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Urology > Lecture 20 Tumours of the Urinary System 2 (Bladder and Renal Cancer) > Flashcards

Lecture 20 Tumours of the Urinary System 2 (Bladder and Renal Cancer) Flashcards

1
Q

What cells are involved in urothelial cancers

A

Transitional cell epithelium

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2
Q

Where can Uroethelial cancers occur

A

• Can occur at point from the renal calyces to the tip of the urethra

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3
Q

Where Schistosomiasis is endemic what type of bladder cancer

A

Squamous cell carcinoma

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4
Q

Risk factors doe TCC

A

Smoking
Aromatic amines
Non-hereditary genetic abnormalities (e.g. TSG incl. p53 and Rb)

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5
Q

Risk factors for SCC

A

– Schistosomiasis (S. haematobium only)
– chronic cystitis (e.g. recurrent UTI, long term catheter, bladder stone)
– cyclophosphamide therapy
– pelvic radiotherapy

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6
Q

What are the presenting features

A 
Painless visible Haematuria 
Recurrent UTI
Storage bladder symptoms :
–	dysuria, frequency, nocturia, urgency +/- urge incontinence
–	bladder pain
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7
Q

Investigations of Haematuria

A 
Urine culture
Cystourethroscopy
•	CT Urogram (IVU)
•	ultrasound scan
•	Urine Cytology
–	Limited use in Dipstick haematuria
•	BP and U&E’s
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8
Q

What action should be taken if an individual has frank haematuria and >50 years

A

Flexible cystourethroscopy within 2 weeks
CT urogram & USS
Urine Cytology may also be useful
Risk of malignancy- 25-35%

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9
Q

What action should be taken if an individual has dipstick or microscopic haematuria and >50 years

A
  • Flexible cystourethroscopy within 4-6 weeks

* USS

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10
Q

How is a diagnosis made for uroethelilal cancers

A
  • Cystoscopy and endoscopic resection (TURBT)

* EUA to assess bladder mass/thickening before and after TURBT

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11
Q

How are endothelial cancers treated

A

Endoscopic or Radical Cystectomy

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12
Q

Grade of tumour G1

A

Well differentiated

Commonly non-invasive

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13
Q

Grade of tumour G2

A

Moderately differentiated

Often non-invase

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14
Q

Grade of tumour G3

A

Poorly differentiated

Often invasive

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15
Q

Grade of Carcinoma in situ

A

Not invasive but very aggressive

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16
Q

Stage Ta/T1

A

Non muscle invasive

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17
Q

Stage T2/T2b

A

Muscle invasive

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18
Q

Stage T3a/3b

A

Muscle invaisve

19
Q

Stage T4a

A

Prostate invasive

20
Q

Treatment of low grade non-muscle invasive bladder cancer

A

– endoscopic resection followed by single instillation of intravesical chemotherapy (mitomycin C) within 24 hours
– prolonged endoscopic follow up for moderate grade tumours
– consider prolonged

21
Q

Treatment for high grade non muscle invasive or CIS

A

– CIS consider intravesical BCG therapy (maintenance course, weekly for 3 weeks repeated 6 monthly over 3 years)
– Patients refractory to BCG – need radical surgery

22
Q

Treatment for muscle invasive bladder (T2-T3)

A

Neoadjuvat therapy
Radical therapy
radical cystoprostatectomy
anterior pelvic exenteration with urethrectomy
– radical surgery combined with incontinent urinary diversion

23
Q

What does the prognosis of bladder cancer depend on

A
  • stage
  • grade
  • size
  • multifocality
  • presence of concurrent CIS
  • recurrence at 3 months
24
Q

What are the main symptoms of upper tract urothelial cancer

A 
Frank haematuria 
Unilateral ureteric obstruction
Flank or loin pain
Metastatses or nodal:
Bone pain
Hypercalcaemia
Lung
Brain
25
Q

Diagnostic Investigations of upper tract urothelial cancer

A
  • CT-IVU or IVU- Urogram
  • Urine cytology
  • Ureteroscopy and biopsy
26
Q

Upper tract TCC are most commonly seen in the __

A

renal pelvis or collecting system

27
Q

What grade are upper tract TCC most commonly

A

High grade

Multifocal

28
Q

What is the treatment of UT TCC

A

nephro-ureterectomy

if unfit or has bilateral disease ureteroscopic laser ablation

29
Q

Name benign renal conditons

A

Oncocytoma

Angiomyolipoma

30
Q

Name malignant renal conditions

A

Renal adenocarcinoma

31
Q

Where does renal adenocarcinoma most commonly arise

A

Proximal tubules

32
Q

What are the histological types of renal adenocarcinoma

A

Clear cell
Papilloma
Chromophobe
Bellini type ductal carcinoma

33
Q

Name risk factors of renal adenocarcinoma

A 
Family history
Smoking
Anti-hypertensice medication
Obesity
ESRF
Acquired renal cystic disease
34
Q

What is the clinical presentation of renal adenocarcinoma

A

• Asymptomatic
• Flank pain, mass and haematuria
• Paraneoplastic syndrome
Metastatic- bone, brain, liver and lungs

35
Q

What is T1 staging of renal cancer

A

<7cm confined within renal capsule

36
Q

What is T2 staging of renal cancer

A

> 7cm confined within Rena capsule

37
Q

What is T3 staging for renal cancer

A

Local extension outside the capsule

38
Q

What is T3a staging for renal cancer

A
  • Into adrenal or peri-renal fat
39
Q

What is T3b staging for renal cancer

A
  • Into renal vein or IVC below diaphragm
40
Q

What is T3c staging for renal cancer

A

Tumour thrombus in IVC extends above diaphragm

41
Q

What is T4 staging for renal cancer

A

Tumour invades beyond Gerota’s fascia

42
Q

What investigations are carried out for a renal cancer

A

CT- abdomen and chest
Bloods- U&Es, FBC
US
– DMSA or MAG-3 renogram to assess split renal function

43
Q

How is renal cancer metastasis treated

A 
RCC is radioresistant and 
–	multitargeted receptor tyrosine kinase inhibitors
•	relatively new
–	immunotherapy
•	Interferon alpha
•	Interleukin-1

Urology (26 decks)

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