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3 - Urinary > deck_1664614 > Flashcards

deck_1664614 Flashcards

1
Q

Name three main risk factors for prostate cancer

A

• Age • Family history • Race

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2
Q

How is age a risk factor for prostate cancer?

A

• There is a correlation with increasing age • Uncommon in men younger than 50

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3
Q

How is family history a risk factor for prostate cancer?

A

• 4x increased risk • If one 1st degree relative is diagnosed with prostate cancer before age 60 • After 60 diagnosis probably age related

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4
Q

How is prostate cancer related to race?

A

• Incidence in asian

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5
Q

Give the usual presentation of prostate cancer

A

• Vast majory asymptomatic • Urinary symptoms ○ Benign enlargement of prostate ○ Bladder over activity ○ +/- CaP • Bone pain ○ Advanced metastatic

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6
Q

Give an unusual symptom of prostate cancer

A

haematuria

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7
Q

Outline how prostate cancer is diagnosed

A

• A digital rectal examination • A serum PSA ○ Used to assess wether or not a biopsy in necessary • If it is, carried out via a TransRectal UltraSound guided biopsy of prostate • Lower urinary tract symptoms are treated with a TransUrethral Resection of Prostate

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8
Q

Give 5 factors influencing treatment decisions in prostate cancer

A

MADBP • Age • Digital Rectal Exam • PSA level • Biopsies • MRI scan and bone scan

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9
Q

What are the three different results you can get from a digital rectal exam?

A

• Localised (T1/2) • Locally advances (T3) • Advanced (T4)

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10
Q

What can biopsies tell us about the advancement of prostate cancer?

A

• Gleason grade

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11
Q

What is a Gleason grading?

A

• Pathologist adds together grading score of most common cell type and adds to highest graded prostate tissue

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12
Q

Give three treatments for established prostate cancer

A

• Surveillance ○ Watch cancer, tumor not severe enough to outweigh risks of treatment • Radical prostateectomy Radiotherapy - External beams or low dose brachytherapy

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13
Q

Give three treatments for developmental prostate cancers

A

• High intensity focused ultrasound • Primary cryotherapy - freeze the prostate • Brachytherapy - High dose (small rods implanted in prostate)

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14
Q

How can metastatic prostate cancer be treated?

A

• Hormones ○ Surgical castration, medical castration • PalliationSingle-dose radiotherapy, bisphosphonates, chemotherap

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15
Q

Give three ways to treat locally advanced prostate cancer

A

• Surveillance • Hormones • Hormones & radiotherapy

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16
Q

What is haematuria?

A

• Blood in urine • Classified as visible or non-visible

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17
Q

What does it mean if haematuria is visible?

A

• On investigation there is a 20% chance a malignancy is present

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18
Q

What does it mean if haematuria is non-visible?

A

• Can be symptomatic or asymptomatic Detected via microscopy or urine dipstick

19
Q

Give three causes of haematuria

A

• Cancer • OtherNephrological

20
Q

Give four types of cancer which can cause haematuria

A

• Renal cell carcinoma • Upper tract transition cell carcinoma • Bladder cancer • Advanced prostate cancer

21
Q

Give five non-cancerous causes of haematuria

A

• Stones • Infection • Inflammation • Benign prostatic hyperplasiNephrological

22
Q

What questions must be taken on investigating the history of someone with haematuria?

A

• Smoking • Occupation • Pain levels • Other UTI symptoms • Family history

23
Q

What should be looked for on examination of someone with haematuria

A

• BP • Abdominal mass • Varicocele – collection of veins in the scrotum (‘bag of worms’) • Leg swelling • Assess prostate by DRE (male) – Size, texture

24
Q

What investigations should be done for haematuria?

A

• Urine culture • Cytology • FBC • Ultrasound • Flexible cystoscopy

25
Q

Outline the epidemiology of bladder cancer

A

• 7th most common cancer in the UK, but incidence decreasing] • Male to female ratio 2.5:1 and 90% are transitional cell carcinomas

26
Q

Give three large risk factors for bladder cancer

A

• Smoking • Occupational exposure • Schistomiasis

27
Q

How much does smoking increase risk of bladder cancer?

A

• 4x increased risk

28
Q

Give three examples of occupational exposure increasing risk of bladder cancer

A

• Rubber or plastics manufacture (arylamines) • Handling of carbon, crude oil, combustion (polyaromatic hydrocarbons) • Painters, mechanics, printers, hairdressers

29
Q

Outline the staging of bladder cancer

A

• 75% of cancers are superficial • 5% are in situ • 20% are muscle invasive

30
Q

Give three types of bladder cancer which all have different treatments

A

• High risk non-muscle invasive TCC (transitional cell carcinoma, you simpleton) • Low risk non-muscle invasive TCCMuscle invasive TCC

31
Q

Give two treatments for high risk non-muscle invasive TCC

A

• Check cystoscopies • Intravesical chemotherapy/immunotherapy

32
Q

Give a treatment for low risk non-muscle invasive TCC

A

• Check cystoscopies

33
Q

Give two courses of treatment for muscle invasive TCC

A

• Potentially curative ○ Radical cystectomy or radiotherapy (+/- chemotherapy) ○ Not curative • Palliative chemotherapy/radiotherapy

34
Q

What is a radical cystectomy?

A

• Removal of the urinary bladder

35
Q

What can be done after a radical cystectomy to simulate a bladder?

A

• A piece of ileum may be used to make a conduit from the ureters to the abdomen, where urine can be collected in a bag • May also attempt to reconstruct the bladders from a piece of small intestine

36
Q

Outline the epidemiology renal cell carcinoma

A

• 8th most common cancer in the UK, making up 95% of all upper urinary tract tumours • Male to female ratio of 3:2 and 30% have metastases on presentation

37
Q

Give three risk factors for RCC

A

• Smoking • Obesity • Dialysis

38
Q

Where does RCC mestatasise to?

A

• Lymph nodes • Up the renal vein • Vena cava into right atrium • Into subcapsular fat (perinephric spread)

39
Q

What is the established treatment for RCC?

A

• Surveillance • Radical nephrectomy ○ Removal of kidney, adrenal, surrounding fate and upper ureter • Partial nephrectomy

40
Q

Give a developmental treatment for RCC

A

• Ablation ○ Removal of tumour via erosive process

41
Q

Give two palliative treatments for RCC

A

• Molecular therapies targeting angiogenesis • Immunotherapy

42
Q

What is the epidemiology of Upper Tract Transitional Cell Carcinoma (TCC)

A

• Only 5% of malignancies of URT (Rest are RCC) • 5% due to spread of cancer from bladder • 40% of cancers of the URT spread to bladder

43
Q

Give four investigations for Upper Tract TCC

A

• Ultrasound • CT urogram • Retrograde pyelogram (inject contrast into ureter) • Ureteroscopy ○ Biopsy ○ Washings for cytology

44
Q

What is the treatment for upper tract TCC?

A

• Nephro-ureterectomyRemoval of the kidney, fat, ureter and cuff of bladder

3 - Urinary (39 decks)

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