CXR - cannon ball mets
Tx RCC
Radical nephrectomy
Early stage tumours nephron sparing surgery
Patients unfit or unwilling to fo for surgery
Cryotherapy or radiofrequency ablation as it is chemo and radio-resistant
Unresectable or mets
High dose IL2 and ther T cell activation therapies, anti-angiogenesis agents, mTOR inhibitors
What score is used to predict survival
Mayo prognostic risk score
SSIGN was developed to predict survival and uses information on tumour stage, size, grade, and necrosis.
Prognosis of RCC
10 year survival 96.5% score (0-1 on the mayo predator)
Score >10 19.2%
What is a Wilms Tumour
Nephroblastoma
Childhood tumour of the primitive renal tubules and mesenchymal cells
Tx of prostate ca
Prognostic factors determine whether tx would be worthwhile to watchful waiting/active surveillance is more appropriate than aggressive tx
What are prognostic factors that determine whether watchful waiting or aggressive tx is necessary
Pre tx PSA Tumour stage - TNM Tumour grade - Gleason score Grading 1-5 5 being the highest Gleason grades histology of 2 areas of the tumour specimen
Symptoms Prostate Ca
Asymptomatic Nocturia Hesitancy Poor stream Terminal dribble Obstruction Dec weight +/- bonepain mets Constitutional symptoms
What can a DRE of the prostate show in Prostate Ca
Hard irregular prostate
Ix prostate Ca
PSA
TRUS biopsy
Bone scan
CT.MRI
How many people with prostate cancer have a raised PSA
30% around 1 in 3
How is prostate Ca staged
MRI
What inc risk of prostate Ca
Fhx
Inc testosterone levels
Where do most prostate Ca arise
Peripheral zone
Tx of prostate ca
Radical prostatectomy if <70 yrs excellent disease free survival
+/- adjuvant or neoadjuvant hormonal therapy
Radial radiotherapy +/- hormone therapy neo or adjuvant
Alternative curative option
External beam or brachytherapy
Hormone therapy alone temporarily delayed tumour progression but refractory will develop
Watchful waiting >70 and low risk disease
Hormone therapy :
LNRH agonists - 12 weekly Gosarelin first stimulate but then inhibit pituitary gonadotropin,
Bladder tumour tyoes
TCC - >90% in the Uk
Adenocarcinoma and SCC 10% in the uk
What can cause SCC
Schistosomiasis
Is histology important to prognosis and watch are the grades
Yes
Grade 1 - differentiated
Grade 2 - intermediate
Grade 3 - poorly differentiated
Presentation of bladder cancer
Painless haematuria
Recurrent UTIS
Voiding irritability
What is associated with bladder cancer
Smoking Aromatic amine - rubber industry Chronic cystitis Schistosomiasis Pelvic irradiation
Ix bladder cancer
Cystoscopy with biopsy is diagnostic
Urine MC&S
CT urogram both diagnostic and provides staging
Biannual EUA helps assess spread EUA = exam under anaesthetic
MRI or lymphangiogrphy may show involve pelvic nodes
Tx for stage Tis, Ta,T1
Diathermy via Transurethral cytoscopy/ trans urethral resection of the bladder tumour (TURBT)
Consider a regimen of intravascular BCG which stimulates a non-specific immune response for multiple or high grade tumours
Alternative chemotherapeutic agents - mitomycin, epirubicin and gemcitabine
Tx stage t2/t3 bladder ca
Radial cystectomy is the gold standard
Radiotherapy worse survival rates than surgery
Adjuvant chemo effective
Neo-adjuvant chemo - improves survival compares to surgery or radio alone
T4 bladder cancer tx
Palliative chemo/radio
Harmonic catheterisation and urinary diversion may help to relieve pain
How does bladder cancer spread
Local —> pelvic structures
Lymphatic —> to iliac and para-aortic nodes
Haematogenous —>to liver and lungs
Complication of cystectomy
Sexual and urinary malfunction
Massive bladder haemorrhage may complicate tx or be a feature of disease treated palliatively
Determine cause of bleeding imp
