Male Urogenital Cancers Flashcards
What focal questions should be asked in a history for a patient presenting with haematuria?
- Type of haematuria: initial, total, terminal?
- Clots?
- Pain on micturition or in loin?
- Medication: nephrotoxic drugs or anticoagulants?
- Smoking
- Employment
Name the causes of haematuria
- UTI
- BPH
- Malignancy
- Bladder/renal stones
- Glomerulonephritis
- Trauma
- Bleeding tendency (coagulopathy)
What should you look for on examination of a patient with haematuria?
- DRE: BPH/Prostate Ca
- Hypertension
- Oedema
- Abdominal mass
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What investigations should be carried out in a patient with haematuria?
Urinalysis: dipstick, culture, cytology
FBC, U&Es, Clotting screen
CT urogram
Flexible cystoscopy
How may a transitional cell bladder carcinoma present?
What are the risk factors?
- Haematuria
- Occasionally malignant cystitis
- Ureteric obstruction
Risk factors:
- Smoking
- Benzene compounds
- Drugs (phenacetin, cyclophosphamide)
What are the possible clinical presentations of renal cell carcinomas?
- Often incidental finding on imaging
- Flank pain (clot colic)
- Haematuria
- Mass
- Anaemia, cachexia, hypercalcaemia, pyrexia, abnormal LFTs, polycythaemia
- Paraneoplastic syndromes
How are renal cell carcinomas staged?
What common organs are most commonly metastasised to?
- Stage I: <7cm
- Stage II: 7cm+
- Stage III: Involvement of gerota’s fascia
- Stage IV: Lymph node involvement/other organs (most common bone, lungs, liver, brain but any can be affected)
What are the risk factors for prostate cancer?
- Increasing age
- Family history
- BRCA genes
List the common presentations of prostate cancer
- Erectile dysfunction
- LUTS
- Abnormal DRE
- PSA 3.5+
How is prostate cancer diagnosed?
- MRI prostate
- Transrectal ultrasound guided biopsy
- Transperineal biopsy
How is prostate cancer staged?
T1: Finding at TURP specimen
T2: Localised
T3: Locally advanced
T4: Usually metastatic (lymph nodes, bones, lungs)
Describe the management of renal cell carcinomas
Curative surgery for organ-confined tumours (laparoscopic or open partial or total nephrectomy)
Palliation with tyrosine-kinase inhibitors and mTOR antagonists for metastatic
Describe the management of prostate cancers
- Localised: Monitoring, surgery, brachytherapy
- Locally advanced: radiotherapy, hormones
- Metastatic: chemotherapy, hormones, radiotherapy
How does penile cancer present?
What type of tumour is it usually?
What is it associated with?
How is it treated?
Presents with nodule or ulceration
Squamous cell carcinoma
Associated with HPV
Curative treatment is surgery +/- reconstruction
Advanced: palliative chemo and radiotherapy
What is the criteria for 2 week referral pathway for suspected male urological cancers?
Haematuria
- Visible aged over 45
- Non visible over 60 and high WBC
Raised PSA/abnormal DRE
Mass in body of the testes
Renal mass on imaging or palpation
Penile mass or ulcerated lesion (STD treated or ruled out)
