Imaging the urinary tract: cancers

Question 1

Prostate cancer presentation

Answer 1

asymptomatic unless advanced

Question 2

How is a prostate biopsy done?

Answer 2

transrectal and transperineal ultrasound-guided

Question 3

How do prostate cancer metastases look on xray?

Answer 3

sclerotic (due to osteoblastic activity)

Question 4

If you incidentally detect osteoblastic (sclerotic) lesion on a plain radiograph in an elderly male, what is it until proven otherwise?

Answer 4

prostate cancer (metastases)

Question 5

Top 4 primaries that metastasise to bone

Answer 5

breast
lung
prostate
kidney

Question 6

How might bone metastases present?

Answer 6

pain
cauda equina/cord compression

Question 7

Prostate cancer treatment

Answer 7

active surveillance
radiotherapy
prostatectomy
hormone therapy (anti-androgens)

Question 8

Where to RCCs like to spread to?

Answer 8

renal vein

Question 9

How do RCCs often look on CT?

Answer 9

heterogenous lesion
necrotic centre (hypoattenuated)

Question 10

Where do RCCs often metastasise to?

Answer 10

lungs
bone (lytic lesions)
liver

Question 11

Name some malignant renal tumours

Answer 11

RCC (renal cell carcinoma)
TCC (transitional cell carcinoma)
Wilms tumour
Lymphoma
Metastasis (rare)

Question 12

Name some benign renal tumours

Answer 12

angiomyolipoma
oncocytoma (look like RCCs so are often removed)

Question 13

When should angiomyolipomas be removed?

Answer 13

> 4cm as bleeding risk

Question 14

Which condition is associated with developing angiomyolipomas?

Answer 14

tuberous sclerosis

Question 15

What is the commonest location of a transitional cell carcinoma?

Answer 15

bladder (arise in urothelium)

Question 16

How does transitional cell carcinoma present?

Answer 16

haematuria

Question 17

What 2 tests should be done to investigate haematuria?

Answer 17

USS urinary tract (look for kidney cancer)
cystoscopy (look for bladder cancer)

Question 18

If you haven’t found a cause of haematuria after USS urinary tract and cystoscopy, where should you look next?

Answer 18

ureters

Question 19

When can cystectomy be used to treat bladder cancer?

Answer 19

if MRI shows no invasion of cancer out of bladder (must be able to see clear area all around the bladder on MRI)

Question 20

How are testicular cancers imaged?

Answer 20

USS

Question 21

What tumour markers could be present in non-seminoma germ cell tumour of the testicles?

Answer 21

AFP
HCG
LDH

Question 22

What is an orchiectomy?

Answer 22

a surgical procedure to remove one or both testicles

Question 23

How are tumour markers used in testicular cancer?

Answer 23

usually checked before and after orchiectomy
monitor patient’s treatment response and to detect recurrence

Question 24

Where is the sentinel node in testicular cancer?

Answer 24

below renal vein (only pelvic organ that doesn’t affect pelvic lymph nodes first)