L6 - Bladder and Kidney cancer Flashcards
1. Describe incidence, age, sex, geographical areas, predisposing factors, macroscopic and microscopic appearance of the common types of bladder and kidney cancers. 2. Briefly be bale to outline the investigation of patients in haematuria clinic.
Describe the epidemiology of bladder cancer?
- 10th most common in UK
Men: 8th
Women: 16th
50% survival for >10 years
49% preventable cases
What are risk factors for bladder cancer?
- Smoking (increases 4 fold)
- Exposure to arylamines in rubber or plastics manufacture
- Parasitic infection (schistoma)
- Pelvis radiotherapy
- chronic cystitis
- long term indwelling catheter
- chemotherapy with cyclophosphamide
On a molecular basis describe risk factors for bladder cancer?
- Oncogenes: P21 RAS oncogene (high grade)
- Tumour suppressor gene: TP53, 9q loss (low grade)
- Amplification & overexpression: over expression of epidermal growth factor (EGF)
Describe some clinical manifestations of bladder cancer?
- Painless gross haematuria.
- Irritative bladder symptoms
- Pelvic or bony pain, lower extremity oedema or flank pain.
- Palpable mass on physical examination (rare in superficial bladder cancer)
Examples of irritative bladder cancer?
Dyuria
Urgency
Frequency of urination
State the different types of bladder cancer?
Transitional cell carcinoma
Squamous cell carcinoma
Adenocarcinoma
Sarcoma
Small cell cancer
Describe transitional cell carcinoma?
Most common.
Can arise anywhere in urinary tract e.g. renal pelvis, ureter, bladder and urethra.
Describe squamous cell carcinoma?
Associated with persistent inflammation from long-term indwelling catheters and bladder stones.
Describe adenocarcinoma?
Primary adenocarcinoma: derived from urothelium of bladder but exhibits pure glandular phenotype.
- haematuria common.
Describe non-muscle invasive bladder cancer?
Stage T1 cancer invades lamina propria but not the muscle of the bladder.
Where do transitional cell carcinoma’s arise from?
Stem cells that are adjacent to basement membrane of the epithelial surface.
Where do squamous cell carcinoma’s arise from?
Derived from bladder urothelium.
Has pure squamous phenotype.
What are carcinosarcomas?
Highly malignant tumours that contain a combination of mesenchymal and epithelial elements.
Describe small cell carcinosarcoma?
Highly malignant tumors that contain a combination of mesenchymal and epithelial elements.
Where do primary bladder lymphomas arise from?
Submucosa of bladder.
What are common bladder cancer presenting features?
Blood in urine - non visible haematuria - visible haematuria Weight loss, tiredness Loss of appetite General feeling of poor health
Bladder cancer stage Ta
Non-invasive papillary carcinoma
TX
Primary tumor cannot be assessed
T0
No evidence of primary tumor
T1
Invades connective tissue
T2a
Invades inner muscle layer
T2b
Invades outer muscle layer
T3a
Invades fatty tissue (microscopically)
T3b
Invades fatty tissue (macroscopically)
T4
Tumour invades nearby organs such as prostate in men and uterus in women.
T4a
Tumour invades prostatic stroma
T4b
Tumour invades pelvic wall, abdominal wall
Describe epidemiology for renal cancer?
7th most common
Men: 1/48
Women: 1/83
Describe how certain geographical areas may contribute to bladder cancer?
People living in urban areas more likely to develop bladder cancer.
- exposure to numerous carcinogens
Reasons for needing a long-term indwelling catheter?
Patients with urinary retention/ incontinence
Patients with a condition affecting nerves that control the bladder, such as spina bifida, MS, stroke or spinal injury.
Give examples of lab studies used in the diagnosis of renal cell carcinoma?
- Urinalysis
- Complete blood cell fount
- Electrolytes
- Renal profile
- Liver function tests (aspartate aminotransferase) and alanine aminotransferase (ALT)
- Serum calcium
Where is the tissue of orgin for renal cell carcinoma?
Proximal renal tubular epithelium.
What forms may renal cancer occur in?
Sporadic
- nonhereditary
Hereditary form
Both forms of renal cancer are associated with structural atlerations in what?
The short arm of chromosome 3.
State multiple hereditary syndromes associated with renal cell carcinoma?
- Von Hippel-Lindau syndrome
- Hereditary papillary renal carcinoma HPRC
- Familial renal oncocytoma FRO associated with Birt-Hogg-Dube syndrome BHDS
- Hereditary renal carcinoma HRC
Describe risk factors for renal cancer?
- Smoking
- Obesity
- Hypertension
- Occupational exposure to certain chemicals such as trichloroethylene.
- Chronic renail failure and dialysis
Describe the presenting features of renal cancer?
- Classical triad of haematuria, loin pain and mass
- Bone pain - suggestive of metastatic disease
- Weight loss
- Hypercalcemia manifestations
- Hyponatraemia
What may be signs of obstruction to renal vein / IVC with tumour thrombus?
- Varicocele, usually left sided due to obstruction of testicular vein.
- Bilaterla lower limb oedema
Robson staging system:
Stage 1
Tumor confined within capsule of kidney
Robson staging system:
Stage 2
Tumor invading perinephric fat but still ocntained within the Gerota Fascia
Robson staging system:
Stage 3
Tumor invading the renal vein or IVC (A)
Regional lymph node involvement (B)
Robson staging system
Stage 4
Tumor invading adjacent viscera (excluding ipsilateral adrenal) or distant metastases.
What investigations may be done in a patient with suspected kidney cancer?
- Urine test
- Blood rest
- Scans
- Cystoscopy
Wilms tumor
Most common childhood abdominal malignancy.
most common age around 3
Requires nephrectomy followed by chemotherapy.
Acute pyelonephritis
Bacterial infection of renal parenchyma that may lead to renal scarring.
Bacteria usually ascended from the lower urinary tract but may also reach the kidney via the blood stream.
Chronic pyelonephritis
Renal inflammation and scarring induced by recurrent or persistent renal infection.
