Genitourinary - cancers

Question 1

what are the different types of renal cell carcinoma?

Answer 1

There are three main types of renal cell carcinoma:

MC /MS - Clear cell
Papillary
Chromophobe

Question 2

Which Gene mutation is highly associated with RCC?

Answer 2

VHL - Von Hippel Lindau gene found on Chr3

Autosomal dominant

Question 3

How does VHL gene mutation lead to RCC?

Answer 3

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.

Question 4

How would RCC present?

Answer 4

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

Question 5

RCC RF?

Answer 5

Age
smoking
obesity
Fhx
Hypertension

VHL syndrome

Question 6

RCC RED FLAGS

Answer 6

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

Question 7

RCC DX

Answer 7

1st line RENAL USS
GS- CT abdo/chest/pelvis

Question 8

RCC mets to?

Answer 8

Brain,
Liver
Lungs
Pancreas
Adrenal

Question 9

RRC TX

Answer 9

Nephrectomy (partial/full)
+
Mets:
Biologics - TK inhibitor
Sunitinib

Question 10

How may RCC paraneoplastic syndrome present?

Answer 10

Upto 30% of RCC present with this:

Fever
Hypercalcaemia
Hypertension
Neuromyopathies
Polycythaemia
Cushing’s syndrome

Question 11

what is WILMS Tumour

Answer 11

Wilms tumour is a renal mesenchymal stem cell tumour seen in toddler <3years

NEPHROBLASTOMA

Question 12

Name different types of bladder cancer?

Answer 12

MC - Transitional cell carcinoma

Squamous cell carcinoma (Strongly linked to schistosomiasis)

Question 13

What is TCC- transitional cell carcinoma?

Answer 13

TCC aka urothelial carcinoma arises from transitional (urothelial) epithelium - lining of the urinary tract

Question 14

TCC RF

Answer 14

Smoking (most important risk factor!)

Age (85-89yrs)

Occupation and chemical associated exposures (e.g. painter, tyres, hairdress)

Medications (e.g. cyclophosphamide)

Radiotherapy

Question 15

TCC Sx

Answer 15

Cardinal Sign:
PAINLESS haematuria (microscopic or macro)

+/- LUTs

Advanced disease:
Pelvic pain
flank pain
periheral oedema
wt loss/fever/night swaets

Question 16

TCC Red flags

Answer 16

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.

Question 17

TCC DX

Answer 17

Urinalysis

GS - Cystoscopy & Biopsy

CT/MRI prior

Question 18

TCC TX

Answer 18

TURBT
trans-urethral resection of bladder tumour
+
Intravesical mitomycin C
(Ab w/anti-neoplastic effects, given following TURBT to reduce recurrence)

Radio/chemo

Question 19

TCC Mets to

Answer 19

Lymph
bone
liver lung

Question 20

Prostate cancer RF?

Answer 20

Age
Black ethnicity
Family history
Obesity

Question 21

Which gene is associated with prostate cancer?

Answer 21

BRCA 2-
HOXB13

Question 22

Difference between prostate cancer and BPH

Answer 22

BPH = hyperplasia of transitional zone = smooth enlarged prostate

Prostate cancer is am adenocarcinoma primarily of the peripheral zone
= (hard, nodular, enlarged, asymmetrical)

Question 23

SX Prostate cancer

Answer 23

Initially Asx

LUTS + Visible haematuria
+
Systemic Sx: Wt loss, fatigue, back/bone pain(mets)

Question 24

Prostate cancer DX

Answer 24

1st Line: DRE and PSA
Multiparametric MRI

GS Biopsy

Question 25

When should DRE be considered

Answer 25

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)

Question 26

Prostate cancer MEts

Answer 26

BONE BONE BONE
liver
lung
brain

Question 27

Prostate cancer classification

Answer 27

Gleason Score

Question 28

Prostate cancer TX

Answer 28

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

Question 29

How do androgen depravation therapy work in the context of prostate cancer

Answer 29

(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

Question 30

What are the different types of testicular cancer

Answer 30

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

Question 31

Testicular cancer Sx

Answer 31

Painless lump in testicale
DOES NOT TRANSLUMINATE

Question 32

Testicular cancer complication

Answer 32

Infertility, Erectile dysfunction, Loss of libido

Question 33

Testicular cancer Dx

Answer 33

Urgent - Doppler USS

Tumour Markers:
Teratoma - AFP serum alpha-fetoprotein (AFP)

Seminoma - BhCG beta human chorionic gonadotropin

Question 34

Testicular cancer TX

Answer 34

Orchidectomy + hormone replacement

Adjunct: Chemo/radio