Clinical Topic 3: Haematuria Flashcards
What are the three zones of the Prostate called? Which is the largest zone?
Peripheral zone (largest)
Central zone
Transitional zone
Which zone of the prostate does Benign Prostatic Hyperplasia commonly affect?
Transitional zone
What is the most common type of Prostate cancer?
Adenocarcinoma (most common)
Mutations in what genes are associated with Prostate Adenocarcinoma?
BRCA1
BRCA2
Outine the how a Gleason score is produced?
Gleason is comprised of two scoring patterns which range from 1 to 5 each. These two scores are added together to make a score of 10
2 = Best prognosis 10 = Worst prognosis
A “boggy” prostate is associated with..?
Prostatitis
What are some risk factors associated with Prostate Cancer?
Old age, obesity, high fat and low fibre diet, family history, Afro-carribean ethnicity
Which circumstances may raise a PSA level and for how long?
- Benign Prostatic Hyperplasia
- Prostatitis (for at least 1 month)
- Urinary Tract Infection (for at least 1 month)
- Ejaculation (for at least 48 hours)
- Vigorous exercise (for at least 48 hours)
- Urinary retention
- Trauma
According to NICE, what is a normal PSA level in patients aged 50-69?
< 3 ng/ml
What does active surveillance comprise of in patients with Prostate cancer?
10 core biopsies + 1 re-biopsy
Which zone of the prostate does Prostatic cancer commonly affect?
Peripheral zone
What is are two common complications of Prostatectomy?
Urinary incontinence
Erectile dysfunction
Prostate cancer commonly metastasises where?
Vetrabrae and pelvis
In what Prostate Cancer patients is the “watch and wait” more appropriate to do?
Elderly
Multiple co-moribidies
Low Gleason score
Why is hormonal therapy indicated in patients with Prostate cancer? What are the types of hormonal therapy?
Testosterone stimulates prostatic tissue, hence:
- Bilateral orchiectomy
- Goserelin (GnRH agonist)
What are the two types of Radiotherapy offered to patients with Prostate cancer?
External beam therapy
Brachytherapy
What tests can be performed to diagnose Prostate Cancer?
- Digital Rectal Exam (DRE)
- Prostate Specific Antigen (PSA)
- Transrectal Ultrasound +/- Biopsy (TRUS)
- MRI / CT scan
Renal Cell carcinomas typically form from what cells and where in the kidney?
Polygonal epithelial cells in the PCT
What is the classic triad of symptoms associated with Renal Cell Carcinoma?
Flank pain
Palpable mass
Haematuria
Renal Cell Carcinomas associated with Von Hippel Lindau disease are caused by what genetic mutation on what chromosome? What is the inheritance pattern?
VHL gene on 3p chromosome
Autosomal dominant
Sporadic renal cell carcinomas commonly occur where in the kidneys?
Upper poles of kidney
What are the treatment options for renal cell carcinoma?
If localised, total or partial nephrectomy
Medications such as Alpha interferon, IL-2, RTK inhibitors
RCCs are usually resistant to chemotherapy / radiotherapy
What paraneoplastic syndromes are associated with Renal Cell Carcinoma?
- Release of EPO -> polycythaemia
- Release of Renin -> hypertension
- Release of PTHrP -> hypercalcaemia -> ACTH -> cortisol -> Cushing’s
If a renal cell carcinoma invades the left renal vein, what affect can this have? What this also happen if RCC invades the right renal vein?
Invasion of left renal vein prevents drainage to the left testicle, leading to a varicocele formation
Does not happen in right sided invasion, as the right testicular vein directly drains into the IVC, not causing varicocele formation
What is the most likely common site of distant metastasis associated with renal cell carcinoma? Why?
Lungs due to renal vein draining into IVC
What are the two main cancers which affect the bladder?
Transitional Cell Carcinoma (TCC)
Squamous Cell Carcinoma (SCC)
What are the risk factors for Transitional Cell Carcinoma?
PEESAC
P - Phenacetin E - Ethanol (drinking alcohol) E - Emptying (delayed emptying / stasis) S - Smoking A - Aniline dyes C - Cyclophosphamide
What are the risk factors for Squamous Cell Carcinoma of the Bladder?
Smoking
Schistosomiasis
What is the first-line investigation for diagnosing Bladder Cancer?
Flexible Cystoscopy
Following neobladder reconstruction, patients are at increased risk of which cancer?
Adenocarcinoma
What is the treatment option for Bladder carcinoma in situ, and Invasive Bladder cancer?
BCIS - Transurethral resection
Invasive Cancer - Radical cystectomy
What is the most common benign tumour in the kidneys? Where is it commonly found? Which condition is it commonly associated with
Angiomyolipoma, commonly affects the R kidney. Associated with tuberous schlerosis
What is the most common malignant tumour in children? What are is the main symptom and what are other symptoms?
Wilm’s tumour
Abdominal mass* (main symptom)
Painless haematuria
Flank pain
What two conditions are associated with Wilm’s tumour?
WAGR (Wilm’s, Aniridia, Genitourinary Malformation, Retardardtion)
Beckwith Weiderman syndrome
What is the epidemiology of testicular cancer?
Most common malignancy in males aged 20-30
95% of testicular cancers are what? What can this be further divided into?
Germ cell tumours:
- Seminomas
- Non-seminomas, i.e. Embryonal, Yolk, Teratoma, Choriocarcinoma
What is the diagnostic test of choice for testicular cancers?
Ultrasound
What are the risk factors of Testicular cancer?
Infertility Undescended testes Family history Kleinfelter's syndrome Mumps Orchitis
What is the general treatment for Testicular cancer?
Orchiectomy
Chemotherapy + Radiotherapy
During the first stages of treatment, goserelin may cause a transient increase in symptoms of prostatic cancer, called the “flare effect”. What can be done to prevent this?
Pre-treatment with Flutamide
What is the first and second-line treatment for BPH?
First-line: Alpha 1 antagonists
Second-line: 5-alpha reductase inhibitors
What is the most common organism associated with Prostatitis?
E. coli
In non-seminomas testicular tumours, what markers may be elevated?
Raised AFP
Raised hCG
