Haematuria PT1 Flashcards
mortality of kidney cancer
40%
most common type of renal tumour
renal cell carcinoma
renal cell carcinoma affects
the proximal convoluted tubule
second most common form of kidney cancer
transitional cell carcinoma
describe cells of renal cell carcinoma
- clear cytoplasmic polygonal cells
- with carbohydrate and lipid deposits forming yellow cells
inherited mutation that can cause RCC
von-Hippel lindau gene on 3P chromosome
what does mutation of the von-hippel lindau gene cause
increases secretion of IGF-1 growth factor upregulating expression of hypoxic-inducible factors (HIF)
3 genes HIF promotes the transcription of
- vascular endothelial growth factor
- platelet-derived growth factor
- epidermal growth factor receptor
2 ways RCC can develop
sporadic
inherited
sporadic RCC tumours more common in
upper poles of kidneys in older men who have smoked
when does inherited von-Hippel Lindau RCC disease occur
younger men and women
inheritance pattern of Hippel Lindau RCC
autosomal - child with 1 parent has 50% chance of inheriting disorder
other organs impacted by Von-Hippel Lindau disease
- retinal angiomas
- pheochromocytomas
- pancreatic neuroendocrine tumours
signs and symptoms of RCC (6)
- asymptomatic
- classic triad- haematuria, flank pain and palpable abdo mass (<10%)
- fever & weight loss
- anaemia
- bone pain
- paraneoplastic syndromes
paraneoplastic syndrome=
when tumours act as ectopic endocrine organs resulting in over-secretion of hormones
paraneoplastic syndromes of RCC (3)
- EPO secretion
- renin release
- PTH-RP
excess PTH-RP leads to
hypercalcaemia
excess EPO leads to
polycytheamia
excess renin leads to
hypertension
in a late stage RCC what can happen to the left renal vein
can become compressed interrupting the venous draining of the left testies -left scrotal varicocele
in late stage RCC what can the tumour invade
IVC resulting in lower limb oedema
risk factors of RCC (9)
- smoking
- obesity
- hypertension
- age
- male
- PKD
- dialysis
- testicular/ gynaecological radiotherapy
- family history
treatment of early stage RCC
- partial or total local resection nephroctomy
- radiotherapy
- cryotherapy
treatment of stage 3 RCC
- radical nephrectomy
- adjuvant therapy with targeted molecular therapy - Sunitinib first line
sunitinib=
tyrosine kinase inhibitor
adjuvant therapy of RCC stage 3 (4)
- IFN-alpha monoclonal antibody
- sunitinib
- Bevacizumab
- Temsirolimus
Treatment of RCC stage 4 (5)
- targeted molecular -therapy
- surgery
- clinical trials
- chemotherapy
- palliative care
most common cause of malignant renal carcinomas in children under 15 =
Wilms disease
what is Wilms disease
a triphasic nephroblastoma
what does a triphasic nephroblastoma consist of (3)
- metanphric blastemal cells
- mesenchymal stromal cells
- Epithelial cells
a blastema=
- a mass of cells capable of growth and regeneration into organs or body parts
- undifferentiated pluripotent cells
how does a nephroblastoma in Wilms disease occur
unregulated proliferation of metanephric blastemal cells
where is a blastema seen in development
early stages of genitourinary developement
mutation in Wilms disease
11p14 locus and WT1 tumour suppressor genen
when does the DNA mutation happen in Wilms disease
pre-zygotic DNA
pattern of the tumours in Wilms disease (4)
- unilateral
- capsulated
- vascularised
- do not cross midline
precursor lesions in Wilms disease
nephrogenic rests (microscopic foci of primitive blastemal)
a kidney affected by Wilm’s tumour will histologically show
abortive/ partly developed glomerular and tubular structures
associations with Wilms disease
- WAGR syndrome
- Beckwith-wiedemann syndrome
signs of symptoms of Wilms disease (5)
- palpable flank mass
- abdominal distension
- pallor (anaemia)
- haematuria
- hypertension
what defines the level of the tumour in the TNM staging of renal cancer
gerota’s fascia (connective tissue encapsulating the kidney and adrenal gland)
which stage does the tumour invade the renal fascia
T4
5 sub-groups of RCC
- clear cell
- papillary
- chromophobic
- collecting duct
- unclassified
percentage of renal tumours that are RCC
80%
4th commonest cancer in men=
bladder cancer
overal mortality of bladder cancer
50%
signs and symptoms of bladder cancer (5)
- painless gross haematuria
- irritative bladder symptoms
- recurrent UTIs
- pelvic or bone pain
- palpable mass
haematuria present at start of the urinary stream indicates
urethral damage
risk factors for bladder cancer
-smoking
-occupation- aromatic dyes
-age >55 years
-pelvic radiation
-male
family history
-chronic UTIs
-schistomiasis
chronic UTIs can lead to which type of bladder cancer
squamous cell carcinoma
bladder cancers as a consequence of schistomiasis
simple squamous carcinoma
spread of schistomiasis
contaminated water with parasites in freshwater snails
95% of bladder cancers are
transitional cell carcinomas
3 types of bladder cancer (most-least common)
- transitional cell
- squamous
- adenocarcinomas
why is bladder cancer more common than ureter and urethra
bladder is exposed to carcinogens longer with constant changing shape of transitional cells during urinary retention and micturition
at presentation what are most TCC in the bladder
multifocal (more than 1)
possible pattern of growth of TCC
papillary
sessile
carcinoma in situ
TCC p53 dependant - sessile and nodular carcinomas are (4)
- typically flat
- rapidly proliferative
- high grade
- highly muscle invasive
p53 independent TCC tend to be
non-invasive bladder cancers -papillary tumours
squamous cell carcinoma of the bladder related to
schistosoma parasitic flatworm
2 features of squamous cell carcinoma of the bladder
- more invasive
- less metastatic than TCC
where does adenocarcinoma develop in the bladder
glandular tissue
cancer of the bladder muscle=
sarcomas
typically metastatic spread of bladder cancer is where
local
important investigations for bladder cancer
cystoscopy
treatment of non-muscle invasive bladder cancer
TURBT- transurethral resection of bladder tumour
how often do low grade bladder tumours undergo cystoscopic surveillance
5-10 years
moderately high grade non-muscle invasive bladder tumour treatment (3)
- intravesical chemo- mitomycin C cisplatin based
- BCG immunotherapy
- cystoscopic surveillance
locally invasive bladder tumour treatment
- radical or partical cystectomy with regional lymph node dissection
- neoadjuvant cisplatin chemo
metastatic disease of bladder tumour treatment
palliative chemo
palliative radiotherapy for local symptoms
7 stages of bladder cancer (best to worse)
Tis Ta T1 T2 T3a T3b T4
grade 1 bladder tumours =
well differentiated low grade
grade 3 bladder tumours=
poorly differentiated with loss of original cytological appearance and high grade growth
