Lecture 20 - Carcinoma Of The Kidney And Bladder Flashcards
What are the 2 main types of malignancy of the urinary tract?
Renal cell carcinoma
Urothelial cell carcinoma
What part of the urinary tract does Renal Cell Carcinoma affect?
The parenchyma of the kidney (the functional cells)
What is considered the parenchyma of the kidney?
Cortex
Medulla
What part of the urinary system are urothelial cell carcinomas found?
Collecting system
From the calyces to the bladder
What embryological structure does the collecting system form from?
Ureteric bud
What 2 structures dont interact in embryological development leading to renal agenesis?
Ureteric bud and metanephric blastema
Which cancer is more common, renal cell carcinoma or urothelial cell carcinoma?
Renal cell carcinoma (90%)
What type of epithelium does Renal Cell Carcinoma arise from?
Tubular epithelium
Why is the prognosis of renal cell carcinoma poor?
Most patients who present are in late stage where they already have metastatic disease
What are the risk factors of renal cell carcinoma?
SMOKING
Dialysis
Diabetes
Men more common than women
What route would a tumour take to spread to the right atrium in a renal cell carcinoma?
Renal vein
Inferior vena cava
Right atrium
What is the most common age for renal cell carcinoma?
60-70
Rare in kids since takes long time to develop
How does Renal Cell Carcinoma present?
HAEMATURIA
Fatigue
Weight loss
Fever
Mass in loin
Large Varicocele
Why can some patients with renal cell carcinoma present with Hypercalcaemia?
Cancer can secrete hormone like substance like PTH-rP (PTH related peptide)
Why can patients with a Renal Cell Carcinoma present with a large varicocele?
Left testicular vein drains into the left renal vein which then drains into the IVC
If tumour grows across the left renal vein it impairs the drainage of the testicular veins into the IVC leading to back flow of venous blood into left testicular vein increasing hydrostatic pressure leading to the bag of worms appearance
What investigations are done for renal cell carcinoma?
Ultrasound or CT
Flexible cystoscope
Cytology of urine (cells)
How is localised renal cell carcinoma treated?
Surveillance
Partial nephrectomy (for small tumours)
Nephrectomy with adrenectomy and removal or periephric fat, upper ureter and para-aortic lymph nodes (large tumours)
How can you treat metastatic renal cell carcinoma?
Not much you can do since resistant to chemo and radiotherapy
Palliative treatment (target angiogenesis)
What is urothelial cell carcinoma?
Malignancy of the bladder, ureters, major or minor calyces (collecting system)
How does urothelial cell carcinoma present?
HAEMATURIA
Weight loss
Loss of appetite
Signs/symptoms of obstruction
What are some causes/risk factors of developing bladder cancer?
SMOKING
Analgesic misuse
Exposure aniline dyes used in manufacturing of dyes, rubber and plastics
How is bladder cancer diagnosed?
CT or MRI
CXR
Cystoscopy or ureteroscopy
What is considered a highly invasive bladder cancer?
When the cancer invades the detrusor muscle of the bladder
What is a bladder carcinoma in situ?
Flat tumour on the surface of bladder
How is a bladder cancer treated>
Low risk non-muscle invasive - Treated with TURBT or intravesical chemotherapy to bladder
High risk non-muscle invasive - TURBT and intravesical chemotherapy , intravesical BCG treatment, cystectomy
Muscle invasive cancer - cystectomy + radiotherapy or palliative care
What is a cystectomy and what happens?
Removal of the bladder
Ureters then connected to a stoma bag
What is a TURBT?
Transurethral resection of bladder
What is intravesical chemotherapy?
Chemotherapy agent put in the bladder
Why do patients with urothelial cell carcinoma of the upper urinary tract often develop bladder cancer?
Cancer can break off from the upper urinary tract into the bladder and seed there
How does urothelial cell carcinoma of the upper urinary tract present?
Haematuria and obstructions early on
How is urothelial cell carcinoma of the upper urinary tract treated?
Nephron-ureterectomy (kidney, fat, ureter, cuff of bladder)
Why is the cuff often removed in a nephro-uretercetomy to treat Urothelial cell carcinoma of the upper urinary tract?
Since cancers cells normally spread and get stuck here
What cells do renal cell carcinoma originate from?
Parenchyma of the kidney
What cells do urothelial cell carcinomas?
Originates from Urothelium
What are some differential diagnosis of a 72yr old patient with Haematuria, lethargy and pyrexia?
Cancer
UTI
STI
Nephritic syndrome
Obstruction
Polycystic kidney disease
What are some questions you may want to ask a 72yr old patient with Haematuria, lethargy and pyrexia?
Weight loss
Urine frequency and changes
Pain
Amount of blood any clots
Smoking
Exposure to dyes
If a urine dipstick is done, what indicates a UTI?
Postive nitrites
Postive leukocytes esterase
What organism causing a UTI would give a negative nitrites but Postive leukocytes?
Staphylococcus saprophyticus
What investigations would be done on a 72yr old patient with Haematuria, lethargy and pyrexia?
Urine dip
FBC
U+Es
US or CT
Cystoscopy
Cytology
Bladder
Who should manage bladder cancer patients?
Urologists
How should bladder cancers generally be managed?
TURBT
Intravesical chemotherapy
