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GU > Carcinoma of the prostate, bladder, renal, testes > Flashcards

Carcinoma of the prostate, bladder, renal, testes Flashcards

1
Q

Epidemiology of prostate cancer

A 
Most common cancer in men
10% of cancer rate deaths
Increasing incidence
Familial incidence
Higher in black americans
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2
Q

Where in the prostate do mo most cancers arise

A

The peripheral zone

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3
Q

Describe the symptoms of prostate cancer

A

No symptoms.Only way of finding it is PSA test or PR exam for firmness/enlargment

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4
Q

How to diagnose prostate cancer

A 
PSA (low specificity and sensitivity)
Direct rectal exam
Trans rectal USS (not reliable)
MRI (being used more)
PET scans 
Biopsy
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5
Q

What would it appear microscopically

A

Diffuse region.

Higher magificantion - adenocarcinoma less defined cells, large nucleoli, absence of basal cells

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6
Q

Describe the grading of prostate cancers

A

Gleason grading 1-5. Correlate with death rate. Primary and secondary patterns used. The two most common patterns are added together. E.g. gleans score 7 (3+4). Grading is based on level of diffuseness

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7
Q

What is lowest grade tumour in gleans grading

A

6 Because grades 1 and 2 not used as not actually cancer.

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8
Q

How does prostatic cancer spread

A

Local spread: Through extraprostatic fat, seminal vesicles, other pelvic organs
Lymph nodes: pelvic, aortic
Distant metastasis: particularly vertebral bodies

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9
Q

Where do the main nerves of the prostate run, what is it and what is the clinical significance in radical prostatectomy

A

Between prostate and rectum stem from pudendal nerve that innervates the penis. Removal of prostate can result in impotence

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10
Q

Describe the levels of TNM staging

A

T1- Clinically inapparent tumour
T2 Palpable tumour confined within prostate
T3 Tumour extends through prostate
T4 Fixed tumour or invades adjacent structures other than seminal vesicles

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11
Q

Three categories of managment

A

Small low grade- active surveillance
Significant tumours- radical treatment
Advanced tumour- palliative treatment

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12
Q

What are the two forms of radical treatment

A

Radical prostatectomy

Radical radiotherapy

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13
Q

Palliative therapy

A

Anti androgen treatment

Palliative radiotherapy

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14
Q

Pathologies of the bladder

A 
Congenital abnormaltites
Diverticula
Stones
Inflammations
Tumour-like conditions
Tumours
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15
Q

What are the main kinds of tumours of the bladder

A

Carcinoma’s epithelial

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16
Q

Epidemiology

A

More common in males, eitiology smoking, industrial chemicals.

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17
Q

Pathogenesis of cancer

A

Arises from urothelial cell CIS

18
Q

Presentation

A

Present with haematuria

19
Q

Micro morphology

A

Most are urothelial (transitional) carcinomas. Some are squamous adenocarcinomas

20
Q

Treatment of bladder cancer

A

BCG (tuberculous bacteria) put live into bladder. Bacteria proliferate and cause intense inflammatory response which kills tumour.
If tumour has moved into detrusor muscle cystectomy required.
Radiation only used in palliative care

21
Q

Renal cell carcinoma epi

A 
Most common kind of renal cancer
more common in males
Occurs in older people
Smokers
Genetic non Hippel-Lindau disease
22
Q

What is the risk with renal cell carcinomas

A

Well circumscribed within kidney but can invade renal vein, through this they spread

23
Q

Symptoms of renal cell carcinoma

A 
Symptoms occur late
Haematuria
Flank pain
Palpable abdo mass (not likely)
Ectopic hormone production
24
Q

Mass in the scrotum differential diagnosis

A

Hernia, hydrocoele, haematocoele, epididymis

25
Q

Describe epididymytis

A

Inflammation of the epididymis due to tuberculous bacteria

26
Q

Describe haematocoele

A

Collection of blood within the testes usually due to trauma

27
Q

Clinical presentation of testicular tumour

A

Enlargement or irregularity of testes. Painless

Can present with gynaecomastia, due to sertoli/leydig cell tumours which have endocrine functions

28
Q

What is usual lymphatic drainage of testes

A

Aortic nodes

29
Q

What is the most common classification of testicular cancers

A

Germ cell tumours

30
Q

To classifications of GCT

A

Seminoma and non-seminomatous GCT or combined

31
Q

What are the classifications of non-seminomatous GCT

A

Embryonal carcinoma, teratoma, choriocarcinoma, yolk sac tumour

32
Q

Risk factors

A

Undescended testes, famililal , gonadal dysgenesis (pseudohermaphridism)

33
Q

What is intratubular germ cell neoplasia

A

Precurser to germ cell tumour in testes

34
Q

What is the difference between seminoma and non seminoma germ cell tumours

A

Seminoma are non differentiated non seminoma are differentiated

35
Q

Diagnosis of testicular cancer

A

Clinical examination
USS
Inguinal orchidectomy (removal of testes through inguinal canal)

36
Q

Staging of testicular cancer

A

Chest xray and CT of chest/abdo/pelvis presumably to exclude metastases.
Serum tumour markers

37
Q

Spread of testicular GCT

A

Local invasion only relevant if it makes it to the tunica albuginia
Lymphatic- common iliac and para aortic
Haematogenous

38
Q

Name the two serum tumour markers

A

Beta HCG

Alpha Feto Protein

39
Q

Cancer of the penis, classification.

A

Squamous cell carcinoma

40
Q

Why is mortality high from carcinoma of the penis

A

Rapid spread to inguinal lymph nodes

GU (9 decks)

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