cancers of the urinary tract

Question 1

what is the gleason score used for

Answer 1

grading prostate cancer histologically

Question 2

when is MRI used in prostate cancer

Answer 2

1. pre-biopsy
2. local staging
3. guide targeted biopsy

Question 3

what zone of the prostate does BPH occur in

Answer 3

transitional zone -> groove becomes deeper

Question 4

when should bone scanning be done (prostate cancer)

Answer 4

if PSA >20ng/mL -> look for mets

Question 5

what bone abnormality may be seen on bones in prostate cancer

Answer 5

all uniformly sclerotic

Question 6

what cancers are the top primaries to metastasize to bone

Answer 6

1. breast (if bone sclerosis seen in F assume this is the primary)
2. prostate (if bone sclerosis seen in M assume this is the primary)
3. lung
4. kidney

Question 7

what appears bright on T1 MRI (2)

Answer 7

1. blood
2. fat

Question 8

what appears bright on T2 MRI

Answer 8

fluid e.g. CSF

Question 9

how will normal vertebrae appear on T1 imagine (bright or dark)

Answer 9

bright - they are fatty so appear bright on T1 imaging

Question 10

where is an RCC likely to spread to and why

Answer 10

the renal vein -> it is a highly vascular tumour

Question 11

RCC appearance on imaging

Answer 11

1. central hypoattenuation
2. irregular
3. heterogenous
4. exophytic

Question 12

where do RCCs commonly metastasize to (3)

Answer 12

lung, bone, liver

Question 13

if a lytic bone lesion is seen on imaging, what are the primary/secondary malignancies likely to be

Answer 13

primary - osetosarcoma
secondary - breast, lung, kidney
prostate is usually sclerotic not lytic!!!

Question 14

what might a solitary lytic bone lesion indicate

Answer 14

plamacytoma - a tumor of plasma cells of bony or soft tissue

Question 15

are kidney mets common

Answer 15

no - they kidneys are one of the last places to metastasise to

Question 16

what benign tumour is easily confused with RCC on imaging

Answer 16

oncocytoma - they are usually removed to be safe

Question 17

2 benign renal tumours

Answer 17

1. angiomyolipoma
2. oncocytoma

Question 18

4 malignant renal tumours

Answer 18

1. renal cell carcinoma
2. transitional cell carcioma
3. wilms tumour
4. lymphoma

Question 19

what is tubulosclerosis

Answer 19

a rare genetic condition that causes mainly benign tumours to develop in different parts of the body
-> predisposes a person to angiomyelomas in kidneys, they can bleed drastically but are otherwise benign

Question 20

what is the commonest location for a TCC

Answer 20

bladder

Question 21

2 initial imaging investigations for haematuria

Answer 21

1. US urinary tract
2. cystoscopy

Question 22

3 methods of upper urinary tract imaging

Answer 22

1. IV urogram
2. CT urogram
3. uteroscopy

Question 23

if a dark outline surrounding a bladder tumour can be seen on imaging, what does this indicate about the tumour

Answer 23

is it confined to muscle

Question 24

what imaging modality is used to image testicular cancer

Answer 24

ultrasound

Question 25

what is a seminoma

Answer 25

a malignant germ cell tumor that involves most commonly the testicle or less frequently the mediastinum, the retroperitoneum, or other extra-gonadal sites

Question 26

what tumour cell markers are high in non-seminoma germ cell tumours

Answer 26

1. AFP (alpha-fetoprotein)
2. HCG (human chorionic gonadotropin)
3. LDH

Question 27

when are tumour markers checked in testicular cancer

Answer 27

before and after orchidectomy

Question 28

where does testicular cancer commonly spread to

Answer 28

the retroperitoneal lymphnodes + other nodes below the pelvic pathway as they drain below the renal vein

Question 29

what are sentinel nodes

Answer 29

the first few lymph nodes to which cancer spreads

Question 30

what congenital abnormality is a big risk for testicular cancer

Answer 30

undescended testis