Carcinoma of the kidney and bladder Flashcards
Where does renal cell carcinoma present?
- Parenchyma of kidney
- Main functional part where nephron is found
- Originates from metanephric blastema
Where does transitional cell carcinoma present?
-From calyx to bladder
- Calyces, pelvis, ureter and bladder can be affected
- Urothelium
How does renal cell carcinoma present?
- Haematuria or incidental finding
- Non-specific symptoms e.g. fatigue, weight loss, fever, mass in the loin
- Often metastasise before local symptoms develop
How does advanced renal carcinoma present?
- Small number of tumours can secrete hormone like substances (patients present with hypercalcaemia)
- Large varicocele may be present due to compression of gonadal vein
- Only seen on left side as only renal vein is affected
Outline the epidemiology of renal cell carcinoma
- 90% of renal malignant tumours in adults are RCCs
- Arise from tubular epithelium
- Rare in children
- Peak incidence in 60-70 year olds
- More common in males
What are the risk factors of renal cell carcinoma?
- Dialysis
- Smoking
- Obesity
- Polycystic kidney disease
How do we investigate renal cell carcinoma?
- Radiology - ultrasound or CT scan
- Endoscopy - flexible cystoscopy
- Urine - cystology
How is localised renal cell carcinoma treated?
- Surveillance
- Increasingly small tumours removed with partial nephrectomy to preserve some renal function
- Radical nephrectomy for large tumours with no distant metastases
What does a radical nephrectomy involve?
- Removal of associated adrenal gland
- Perinephric fat
- Upper ureter
- Para-aortic lymph nodes
- Renal artery
- Renal vein
How is metastatic renal cell carcinoma treated?
- Little effective treatment for metastatic disease
- Chemotherapy and radiotherapy resistant
- Palliative treatment
- Target angiogenesis to cut off blood supply to tumour
How does transitional cell carcinoma present?
- Haematuria
- Incidental finding on imaging (ultrasound or CT)
- Weight loss, loss of appetite
- Signs/symptoms of obstruction
What are some differential diagnoses to consider for a patient with haematuria?
- Bladder cancer
- Bleeding from the prostate
- Renal cell carcinoma
- UTI
- Nephritic conditions
- Polycystic kidney disease
What questions would you want to ask a patient with haematuria?
- Amount of bleeding, where in the stream
- How long
- Has it cleared up
- Type of blood seen
- Urinary symptoms (frequency, nocturia, urgency, dysuria etc.)
- Medical problems - previous urological problems, operations, renal disease, hypertension
- Occupation
- Smoking
- Any other symptoms
Outline the epidemiology of bladder transitional cell carcinoma
- More males affected than females
- 8th most common cancer in men
- 14th most common cancer in women
What are the causes of bladder transitional cell carcinoma?
- Analgesic misuse
- Exposure to aniline dyes used in industrial manufacture of dyes, rubber and plastic
- Smoking
How is bladder transitional cell carcinoma diagnosed?
- CT scan
- MRI scan
- Chest X-ray
- Cystoscopy
- Ureteroscopy
What investigations are done when a patient suffers from haematuria?
- Urine dipstick to exclude UTI
- Urine cytology - suggests poorly differentiated tumour or carcinoma
- Urine culture and sensitivity - if dipstick suggests infection
- FBC - assesses blood loss and effects of renal failure
- U&Es to assess renal failure
- Biochemical profile - assess evidence of bone or liver metastases
- X-ray kidneys, ureters and bladder
- Ultrasound - renal cancers, hydronephrosis, check state of bladder
- Flexible cystoscopy
How is transitional cell bladder carcinoma diagnosed?
- Investigation via cystoscopy and biopsy allows histological examination and staging
- Diagnosis based on cytological examination of urine to check for presence of malignant cells
- And cystoscopy of lower urinary tract
How is transitional cell bladder carcinoma treated?
- Low-risk non-muscle invasive is treated with transurethral resection of bladder (TURBT) + intravesical chemotherapy to bladder
- High risk non-muscle invasive - TURBT +intravesical chemotherapy, intravesical BCG treatment, cystectomy
- Muscle invasive cancer - cystectomy + radiotherapy (with radiosensitiser) or palliative care
How should patients with bladder cancers be referred?
- All patients should be managed by urologists
- Definitive diagnosis is made on biopsy
- Important to include bladder muscle because muscle invasion is single most important prognostic factor of bladder cancer
How is a patient with suspected bladder cancer managed?
- Referral to urology
- Management of cancer depends on grade and stage of tumour
Outline transitional cell carcinoma of the upper urinary tract?
- Only 5% of malignancies affect upper urinary tract
- Patients have a 40% chance of developing bladder cancer due to seeding
How does transitional cell carcinoma of the upper urinary tract present?
- Haematuria
- Obstruction
- Presentation occurs early because renal pelvis projects directly into pelvicalyceal cavity
How is transitional cell carcinoma of the upper urinary tract treated?
- Treated with nephro-ureterectomy
- (Kidney, fat, ureter, cuff of bladder)
