Haematuria & Urinary Tract Malignancies

Question 1

What is the mean age of Renal Cell Carcinoma and where does it arise from?

Answer 1

55 years

Proximal Renal Tubular Epithelium

Question 2

What are the features of RCC?

Answer 2

Loin pain
Haematuria
Abdominal mass
Anorexia
Malaise
Weight loss
Varicocele if compression of left testicular vein

Question 3

Where does RCC spread?

Answer 3

Can either be direct via renal vein

Or spread via lymph, bone, liver or lung

Question 4

What do investigations show in RCC?

Answer 4

Increased BP
Polycythaemia from increased erythropoetin production
ESR
U&E
Raised ALP if there's bony mets
CXR: cannonball metastases
US
CT/MRI

Question 5

What is the management for RCC?

Answer 5

Radical nephrectomy
Cryotherapy
Radiofrequency ablation

Question 6

What is the score used for RCC?

Answer 6

Mayo prognostic risk score

Question 7

What are the two types of TCC?

Answer 7

Can be p53 dependent (usually flat and invasive)

Can be p53 independent (papillary tumour. less aggressive). 70%

Question 8

What are the features of TCC?

Answer 8

Painless haematuria
Increased urination frequency
Urgency
Dysuria 
Recurrent UTI's

Question 9

What are the risk factors for TCC?

Answer 9

‘Having trouble with your PSAC?’

Phenacetin
Smoking
Analine
Cyclophosphamide

Question 10

What are the diagnostic investigations for TCC?

Answer 10

Cystoscopy with biopsy is diagnostic

CT urogram provides staging

Question 11

What is the management for TCC?

Answer 11

Transurethral resection
(Followed with catheter chemotherapy if recurrence)

Those with T2 tumours are offered either radical cystectomy or radical radiotherapy

Question 12

What diagnostic investigations do you do in prostate cancer?

Answer 12

Increased PSA
MRI/CT
Transrectal US and biopsy

Question 13

What is the management for localised prostate cancer (T1/T2)?

Answer 13

Active monitoring/watchful waiting
Radical prostatectomy
Radiotherapy: external beam/brachytherapy

Question 14

What is the management for localised advanced prostate cancer (T3/T4)?

Answer 14

Hormonal therapy: synthetic GnRH agonist
Radical prostatectomy
Radiotherapy: external beam/brachytherapy

Question 15

What is the management for metastatic prostate disease?

Answer 15

Synthetic GnRH agonist (goserelin)
Cover initially with an anti-androgen to prevent rise in testosterone
Goserelin first stimulates then inhibits pituitary gonadotropin

Question 16

What score is used for prostate cancer?

Answer 16

Gleason score

Question 17

When do you make a renal referral for a patient with haematuria?

Answer 17

eGFR <60
Coexistent proteinuria
Hypertension
FHx of renal disease

Question 18

When do you refer for suspected bladder cancer?

Answer 18

> 45 years and have: unexplained visible haematuria without UTI, persistent haematuria that persists after UTI treatment

> 60 years and has: unexplained invisible haematuria

Question 19

When do you refer for suspected renal cancer?

Answer 19

> 45 years and has: unexplained visible haematuria without UTI, persistent visible haematuria that persists after UTI treatment

Question 20

After UTI & menstruation are excluded, what are the causes of haematuria?

Answer 20

Malignancy
Calculi
IgA nephropathy
Alport syndrome
Polycystic kidneys