deck_1664614 Flashcards
Name three main risk factors for prostate cancer
• Age • Family history • Race
How is age a risk factor for prostate cancer?
• There is a correlation with increasing age • Uncommon in men younger than 50
How is family history a risk factor for prostate cancer?
• 4x increased risk • If one 1st degree relative is diagnosed with prostate cancer before age 60 • After 60 diagnosis probably age related
How is prostate cancer related to race?
• Incidence in asian
Give the usual presentation of prostate cancer
• Vast majory asymptomatic • Urinary symptoms ○ Benign enlargement of prostate ○ Bladder over activity ○ +/- CaP • Bone pain ○ Advanced metastatic
Give an unusual symptom of prostate cancer
haematuria
Outline how prostate cancer is diagnosed
• 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
Give 5 factors influencing treatment decisions in prostate cancer
MADBP • Age • Digital Rectal Exam • PSA level • Biopsies • MRI scan and bone scan
What are the three different results you can get from a digital rectal exam?
• Localised (T1/2) • Locally advances (T3) • Advanced (T4)
What can biopsies tell us about the advancement of prostate cancer?
• Gleason grade
What is a Gleason grading?
• Pathologist adds together grading score of most common cell type and adds to highest graded prostate tissue
Give three treatments for established prostate cancer
• Surveillance ○ Watch cancer, tumor not severe enough to outweigh risks of treatment • Radical prostateectomy Radiotherapy - External beams or low dose brachytherapy
Give three treatments for developmental prostate cancers
• High intensity focused ultrasound • Primary cryotherapy - freeze the prostate • Brachytherapy - High dose (small rods implanted in prostate)
How can metastatic prostate cancer be treated?
• Hormones ○ Surgical castration, medical castration • PalliationSingle-dose radiotherapy, bisphosphonates, chemotherap
Give three ways to treat locally advanced prostate cancer
• Surveillance • Hormones • Hormones & radiotherapy
What is haematuria?
• Blood in urine • Classified as visible or non-visible
What does it mean if haematuria is visible?
• On investigation there is a 20% chance a malignancy is present
What does it mean if haematuria is non-visible?
• Can be symptomatic or asymptomatic Detected via microscopy or urine dipstick
Give three causes of haematuria
• Cancer • OtherNephrological
Give four types of cancer which can cause haematuria
• Renal cell carcinoma • Upper tract transition cell carcinoma • Bladder cancer • Advanced prostate cancer
Give five non-cancerous causes of haematuria
• Stones • Infection • Inflammation • Benign prostatic hyperplasiNephrological
What questions must be taken on investigating the history of someone with haematuria?
• Smoking • Occupation • Pain levels • Other UTI symptoms • Family history
What should be looked for on examination of someone with haematuria
• BP • Abdominal mass • Varicocele – collection of veins in the scrotum (‘bag of worms’) • Leg swelling • Assess prostate by DRE (male) – Size, texture
What investigations should be done for haematuria?
• Urine culture • Cytology • FBC • Ultrasound • Flexible cystoscopy
Outline the epidemiology of bladder cancer
• 7th most common cancer in the UK, but incidence decreasing] • Male to female ratio 2.5:1 and 90% are transitional cell carcinomas
Give three large risk factors for bladder cancer
• Smoking • Occupational exposure • Schistomiasis
How much does smoking increase risk of bladder cancer?
• 4x increased risk
Give three examples of occupational exposure increasing risk of bladder cancer
• Rubber or plastics manufacture (arylamines) • Handling of carbon, crude oil, combustion (polyaromatic hydrocarbons) • Painters, mechanics, printers, hairdressers
Outline the staging of bladder cancer
• 75% of cancers are superficial • 5% are in situ • 20% are muscle invasive
Give three types of bladder cancer which all have different treatments
• High risk non-muscle invasive TCC (transitional cell carcinoma, you simpleton) • Low risk non-muscle invasive TCCMuscle invasive TCC
Give two treatments for high risk non-muscle invasive TCC
• Check cystoscopies • Intravesical chemotherapy/immunotherapy
Give a treatment for low risk non-muscle invasive TCC
• Check cystoscopies
Give two courses of treatment for muscle invasive TCC
• Potentially curative ○ Radical cystectomy or radiotherapy (+/- chemotherapy) ○ Not curative • Palliative chemotherapy/radiotherapy
What is a radical cystectomy?
• Removal of the urinary bladder
What can be done after a radical cystectomy to simulate a bladder?
• 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
Outline the epidemiology renal cell carcinoma
• 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
Give three risk factors for RCC
• Smoking • Obesity • Dialysis
Where does RCC mestatasise to?
• Lymph nodes • Up the renal vein • Vena cava into right atrium • Into subcapsular fat (perinephric spread)
What is the established treatment for RCC?
• Surveillance • Radical nephrectomy ○ Removal of kidney, adrenal, surrounding fate and upper ureter • Partial nephrectomy
Give a developmental treatment for RCC
• Ablation ○ Removal of tumour via erosive process
Give two palliative treatments for RCC
• Molecular therapies targeting angiogenesis • Immunotherapy
What is the epidemiology of Upper Tract Transitional Cell Carcinoma (TCC)
• 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
Give four investigations for Upper Tract TCC
• Ultrasound • CT urogram • Retrograde pyelogram (inject contrast into ureter) • Ureteroscopy ○ Biopsy ○ Washings for cytology
What is the treatment for upper tract TCC?
• Nephro-ureterectomyRemoval of the kidney, fat, ureter and cuff of bladder
