Carcinoma of the prostate, bladder, renal, testes Flashcards
Epidemiology of prostate cancer
Most common cancer in men 10% of cancer rate deaths Increasing incidence Familial incidence Higher in black americans
Where in the prostate do mo most cancers arise
The peripheral zone
Describe the symptoms of prostate cancer
No symptoms.Only way of finding it is PSA test or PR exam for firmness/enlargment
How to diagnose prostate cancer
PSA (low specificity and sensitivity) Direct rectal exam Trans rectal USS (not reliable) MRI (being used more) PET scans Biopsy
What would it appear microscopically
Diffuse region.
Higher magificantion - adenocarcinoma less defined cells, large nucleoli, absence of basal cells
Describe the grading of prostate cancers
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
What is lowest grade tumour in gleans grading
6 Because grades 1 and 2 not used as not actually cancer.
How does prostatic cancer spread
Local spread: Through extraprostatic fat, seminal vesicles, other pelvic organs
Lymph nodes: pelvic, aortic
Distant metastasis: particularly vertebral bodies
Where do the main nerves of the prostate run, what is it and what is the clinical significance in radical prostatectomy
Between prostate and rectum stem from pudendal nerve that innervates the penis. Removal of prostate can result in impotence
Describe the levels of TNM staging
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
Three categories of managment
Small low grade- active surveillance
Significant tumours- radical treatment
Advanced tumour- palliative treatment
What are the two forms of radical treatment
Radical prostatectomy
Radical radiotherapy
Palliative therapy
Anti androgen treatment
Palliative radiotherapy
Pathologies of the bladder
Congenital abnormaltites Diverticula Stones Inflammations Tumour-like conditions Tumours
What are the main kinds of tumours of the bladder
Carcinoma’s epithelial
Epidemiology
More common in males, eitiology smoking, industrial chemicals.
Pathogenesis of cancer
Arises from urothelial cell CIS
Presentation
Present with haematuria
Micro morphology
Most are urothelial (transitional) carcinomas. Some are squamous adenocarcinomas
Treatment of bladder cancer
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
Renal cell carcinoma epi
Most common kind of renal cancer more common in males Occurs in older people Smokers Genetic non Hippel-Lindau disease
What is the risk with renal cell carcinomas
Well circumscribed within kidney but can invade renal vein, through this they spread
Symptoms of renal cell carcinoma
Symptoms occur late Haematuria Flank pain Palpable abdo mass (not likely) Ectopic hormone production
Mass in the scrotum differential diagnosis
Hernia, hydrocoele, haematocoele, epididymis
