Genitourinary - cancers Flashcards
what are the different types of renal cell carcinoma?
There are three main types of renal cell carcinoma:
MC /MS - Clear cell
Papillary
Chromophobe
Which Gene mutation is highly associated with RCC?
VHL - Von Hippel Lindau gene found on Chr3
Autosomal dominant
How does VHL gene mutation lead to RCC?
VHL - Tumour suppressor gene regulating HIF hypoxia inducible factor
HIF promotes the transcription of VEGF vascular endothelial GF, and PDGF platelet derived growth factor.
These cause unregulated cell proliferation and division that subsequently create being tumour/cyst in renal architecture. These can further develop to form RCC.
How would RCC present?
Usually Asx and found incidentally
Cardinal signs:
Haematuria,
Loin pain
Loin mass
Fever
+ classic cancer signs:
Weight loss/ fatigue/ night sweats
+/- Paraneoplastic syndromes
Other signs: Bone pain/hypercalcemia, HTN, varicocele
RCC RF?
Age
smoking
obesity
Fhx
Hypertension
VHL syndrome
RCC RED FLAGS
Suspect cancer and urgent referral if:
> 45 years old +
- Unexplained visible haematuria without urinary tract infection or
-Visible haematuria that persists or recurs after successful treatment of urinary tract infection
RCC DX
1st line RENAL USS
GS- CT abdo/chest/pelvis
RCC mets to?
Brain,
Liver
Lungs
Pancreas
Adrenal
RRC TX
Nephrectomy (partial/full)
+
Mets:
Biologics - TK inhibitor
Sunitinib
How may RCC paraneoplastic syndrome present?
Upto 30% of RCC present with this:
Fever
Hypercalcaemia
Hypertension
Neuromyopathies
Polycythaemia
Cushing’s syndrome
what is WILMS Tumour
Wilms tumour is a renal mesenchymal stem cell tumour seen in toddler <3years
NEPHROBLASTOMA
Name different types of bladder cancer?
MC - Transitional cell carcinoma
Squamous cell carcinoma (Strongly linked to schistosomiasis)
What is TCC- transitional cell carcinoma?
TCC aka urothelial carcinoma arises from transitional (urothelial) epithelium - lining of the urinary tract
TCC RF
Smoking (most important risk factor!)
Age (85-89yrs)
Occupation and chemical associated exposures (e.g. painter, tyres, hairdress)
Medications (e.g. cyclophosphamide)
Radiotherapy
TCC Sx
Cardinal Sign:
PAINLESS haematuria (microscopic or macro)
+/- LUTs
Advanced disease:
Pelvic pain
flank pain
periheral oedema
wt loss/fever/night swaets
TCC Red flags
Same as rcc where
>45 yrs old w/unexplained / refractory haematuria
or
Aged 60 and over and have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test.
TCC DX
Urinalysis
GS - Cystoscopy & Biopsy
CT/MRI prior
TCC TX
TURBT
trans-urethral resection of bladder tumour
+
Intravesical mitomycin C
(Ab w/anti-neoplastic effects, given following TURBT to reduce recurrence)
Radio/chemo
TCC Mets to
Lymph
bone
liver lung
Prostate cancer RF?
Age
Black ethnicity
Family history
Obesity
Which gene is associated with prostate cancer?
BRCA 2-
HOXB13
Difference between prostate cancer and BPH
BPH = hyperplasia of transitional zone = smooth enlarged prostate
Prostate cancer is am adenocarcinoma primarily of the peripheral zone
= (hard, nodular, enlarged, asymmetrical)
SX Prostate cancer
Initially Asx
LUTS + Visible haematuria
+
Systemic Sx: Wt loss, fatigue, back/bone pain(mets)
Prostate cancer DX
1st Line: DRE and PSA
Multiparametric MRI
GS Biopsy
When should DRE be considered
Lower urinary tract symptoms
Haematuria
Unexplained symptoms that may be explained by advanced prostate cancer (e.g lower back pain, bone pain, weight loss)
Erectile dysfunction
Other reasons to be concerned of prostate cancer (e.g. elevated PSA)
Prostate cancer MEts
BONE BONE BONE
liver
lung
brain
Prostate cancer classification
Gleason Score
Prostate cancer TX
Low risk - Active surveillance
Regular PSA measures, DRE and MRI
Localised - Prostatectomy
Comp - Urinary incontinence, erectile dysfunction
Defintive treatment for localised:
Radical radiotherapy:
Androgen depravation therapy:
Gonadotropin-releasing hormone (GnRH) agonist: Goserelin#
2nd line: Bilateral orchidectomy
How do androgen depravation therapy work in the context of prostate cancer
(GnRH) agonist: cause a ‘chemical castration’.
GnRH stimulates LH/FSH release from the anterior pituitary. Initially it causes an increase in LH/FSH release. However, the persistent presence of an agonist causes downregulation of receptors on the pituitary gland leading to reduced LH/FSH release.
HPA axis suppression = Less testosterone = reduced growth
What are the different types of testicular cancer
Testicular cancer is the most common caner in young males
Types of testicular cancer is divided into 2 groups:
Germ cell derived - MC 90%
- Seminoma
- Teratoma
Non-Germ cell derived
-Sertoli
-Leydig
-Sarcoma
Testicular cancer Sx
Painless lump in testicale
DOES NOT TRANSLUMINATE
Testicular cancer complication
Infertility, Erectile dysfunction, Loss of libido
Testicular cancer Dx
Urgent - Doppler USS
Tumour Markers:
Teratoma - AFP serum alpha-fetoprotein (AFP)
Seminoma - BhCG beta human chorionic gonadotropin
Testicular cancer TX
Orchidectomy + hormone replacement
Adjunct: Chemo/radio
