Lecture 21 - urological cancers TCC and RCC Flashcards
TCC location
Transitional epithelial cells - urothelium
In the:
- Renal calyces
- renal pelvis
- ureters
- bladder (most common bladder cancer)
RCC location
Kidney parenchyma
RCC presentation
Haematuria
Coincedental finiding on USS/CT
Advanced: Hypercalcaemia Palpable mass Weight loss and loss of apetite Large varicoele Pulmonary embolism/tumour
TCC presentation
Haematuria
Coincidental finding
Advanced:
DVT
Weight loss and loss of appetite
Flank pain
Hydronephrosis - blocks vesico-ureteric junction
Urinary retention - block urethral orifice
Differential diagnoses for haematuria
Cancer:
RCC
TCC
Prostate cancer
Benign: Ulcerative coelitis Stones UTI Inflammation BPH Glomerular nephritis
Investigations
Blood - FBC and U+E BP - nephritic syndrome Endoscopy - flexible cystoscopy Radiology - USS/CT Urine - culture and sensitivity + cytology to identify malignancy Biopsy
Examination
DRE - size and texture
Abdominal examination - mass or varicoele
Biopsy
Epidemiology of RCC
95% of all upper UT tumours of renal cell carcinomas
More males than female 3:2
More white people
Risk factors of RCC
Smoking
Obesity
Dialysis
Spread of RCC
Perinephric spread - kidney
Lymph node metastases - around vena cava aorta and renal vein
Via left renal vein to right atrium
Right - unlikely to have variceoele
Imaging of RCC
USS
CT
Treatment of RCC
Surveillance
Excision:
Radical or partial nephrectomy
Ablation- cryoablation or radiofrequency ablation
Epidemiology of TCC
90% of bladder cancers
More men
White people get it more
Risk factors of TCC
Smoking
Occupational exposure - painters, mechanics, hairdressers
Treatment of TCC
Radical cystectomy - curative:
- Nephro - ureterectomy
Radiotherapy
Chemotherapy
