Malignancy Flashcards
what kind of cancer is RCC
adenocarcinoma (most commonly clear cell)
RF for RCC
smoking, obesity, dialysis, Von Hippel–Lindau disease
2WW for RCC
45+ with unexplained haematuria
triad of symptoms for RCC
haematuria, palpable mass, flank pain
which side varicocele is a sign of RCC
left (due to drainage, drains pampiniform plexus –> testicular vein –> left renal vein and then IVC. Not right side does not have a renal vein)
gold standard investigation for visible haematuria
CT urogram!!!
other investigations that may be done for a haematuria
bloods (Hb - due to paraneoplastic syndrome of increased EPO, Ca due to PTHrP), urinalysis, US, CT CAP for staging
Mx of RCC
partial / total nephrectomy depending on size. immuno/radio but NOT CHEMO
-the biological therapy uses anti VEGF
RF for testicular cancer
infertility, cryptorchidism, previous malignancy, klinefelters
what are the divisions of testicular cancer
germ cell tumours (seminoma / non seminomas) and NGCT ( leydig and sertoli - but these are usually benign)
features of a seminoma
average age for diagnosis is 40, good prognosis, rarely metastasise, no tumour markers
what are the 3 non seminomatous germ cell tumour
1) yolk sac (AFP) 2) teratoma 3) choriocarcinoma (HCG)
investigation for a testicular tumour
tumour markers, US, CT - never biopsy
MX of a testicular tumour
orchidectomy +/- chemo
what race are more at risk of testicular cancer
Caucasian
RF for prostate cancer
FHX (BRCA2) obesity and age
prostate feel on DRE with cancer
loss of median sulcus, irregular and craggy
Ix for prostate cancer
DRE, PSA, multi parametricMRI, transperineal US guided biopsy (TRUS outdated)
what is the gleason score
grade of the prostate cancer where 1 is least dysplasia and 5 is most. the two scores added from two most prominent cell types
complications of prostatectomy
ED and stress incontinence
mainstay of Tx for metastatic prostate cancer
hormonal (GnRH agonist - overstimulate receptors, they get down regulated and cause less testosterone after initial flare). Tumour flare needs to be covered with anti androgen to begin with.
Chemo can be used
what is generally used for locally advanced prostate cancer
surgery - prostatectomy or radiotherapy
what is used for localised early prostate cancer
watch and wait / active surveillance or may use prostatectomy / radiotherapy
main side effect of using radiotherapy to treat prostate cancer
proctitis
2WW criteria for haematuria
45+ and unexplained haematuria or 60+ with unexplained non visible haematuria AND dysuria/raised WCC
Rf for TCC
SMOKING, exposure to aromatic dyes and age
symptoms of TCC
haematuria and LUTS
Mx of a Cis TCC
TURBT +/- BCG vaccine into the bladder (This is done for high risk cancers)
RF for squamous cell carcinoma of bladder
long term catheter and schistosomiasis
at what point is a TCC muscle invasive and needs radical cystectomy
T2
what are the methods of urodiversion after a radical cystectomy
1) ileal conduit (part of ileum taken and bought to skin surface and the ureters plumbed in) 2) bladder reconstruction (neobladder)
how is wilms tumour treated
nephrectomy
What is wilms tumour
a nephroblastoma - in children. Present with mass, loin pain and haematuria.
what is TURP syndrome
when there is absorption of the hypoosmolar irrigation fluid. Causes fluid overload and a low sodium. May present with confusion.
RF for penile cancer (squamous cell cancer)
HPV, poor hygiene, smoking
presentation of penile cancer
palpable, ulcerated lesion / skin changes +/- pelvic lymphadenopathy
Mx of penile cancer
penectomy +/- chemo/radio
what is it called where RCC cause problems with liver
stauffer syndrome (exact mechanism for this is not understood)
staging of RCC
T1 - <7cm
T2 - >7cm
T3 - spread but not beyond gerotas fascia
T4 - spread beyond gerotas fascia
what is gerotas facia
separates kidneys AND adrenal glands form other organs
what is stauffer syndrome
in RCC it is a paraneoplastic syndrome which causes hepatic dysfunction without the presence of live mets. It then resolves after nephrectomy.
RCC summarise
Tx for bladder cancer Cis
TURBT + intravesicular chemo
Tx for muscle invasive bladder cancer
radical cystectomy
staging of bladder cancer
MRI pelvis and then CT CAP to look for more distant metastasis
