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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?

A

Infants

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
Q

What investigations would you do in testicular cancer?

A
  • Ultrasound
  • Biopsy and histology
  • Serum tumour markers:
  • CXR & CT - to assess tumour staging
26
Q

What is the treatment for testicular cancer?

A
  • 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
Q

Where does renal cell carcinoma arise from?

A

From the proximal convoluted tubular epithelium

28
Q

What percentage of people who present with RCC will have metastasis?

A

25%

29
Q

What are the risk factors for RCC?

A
  • Smoking
  • Obesity
  • Hypertension
  • Renal failure & haemodialysis (15% develop RCC)
  • Polycystic kidneys
  • Von Hippel Lindau (VHL) syndrome:
30
Q

How does RRC typically present?

A

It is usually asymptomatic and found incidentally

31
Q

What are the signs of RRC?

A
  • 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
Q

What investigations would you do in RRC?

A
  • 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
Q

What is the treatment and management of localised RRC?

A

Nephrectomy (remove kidney) unless tumours are bilateral (present on both kidneys) and then you would do a partial nephrectomy

34
Q

Why would ablative techniques be used in RRC and what are some examples of these techniques?

A

Cryoablation and radiotherapy. They are used in patients with significant comorbidities that wouldn’t be able to tolerate surgery.

35
Q

What is an example of a treatment given in metastatic or locally advanced RRC?

A

Interleukin-2 & Interferon alpha

GU (9 decks)

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