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Cancers Flashcards

1
Q

What type of cancer is bladder cancer?

A

Transitional Cell Carcinoma

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2
Q

What structures are lined with transition cell epithelium?

A

The calyces, renal pelvis, ureter, bladder and urethra

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3
Q

Where is bladder cancer most likely to metastasise to?

A
  • Local → to pelvic structures
  • Lymphatic → to iliac and para-aortic nodes
  • Haematogenous → to liver and lungs
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4
Q

Give 3 risk factors for bladder cancer?

A
  • Smoking
  • Occupational exposure to carcinogens: Beta-naphthylamine, benzidine, azo dyes
  • Workers in the petroleum, chemical, cable and rubber industries are particularly at risk
  • Exposure to drugs e.g. phenacetin and cyclophosphamide
  • Chronic inflammation of urinary tract e.g. schistosomiasis (usually associated with squamous carcinoma) or indwelling catheter
    > 40 yrs
  • Male
  • Family history
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5
Q

What is the epidemiology of bladder cancer?

A

More common in males than females and more common with increasing age. Incidence peaks in the 8th decade. Bladder cancers also account for 50% of all TTC’s.

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6
Q

What are the symptoms of bladder cancer?

A
  • Painless haematuria
  • Recurrent UTI’s
  • Void irritability
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7
Q

What investigations would you do in someone you expect to have bladder cancer?

A
  • Cystoscopy (bladder endoscopy) with biopsy
    DIAGNOSTIC
  • Urine microscopy/cytology - cancers may cause STERILE
    PYURIA (pus in urine)
  • CT urogram - provides staging and is DIAGNOSTIC
    Urinary tumour markers
  • MRI/lymphangiography may show involved pelvic nodes
  • CT/MRI of pelvis
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8
Q

What is the treatment for non-muscle invasive bladder cancer?

A

Surgical resection with or without chemotherapy

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9
Q

What is the treatment for localised bladder cancer?

A
  • Radical cystectomy
  • Radical radiotherapy
  • Chemotherapy
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10
Q

What is the treatment for metastatic bladder cancer?

A

Palliative chemotherapy and radiotherapy

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11
Q

What type of cancers are the majority of prostate cancers?

A

Adenocarcinomas

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12
Q

Where do most prostate cancers arise?

A

In the peripheral zone

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13
Q

What is the most common site of metastasis for prostate cancer?

A

Bone and lymph nodes

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14
Q

What risk factors are associated with prostate cancer?

A
  • Family history (if 3 or more relatives or 2 relatives who have developed early onset. If one first-degree relative has prostate cancer then risk is doubled)
  • Genetic
  • Increasing age
  • Black
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15
Q

What are the symptoms of prostate cancer?

A

Lower Urinary Tracts if there is local disease:
- Nocturia
- Hesitancy
- Poor stream
- Terminal dribbling
- Obstruction - bladder outflow problems similar to BPH e.g. urinary retention
Weight loss, bone pain and anaemia suggest metastasis

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16
Q

What investigations would you do in prostate cancer?

A
  • Digital rectal exam (DRE): Hard, irregular prostate
  • Raised PSA (can be normal in 30% cancers) - if metastases then will be >16ng/ml
  • Trans-rectal ultrasound (TRUS) & biopsy - DIAGNOSTIC:
  • Histological diagnosis is essential before treatment
  • Gleason score used
  • Urine biomarkers e.g. PCA3 or gene fusion protein
  • Endorectal coil MRI - to locally stage tumour
17
Q

What is the treatment for prostate cancer if the disease is confined to the prostate?

A
  • Radical prostatectomy if <70yrs - excellent disease free survival
  • Radiotherapy + hormone therapy - alternative to surgery
  • Brachytherapy - implantation of radioactive material targeted at tumour
  • Hormone therapy temporarily delays tumour progression
  • Active surveillance if >70yrs and low risk
18
Q

What is the treatment for prostate cancer if the disease has metastasised?

A

Endocrine therapy - androgen deprivation

Symptomatic management - Analgesia, Treat hypercalcaemia, Radiotherapy for bone metastases/spinal cord compression.

19
Q

More than 96% of testicular tumours arise from what type of cells?

A

Germ cells

20
Q

In what age groups are seminomas most likely to affect?

A

25-40 yrs and 60 yrs

21
Q

What age group are teratomas most likely to affect?

22
Q

What are the risk factors of testicular cancer?

A
  • Undescended testis
  • Infant hernia
  • Infertility
  • Family history
23
Q

What are the signs of testicular cancer?

A

Hydrocele and abdominal mass

24
Q

What are the symptoms of testicular cancer?

A
  • Painless lump in the testes
  • Testicular pain and/or abdominal pain
  • Cough and dyspnoea - indicative of lung metastases
  • Back pain - indicative of para-aortic lymph node metastasis
25
What investigations would you do in testicular cancer?
- Ultrasound - Biopsy and histology - Serum tumour markers: - CXR & CT - to assess tumour staging
26
What is the treatment for testicular cancer?
- Radical orchidectomy (removal of testes) via inguinal approach - Seminomas with metastases below diaphragm - only treated with radiotherapy - More widespread tumours are treated with chemotherapy - Teratomas treated with chemotherapy - Sperm storage offered
27
Where does renal cell carcinoma arise from?
From the proximal convoluted tubular epithelium
28
What percentage of people who present with RCC will have metastasis?
25%
29
What are the risk factors for RCC?
- Smoking - Obesity - Hypertension - Renal failure & haemodialysis (15% develop RCC) - Polycystic kidneys - Von Hippel Lindau (VHL) syndrome:
30
How does RRC typically present?
It is usually asymptomatic and found incidentally
31
What are the signs of RRC?
- Abdominal mass - Varicocele - Rarely, invasion of the Left Renal Vein results in the compression of the left testicular vein causing varicocele - Polycythaemia in 5% - Hypertension in 30% - due to renin secretion by tumour - Anaemia due to depression of erythropoietin - Fever in around 20%
32
What investigations would you do in RRC?
- Ultrasound - To distinguish simple cyst from complex cyst or tumour - CT chest and abdomen with contrast: More sensitive than ultrasound in detecting a renal mass and will show involvement of the renal vein of inferior vena cava, if present - Using contrast demonstrates kidney function since in normal kidney should see it being taken up and excreted well - MRI - Tumour staging - Blood pressure - may be increased due to renin secretion - Bloods: FBC - detect polycythaemia and anaemia due to EPO decrease. ESR may be raised. Liver biochemistry may be abnormal - Renal biopsy: Get histology to identify tumour - Bone scan - only if there are signs or serum Ca2+ raised
33
What is the treatment and management of localised RRC?
Nephrectomy (remove kidney) unless tumours are bilateral (present on both kidneys) and then you would do a partial nephrectomy
34
Why would ablative techniques be used in RRC and what are some examples of these techniques?
Cryoablation and radiotherapy. They are used in patients with significant comorbidities that wouldn't be able to tolerate surgery.
35
What is an example of a treatment given in metastatic or locally advanced RRC?
Interleukin-2 & Interferon alpha

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