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Urinary > Malignancies > Flashcards

Malignancies Flashcards

0
Q

Risk factors of prostate cancer?

A

Age (uncommon in under 50s)
Family history - increased risk if first degree relative diagnosed under 60
Ethnicity: Asian < Caucasian < Afro-Caribbean

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1
Q

How common is prostate cancer?

A

Most common cancer in men in the UK
Second most common cause of death from cancer in men
However most men likely to die with it than from it

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2
Q

Clinical presentation of prostate cancer?

A

Common

  • asymptomatic
  • urinary symptoms - benign enlargement of prostate, overactive bladder
  • bone pain

Uncommon
-haematuria in advanced stages

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3
Q

Diagnostic pathway of prostate cancer?

A

Digital rectal exam
Serum prostate specific antigen (raised)
Transrectal ultrasound of prostate often with biopsy

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4
Q

Why do a transrectal ultrasound of the prostate with a biopsy?

A

Ultrasound
-more accurate estimation of size than DRE

Biopsy
-helps staging of tumour

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5
Q

How are lower urinary tract symptoms managed when there is an enlarged prostate?

A

Transurethral resection of prostate (TURP)

Go up urethra and cut through core of prostate to allow better ruined flow

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6
Q

Stages of prostate cancer?

A

Localised - T1/2
Locally advanced - T3
Advanced -T4

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7
Q

What factors influence treatment of prostate cancer?

A 
Age
DRE - stage
PSA level
Biopsy - Gleason grade
MRI scan and bone scan - nodal and visceral mets?
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8
Q

Treatment of established prostate cancer?

A

Surveillance - if Gleason score is low. Treatment can do more damage

Radical prostatectomy

Radiotherapy

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9
Q

What are the two types of radiotherapy for prostate cancer?

A

External beam radiotherapy

Brachytherapy - radioactive seeds implanted in the prostate so radiation doesn’t escape prostate -> fewer systemic effects

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10
Q

Treatment of developmental prostatic cancer?

A 
High intensity focused ultrasound
Primary cryotherapy (freeze the prostate)
Brachytherapy
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11
Q

Treatment of metastatic prostate cancer?

A

Hormones - medical castration
Surgical castration
Palliative - single dose of radiotherapy, bisphosphonates, chemotherapy

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12
Q

What is visible haematuria associated with?

A

Malignancy of urinary tract

20% chance

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13
Q

Differential diagnoses of haematuria?

A

Cancer

  • renal cell carcinoma
  • upper tract transition cell carcinoma
  • bladder cancer
  • advanced prostate cancer

Other

  • stones
  • infection
  • inflammation
  • benign prostatic hyperplasia

Nephrological

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14
Q

What history would you take for someone with haematuria?

A 
Smoking
Occupation
Pain
Other lower urinary tract symptoms
Family history
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15
Q

What examinations would you do for someone with haematuria?

A 
Blood pressure
Abdominal mass
Look for varicocele (collection of veins in scrotum)
Leg swelling
Prostate size and texture
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16
Q

What investigations would you do for someone with haematuria?

A

Urine culture and cytology
FBC
Ultrasound
Flexible cytoscopy

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17
Q

Epidemiology of bladder cancer?

A

4th most common cancer in men
5th most common in women
Incidence falling
Presentation more advanced in women

18
Q

Most common type of bladder cancer?

A

Transitional cell carcinoma

19
Q

Risk factors for bladder cancer?

A

Smoking
Occupational exposure (20yr latent period)
-rubber/plastics munufacture
-handling of carbon, crude oil, combustion, smelting
-painters, mechanics, printers, hairdressers
Schistosomiasis

20
Q

Stages of bladder cancer?

A

Those that have not invaded basement membrane are benign so not included in TNM

Ta/T1 - superficial
Tis - in situ
T2-4 - muscle invasive

21
Q

Treatment of transitional cell carcinoma?

A

If high risk and non-muscle invasive - intravesicular chemo/immunotherapy
If low risk non-muscle invasive - check gto?

If muscle invasive

  • radical cystectomy or radiotherapy
  • chemo - potentially curative
  • palliative chemotherapy/radiotherapy
22
Q

After a radical cystectomy, what is often used to replace the bladder?

A

Ileum can be used to make a conduit from ureters to abdomen where urine can be collected in a bag.
Can attempt to reconstruct the bladder from the small intestine.

23
Q

What is the most common upper urinary tract malignancy?

A

Renal cell carcinoma

24
Q

Aetiology of renal cell carcinoma?

A

Smoking
Obesity
Dialysis

25
Q

Where can metastases of renal cell carcinoma spread to?

A 
Lymph nodes
Up renal vein and vena cava into right atrium
Subcapsular fat (perinephric spread)
26
Q

Treatment of renal cell carcinoma?

A

Established treatments

  • surveillance
  • radical nephrectomy
  • partial nephrectomy

Developmental
-ablation - removal of tumour from surface of kidney via erosive process

Palliative

  • molecular therapies targeting angiogenesis
  • immunotherapy
27
Q

Investigations for upper tract transitional cell carcinoma?

A

Ultrasound - detects hydronephritis
CT urogram - identifies filling defect, ureteric structure
Retrograde pyelogram - inject contrast into upper ureter
Ureteroscopy - biopsy, washings for cytology

28
Q

What is hydronephritis?

A

Swelling of the kidney due to back up of urine due to blockage

29
Q

Treatment of upper tract transitional cell carcinoma?

A

Nephro-ureterectomy - removal of kidney, dat, ureter and cuff of bladder

30
Q

What is a radical nephrectomy?

A

Removal of kidney, adrenal gland, surrounding fat and upper ureter.

31
Q

Clinical features of transitional cell carcinoma?

A

Painless haematuria
Pain may occur due to clot retention
Symptoms suggestive of UTI but negative for bacteria
Pain from local nerve involvement in cancer
TCC of ureter and kidney - flank pain as a result of UT obstruction

32
Q

Clinical features of renal cell carcinoma?

A

Symptomless until late stage
Haematuria when tumour spreads to renal pelvis - can occur early on
Flank/loin pain
Palpable mass
Above are the classic signs but only in 15%

Weight loss
Raised ESR
Hypertension
Anaemia
Polycythaemia
Pyrexia
Varicocoele
33
Q

What causes a varicocoele in renal cell carcinoma?

A

Tumour invades left renal vein

Affects drainage of blood from the testes

34
Q

Two tumours in testicular cancer?

A

Seminoma - low grade. Arise from seminiferous tubules

Teratoma - mixture of mature and immature cells. Often contain muscle, bone, fat eye. Classified according to degree of differentiation

35
Q

Where can semioma spread to?

A

Via lymphatics

To lungs

36
Q

Which type of testicular cancer tends to occur in younger populations?

A

Teratomas

37
Q

Presentation of testicular cancer?

A

Firm lump on testes
May be evidence of spread to para-aortic lymph node causing back pain
Testicular ache

38
Q

Investigation of testicular cancer?

A

Examine lumps with ultrasound

Test for serum tumour markers
-α-fetoprotein (AFP - not raised in seminoma)
-β-human chorionic gonadotrophin (HCG)
Tend to be increased with more severe disease

CT/MRI to check for mets

39
Q

Where does testicular cancer tend to spread to?

A

Lungs
Liver
Retroperitoneally

40
Q

Treatment of seminoma?

A

Chemo and radiotherapy
30% chance of recurrence at stage I
5 yr survival 90-95%

41
Q

Treatment of teratoma?

A

Removal of testicle via inguinal route - minimises risk of malignant cells spilling into scrotum. Testicle and soermatic cord removed as far up as inguinal ring

Relapse twice as likely as in seminoma

Cure is 95%
5 yr survival is 60-95%

42
Q

What should testicular pain normally be thought to be?

A

Testicular tortion until proven otherwise

More likely in a younger patient

43
Q

Presentation of testicular torsion?

A

Soermatic cord twists, moving testis up and making it lie on its side, high up. Red and swollen
Epidydimitis has a similar appearance

Urinary (19 decks)

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