Cancers - RCC And TCC Flashcards
What types of tumours are commonly present in the urinary system?
RCC - renal cell carcinoma that appears in the kidney.
TCC - transition cell carcinoma that appears in the kidney, urethra and bladder.
How does RCC present?
Early:
Haematuria
Incidental finding on imaging
Rarely - palpable mass
Late: Large varicocele Pulmonary / tumour embolus Loss of weight / appetite / symptoms of metastasis Hypercalcaemia
How does TCC present?
Localised or advanced:
Haematuria
Indicendal finding on imaging
Advanced:
Loss of weight / appetite / symptom of metastasis
DVT
Lymphoedema
How do you classify haematuria?
Visible
Non visible - symptomatic or asymptomatic
How is hamaturia important?
20% of those presenting with visible haematuria have urological cancer.
What are some common causes of haematuria?
Cancer: RCC Bladder cancer Upper urinary tract TCC Advanced prostate cancer
Other: Stones Infection Inflammation Large BPH
When is it more likely be a Nephrological cause?
Nephrology: High BP Protein urea Under 40 Not visible haematuria
What things do you look for in history for haematuria?
Smoking Occupation Pain? - if pain-stone? Other LUTS (lower urinary tract symptoms) Family history
What things do you look for upon examination of haematuria?
BP Abdominal mass Varicocele Leg swelling Assess prostate by DRE -size, texture
What othe things do you check when come for haematuria?
Radiology -USS of urinary tract (stones, - hydronephrosis, tumour in kidney), CT if abnormal USS
Endoscopy -flexible cystoscopy (see smaller tumours)
Urine - cytology to look for abnormal cells or culture and sensitivity
Bloods (done in primary care) -FBC and U&E
Describe the epidemiology of RCC
7th most common cancer in UK
95% of all upper urinary tract tumour.
Incidence and mortality are rising
Mortality is projected to fall in the next decade
M:F 3:2
30% have metastases on presentation
Aetiology:
Smoking
Obeisity
Dialysis
How does RCC spread?
IVC spread to right atrium
Perinephric spread
Lymph node metastasis
How do you treat RCC?
Surveillance
Excision
- Radical nephrectomy (open or laparoscopic)
- Partial nephroectomy (Open or robotic)
Ablation
- Cryoblation
- Radiofrequency ablation
How do you treat metastatic RCC?
Palliative
Biological therapies
-Targeted therapies = Those targeting angiogenesis (tyrosine kinase inhibitors) are now 1st choice. -Sunitinib
Describe the epidemiology of bladder cancer
8th most common in men, 14th in women
Incidence is decreasing
Presentation is more advanced in women
Mortality is decreasing (less in women)
M:F 3:1
White> non-white
What are the risk factors for bladder TCC?
Smoking (4x. Risk)
Occupation exposure:
-Rubber or plastics manufacture
-Handling of carbon, crude oil, combustion, smelting
Painters, mechanics, printers, hairdressers
How do you treat bladder cancer initially?
Transurethral removal of bladder tumour.
How else do you treat badder TCC?
Low risk non-muscle invasive:
-Check cystoscopy
+/- intravesical chemotherapy
High risk non muscle-invasive:
-Check cytoscopies
Intravesical immunotherapy
Muscle-invasive (most serious):
Neoadjuvant chemotherapy
Radical cystectomy or radiotherapy
BUT, sometimes palliative chemo or radio.
Describe the epidemiology of upper urinary tract TCC
Only 5% of all malignancies of upper urinary tract
Aetiology:
Smoking
Phenacetin (similar to paracetamol by carcinogenic - banned) abuse
Balkan’s nephropathy
Where to upper urinary tract TCC typically spread to?
40% spread to the bladder
What are the initial investigations if you suspect an upper urinary tract TCC
USS - hydronephrosis
CT Urogram - filling defect, ureteric stricture
Retrograde pyelogram
Ureteroscopy - biopsy, washings for cytology
What is the standard treatment of upper urinary tract TCC?
Nephro-ureterectomy (kidney, fat, ureter, cuff of bladder)
What is the treatment of metastatic TCC?
Systemic chemotherapy - Cis-platin based
Biological therapies - immunothrapies
