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Urology > Cancers > Flashcards

Cancers Flashcards

1
Q

What is RCC

A

Arises from proximal renal tubular epithelium

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2
Q

Features of RCC

A 
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
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3
Q

Spread of RCC

A

Lymph
Direct to renal vein
Haematogenous bone liver lung

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4
Q

IX RCC

A 
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
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5
Q

Tx RCC

A

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

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6
Q

What score is used to predict survival

A

Mayo prognostic risk score

SSIGN was developed to predict survival and uses information on tumour stage, size, grade, and necrosis.

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7
Q

Prognosis of RCC

A

10 year survival 96.5% score (0-1 on the mayo predator)

Score >10 19.2%

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8
Q

What is a Wilms Tumour

A

Nephroblastoma

Childhood tumour of the primitive renal tubules and mesenchymal cells

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9
Q

Tx of prostate ca

A

Prognostic factors determine whether tx would be worthwhile to watchful waiting/active surveillance is more appropriate than aggressive tx

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10
Q

What are prognostic factors that determine whether watchful waiting or aggressive tx is necessary

A 
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
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11
Q

Symptoms Prostate Ca

A 
Asymptomatic 
Nocturia
Hesitancy
Poor stream
Terminal dribble
Obstruction
Dec weight +/- bonepain mets 
Constitutional symptoms
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12
Q

What can a DRE of the prostate show in Prostate Ca

A

Hard irregular prostate

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13
Q

Ix prostate Ca

A

PSA
TRUS biopsy
Bone scan
CT.MRI

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14
Q

How many people with prostate cancer have a raised PSA

A

30% around 1 in 3

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15
Q

How is prostate Ca staged

A

MRI

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16
Q

What inc risk of prostate Ca

A

Fhx

Inc testosterone levels

17
Q

Where do most prostate Ca arise

A

Peripheral zone

18
Q

Tx of prostate ca

A

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,

19
Q

Bladder tumour tyoes

A

TCC - >90% in the Uk

Adenocarcinoma and SCC 10% in the uk

20
Q

What can cause SCC

A

Schistosomiasis

21
Q

Is histology important to prognosis and watch are the grades

A

Yes
Grade 1 - differentiated
Grade 2 - intermediate
Grade 3 - poorly differentiated

22
Q

Presentation of bladder cancer

A

Painless haematuria
Recurrent UTIS
Voiding irritability

23
Q

What is associated with bladder cancer

A 
Smoking 
Aromatic amine - rubber industry 
Chronic cystitis 
Schistosomiasis
Pelvic irradiation
24
Q

Ix bladder cancer

A

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

25
Q

Tx for stage Tis, Ta,T1

A

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

26
Q

Tx stage t2/t3 bladder ca

A

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

27
Q

T4 bladder cancer tx

A

Palliative chemo/radio

Harmonic catheterisation and urinary diversion may help to relieve pain

28
Q

How does bladder cancer spread

A

Local —> pelvic structures
Lymphatic —> to iliac and para-aortic nodes
Haematogenous —>to liver and lungs

29
Q

Complication of cystectomy

A

Sexual and urinary malfunction
Massive bladder haemorrhage may complicate tx or be a feature of disease treated palliatively
Determine cause of bleeding imp

Urology (5 decks)

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