Kidney + Bladder Cancer

Question 1

What are the common malignancies of the urinary tract?

Answer 1

Renal cell carcinoma
Urothelial/transitional cell carcinoma

Question 2

Where does renal cell carcioma effect?

Answer 2

Parenchyma of the kidneys
In the cortex + medulla
Arises from the tubular cells

Question 3

What is the most common renal malignant tumour in adults?

Answer 3

Renal cell carcinoma

Question 4

What type of epithelium does renal cell carcinoma arise from?

Answer 4

Tubular epithelium

Question 5

Risk factors of renal cell carcinoma

Answer 5

Dialysis
Smoking
Obesity
(male > female)

Question 6

Presentation of renal cell carcinoma

Answer 6

• haematuria
• fatigue
• weight loss
• fever
• mass in loin
• varicocele (advanced)

Question 7

Investigations of renal cell carcinoma

Answer 7

Ultrasound or CT
Flexible cystoscopy
Cytology

Question 8

Treatment of localised renal cell carcinoma

Answer 8

• surveillance
• partial nephrectomy for small tumours
• radical nephrectomy for large tumours > removal of the associated renal gland, perinephric fat, upper ureter + para-aortic lymph nodes

Question 9

Treatment of metastatic renal cell carcinoma

Answer 9

• little efffective treatment
• resistant to chemo + radiotherapy
• palliative treatment - target angiogenesis (reduces blood flow to tumours by preventing it from making more vessels))

Question 10

Presentation of urothelial cell carcinoma

Answer 10

Haematuria
Weight loss
Loss of appetite
Signs/symptoms of obstruction

Question 11

Why is renal cell carcinoma rare in children?

Answer 11

Long developmental time of the tumour

Question 12

Demographic of renal cell carcinoma

Answer 12

• 60-70 years old
• Male > female
• On dialysis
• Smoker
• Obese

Question 13

Why can a patient with renal cell carcinoma present with Varicocele?

Answer 13

• As tumour grows it can grow across left renal vein
• Blocks the testicular vein
• Fluid cannot drain into renal vein from testis
• Enlargement of vessels in scrotum

Only on left hand side (right drains into IVC)

Question 14

What does a radical nephrectomy involve?
What would it be used for?

Answer 14

• Removal of associated adrenal gland, perinephric fat, upper ureter + para-aortic lymph node
• Large renal cell carcinoma with no distant metastases

Question 15

Causes of bladder cancer

Answer 15

• Analgesic misuse
• Exposure to aniline dyes used in industrial manufacturing of dyes, rubber + plastics
• Smoking

Question 16

Diagnosis of bladder cancer

Answer 16

Cystoscopy
Biopsy
CT or MRI
Chest X ray

Question 17

Types of bladder cancers

Answer 17

Superficial
Carcinoma in situ (flat tumour)
Muscle invasive

Question 18

Treatment of bladder cancer

Answer 18

Depends on classification:
- low risk non-muscle invasive: transurethral resection of bladder +/- intravescial chemotherapy
- high risk non-muscle invasive: transurethral resection of bladder + intravescial chemotherapy or intravescial BCG treatment + cystectomy
- muscle invasive cancer: cystectomy + radiotherapy or palliative care

Question 19

How can patients with urothelial cell carcinoma of the upper urinary tract go on to develop bladder cancer?

Answer 19

Seeding
Malignant cells from upper urinary tract can travel to bladder > bladder cancer

Question 20

Treatment of urothelial cell carcinoma of upper urinary tract

Answer 20

Nephro-ureterectomy
Removal of kidney, fat, ureter+ cuff of bladder

Question 21

Where does urothelial cell carcinoma originate from?

Answer 21

Urothelium
Calyx to bladder
More commonly lower urinary tract

Question 22

Risk factors of squamous cell carcinoma in bladder

Answer 22

• Recurrent UTI > chronic inflammation
• schistosomiasis
• stones

Question 23

Where do renal cell carcinomas most commonly arise?

Answer 23

Proximal convoluted tubule