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Urinary system > Carcinoma of the kidney and bladder > Flashcards

Carcinoma of the kidney and bladder Flashcards

1
Q

Where does renal cell carcinoma present?

A
  • Parenchyma of kidney
  • Main functional part where nephron is found
  • Originates from metanephric blastema
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2
Q

Where does transitional cell carcinoma present?

A

-From calyx to bladder
- Calyces, pelvis, ureter and bladder can be affected
- Urothelium

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3
Q

How does renal cell carcinoma present?

A
  • Haematuria or incidental finding
  • Non-specific symptoms e.g. fatigue, weight loss, fever, mass in the loin
  • Often metastasise before local symptoms develop
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4
Q

How does advanced renal carcinoma present?

A
  • 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
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5
Q

Outline the epidemiology of renal cell carcinoma

A
  • 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
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6
Q

What are the risk factors of renal cell carcinoma?

A
  • Dialysis
  • Smoking
  • Obesity
  • Polycystic kidney disease
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7
Q

How do we investigate renal cell carcinoma?

A
  • Radiology - ultrasound or CT scan
  • Endoscopy - flexible cystoscopy
  • Urine - cystology
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8
Q

How is localised renal cell carcinoma treated?

A
  • Surveillance
  • Increasingly small tumours removed with partial nephrectomy to preserve some renal function
  • Radical nephrectomy for large tumours with no distant metastases
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9
Q

What does a radical nephrectomy involve?

A
  • Removal of associated adrenal gland
  • Perinephric fat
  • Upper ureter
  • Para-aortic lymph nodes
  • Renal artery
  • Renal vein
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10
Q

How is metastatic renal cell carcinoma treated?

A
  • Little effective treatment for metastatic disease
  • Chemotherapy and radiotherapy resistant
  • Palliative treatment
  • Target angiogenesis to cut off blood supply to tumour
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11
Q

How does transitional cell carcinoma present?

A
  • Haematuria
  • Incidental finding on imaging (ultrasound or CT)
  • Weight loss, loss of appetite
  • Signs/symptoms of obstruction
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12
Q

What are some differential diagnoses to consider for a patient with haematuria?

A
  • Bladder cancer
  • Bleeding from the prostate
  • Renal cell carcinoma
  • UTI
  • Nephritic conditions
  • Polycystic kidney disease
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13
Q

What questions would you want to ask a patient with haematuria?

A
  • 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
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14
Q

Outline the epidemiology of bladder transitional cell carcinoma

A
  • More males affected than females
  • 8th most common cancer in men
  • 14th most common cancer in women
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15
Q

What are the causes of bladder transitional cell carcinoma?

A
  • Analgesic misuse
  • Exposure to aniline dyes used in industrial manufacture of dyes, rubber and plastic
  • Smoking
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16
Q

How is bladder transitional cell carcinoma diagnosed?

A
  • CT scan
  • MRI scan
  • Chest X-ray
  • Cystoscopy
  • Ureteroscopy
17
Q

What investigations are done when a patient suffers from haematuria?

A
  • 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
18
Q

How is transitional cell bladder carcinoma diagnosed?

A
  • 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
19
Q

How is transitional cell bladder carcinoma treated?

A
  • 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
20
Q

How should patients with bladder cancers be referred?

A
  • 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
21
Q

How is a patient with suspected bladder cancer managed?

A
  • Referral to urology
  • Management of cancer depends on grade and stage of tumour
22
Q

Outline transitional cell carcinoma of the upper urinary tract?

A
  • Only 5% of malignancies affect upper urinary tract
  • Patients have a 40% chance of developing bladder cancer due to seeding
23
Q

How does transitional cell carcinoma of the upper urinary tract present?

A
  • Haematuria
  • Obstruction
  • Presentation occurs early because renal pelvis projects directly into pelvicalyceal cavity
24
Q

How is transitional cell carcinoma of the upper urinary tract treated?

A
  • Treated with nephro-ureterectomy
  • (Kidney, fat, ureter, cuff of bladder)

Urinary system (22 decks)

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