Malignancy Flashcards
Where does renal adenocarcinoma arise from?
Proximal tubules
What is the most common adult renal malignancy?
Renal adenocarcinoma
What are the histological subtypes of renal adenocarcinoma?
Clear Cell
Papillary
Chromophobe
Bellini Type
What can cause renal adenocarcinoma?
FH
Smoking
Anti-hypertensive medication
Obesity
End stage renal failure
Acquired renal cystic disease
How does renal adenocarcinoma present?
Asymptomatic
Classic Triad
- Flank pain
- Mass
- Haematuria
Anorexia
Cachexia
Pyrexia of unknown origin
Left varicocele
HTN
Metastatic symptoms, such as haemoptysis
What paraneoplastic syndromes are associated with renal cell adenocarcinoma?
Polycythaemia
Hepatic dysfunction
Hypercalcaemia
What investigations are used in renal adenocarcinoma diagnosis?
CT Abdomen and Chest
- Provides radiological diagnosis
- Complete TNM staging
- Assesses contralateral kidney
FBC
- Polycythaemia, paraneoplastic
LFTs
- Abnormal, paraneoplastic hepatic dysfunction
Ca2+
- Hypercalcaemia, paraneoplastic
U&Es
US
- Differentiates tumour from cyst
DMSA or MAG-3 Renogram
- Asses split renal function if doubts
How is renal adenocarcinoma managed?
Laparoscopic Radical Nephrectomy
Immunotherapy for metastatic disease
- Alpha-interferon and interleukin-2
Insensitive to chemo and radiotherapy
What is the prognosis of renal adenocarcinoma?
90% 5 year survival for T1 disease
0-13% 5 year survival for metastatic disease
Describe T1 renal adenocarcinoma
Tumour <7cm
Confined within renal capsule
Describe T2 renal adenocarcinoma
Tumour>7cm
Confined within renal capsule
Describe T3 renal adenocarcinoma
Local extension outside capsule
T3a: Into adrenal or peri-renal fat
T3b: Into renal vein or IVC below diaphragm
T3c: Tumour thrombus in IVC extends above diaphragm
Describe T4 renal adenocarcinoma
Tumour invades beyond the renal fascia
What are the histological classifications of bladder cancer?
Transitional Cell Carcinoma
Squamous Cell Carcinoma
Rarer causes are adenocarcinoma, sarcoma, small cell
What is the most common classification of bladder cancer?
90% transitional cell carcinoma, most common except in areas where schistomiasis is endemic
What group is bladder cancer most common in?
M>F, 3:1
Between 50-80 years
What are the causes of transitonal cell carcinoma bladder cancer?
Smoking
Aromatic amines/workplace carcinomas
- Clothing dyes
- Printing and textile industry
What are the causes of squamous cell carcinoma bladder cancer?
Schistosomiasis
Long term catheter
Chronic cystitis
Cyclophosphamide therapy
Pelvic radiotherapy
Urachal adenocarcinoma
What is the latency period of bladder cancer after exposure to aromatic amines?
Up to 20 years
How does bladder cancer present?
Painless macroscopic haematuria
Recurrent UTI
Storage Bladder Symptoms
- Dysuria
- Frequency
- Nocturia
- Urgency
- Urge incontinence
- Bladder pain
What investigations are used in bladder cancer diagnosis?
Urinalysis
- Culture
Upper Tract Imaging
- US
- CT Urogram
Cystoscopy or Transurethral Resection of Bladder Tumours (TURBT)
- Histological diagnosis information regarding depth of invasion
- Urgently within 2 weeks if frank macroscopic haematuria
- Or 4-6 weeks of dipstix or microscopic
EUA (Pelvic Examination under Anaesthesia)
- Assesses bladder mass/thickening before and after TURBT
Describe Ta bladder cancer
Non-invasive papillary
Describe Tis bladder cancer
Carcinoma in situ
Describe T1 bladder cancer
Tumour invades lamina propria
Describe T2 bladder cancer
Tumour invades muscle
Describe T3 bladder cancer
Tumour extend outside bladder
Describe T4 bladder cancer
Tumour invades adjacent organs
How is non-muscle invasive bladder cancer managed?
Transurethral Resection of a Bladder Tumour (TURBT)
Followed by single instillation of intravesical chemotherapy within 24 hours
Weekly BCG immunotherapy for 6 weeks, in which it is squirted into the bladder via catheter, then every six months for 3 years
How is muscle invasive bladder cancer managed?
Radical cystectomy with ileal conduit
Radiotherapy as neoadjuvant, primary treatment or palliative
IV chemotherapy as neoadjuvant or palliative
How does nephroblastoma present?
Usually present in first 4 years of life
Mass associated with haematuria
Loin pain
Pyrexia
Often metastasise early, usually to lung
Give causes of haematuria
Cancer (bladder, renal, prostate)
Stones
Exercise
Sexual Intercoursw
BPH
Prostatitis
Urethritis
IgA nephropathy
Foods
- Beetroot, rhubarb
Drugs
- Rifampicin
- Doxorubicin
