GU Tract Cancers Flashcards by Clara Sage

Where do renal cell carcinomas arise from?

Proximal renal tubular epithelium

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Epidemiological factors of renal cell carcinoma

90% of all renal cancers
Mean age 55
F:M = 2:1
15% of haemodialysis patients develop RCC

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Features of renal cell carcinoma

50% found incidentally 
Haematuria
Loin pain 
Abdominal mass
Anorexia, malaise and weight loss 
PUO - often in isolation

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What is a rare feature of renal cell carcinoma?

Invasion of left renal vein compresses the left testicular vein causing a varicocele

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Spread of renal cell carcioma

Direct - renal vein
Via lymph
Or haemotogenous (bone, liver, lung)

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% who have mets at presentation with renal cell carcinoma

25%

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Findings in blood in RCC

Polycythaemia due to increased erythropoietin production
ALP - mets
HTN from increased renin production

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Imaging in RCC

US
CT/MRI
CXR - “cannon ball” mets in lung from RCC

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Treatment of RCC

Radical nephrectomy
RCC usually radiotherapy and chemotherapy resistant
Can do nephron sparing surgery if small T1 tumour

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Treatment of unresectable or metastatic RCC

Some have good response to biological therapies - angiogenesis target agents
eg. Sunitinib, Bevacizumab, Sorafenib

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1st line treatment for patients with multiple poor risk factors

Temsirolimus improves survival better than interferon (previous treatment)

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What is Wilms tumour?

Nephroblastoma
Childhood tumour of primitive renal tubules and mesenchymal cells
Chief abdominal malignancy in childhood
Presents with abdominal pain and haematuria

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Incidence of prostate cancer

Increases with age and 80% of men over 80 years

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Associations of prostate cancer

Family history 2-3x increased risk

High testosterone

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Spread of prostate cancer

Local - seminal vesicles, bladder, rectum
Lymph
Haematogenously - sclerotic bone lesions

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Presentation of prostate cancer

Can be asymptomatic
Or nocturia, hesistancy, poor stream, terminal dribbling or obstruction
Weight loss and bone pain - suggests bony mets

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DRE in prostate cancer

May show hard, irregular prostate

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DX of prostate cancer

PSA - normal in 30% of small cancers
Transrectal USS & biopsy
Xrays
Bone scan

Staging of prostate cancer

MRI - contrast-enhancing detecting nodes rises up to 90%

Treatment of disease confined to prostate

Radical prostectomy if

Treatment of metastatic prostate cancer

Hormonal drugs - may give 1-2 years benefit
LHRH agonists eg. goserelin (risks tumour flare because first stimulates then inhibits pituitary gonadotrophin- therefore start anti-androgen eg. cyproterone acetate)

LHRH antagonist - degarelix used in advanced disease

Prognosis of prostate cancer

10% die in 6months 10% live for >10 years

Screening of prostate cancer with PSA

Not very accurate and 1/3 with high PSA will not have prostate cancer
Cancer found won’t necessarily impinge on health

Epidemiology of penile cancer

Rare in UK
More common in far east and africa
Very rare in circumcised

What is penile cancer related to?

Chronic irritation, viruses and smegma

Presentation of penile cancer

Chronic fungating ulcer Bloody/purulent discharge 50% spread to lymph at presentation

Treatment of penile cancer

Radiotherapy and irridium wires if early | Amputation and lymph node dissection if late

What sort of cancer are bladder cancers normally?

>90% are transitional cell carcinoma | these can also occur in renal pelvis, and ureter

Rarely causes of bladder cancer

Adenocarcinoma | Squamous cell carcinoma (follows schistosomiasis)

Histological grading of bladder cancer

Grade 1 = differentiated Grade 2 - intermediate Grade 3 = poorly differentiated 80% confined to bladder mucosa only 20% penetrate into muscle - increased mortality to 50% at 5 years

Presentation of bladder cancer

Painless haematuria Recurrent UTIs Voiding irritability

Associations of bladder cancer

``` Smoking Aromatic amines Chronic cystitis Schistosomiasis Pelvic irradiation ```

DX of bladder cancer

Cystoscopy with biopsy | MRI or lymphangiography may show involved pelvic nodes

Investigation to help staging

EUA

Staging of bladder cancer

Tis - carcinoma in situ - not felt at EUA Ta - tumour confined to epithelium - not felt at EUA T1 - tumour in lamina propria - not felt at EUA T2 - superficial muscle involved - rubbery thickening et EUA T3 - deep muscle involved - EUA: mobile mass T4 - invasion beyond bladder - EUA: fixed mass

Treating Tis-T1 bladder cancer

80% of all patients Diathermy via transurethral cystoscopy or Transurethral resection of the bladder tumour

If multiple Tis-T1 bladder cancers

Consider intravesical chemotherapeutic agents | Mitomycin c, doxorubicin and cisplatin - maintenance to prevent recurrence (MCDC)

Prognosis of Tis-T1 bladder cancers

95% 5 year survival

Treatment of T2-T3 bladder cancers

Radical cystectomy = gold standard Radiotherapy - worse5 year survival but saves bladder Post-op chemo: M-VAC - methrotrexate, vinblastine, adriamycin and cisplatin - toxic but effective IF neck not involved - can do reconstruction using ileum but otherwise urostoma

Treatment of T4 bladder cancers

Usually palliative chemo/radiotherapy

Follow up in high-risk bladder tumours

Every 3 months for 2years and then every 6 months

Follow up in low-risk bladder tumours

First follow up cystoscopy after 9 months and then yearly

Spread of bladder cancers

Local to pelvic structures Lymphatic to iliac and para-aortic nodes Haematogenous to liver and lungs

Infective agent in HUS

E coli