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Medicine Phase 2a GU > Malignant tumours of GU tract > Flashcards

Malignant tumours of GU tract Flashcards

1
Q

Examples

A

Bladder carcinoma
Renal carcinoma (kidney)
Prostatic carcinoma
Testicular carcinoma

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2
Q

Pathophysiology of bladder carcinoma

A

> 90% transitional cell carcinoma
Arises from the transitional cells of the mucosal urothelium.
Can invade the muscle to cause voiding symptoms.
Has a high propensity for metastasis.
(5% squamous cell carcinoma; v rare adenocarcinoma)

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3
Q

Aetiology of bladder carcinoma

A

Genetic
Smoking
Aromatic amines and polycyclic aromatic hydrocarbons (working in a dye factory) are renally excreted
Increasing age
Risk factors: Paraplegia, Smoking, Occupation (carcinogens present), Drugs (aspirin, phenacetin), Bladder stones

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4
Q

Clinical presentation of bladder carcinoma

A

Painless haematuria.
Advanced disease may have voiding symptoms.
Classic cancer symptoms.

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5
Q

Epidemiology of bladder carcinoma

A

Smokers and dye factory workers
85% painless
24% malignant, 15 % present metastases
10yr survival in 50%

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6
Q

Diagnostic tests of bladder carcinoma

A

Transurethral Resection of Bladder Tumour
Cystoscopy: Examine for signs of tumour
Biopsy: Determine cell type, confirm diagnosis
Urine cytology: Rule out infection

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7
Q

Treatment of bladder carcinoma

A

Non-invasive: Transurethral resection
Invasive: Cystectomy (with orthotopic bladder substitute).
Chemotherapy (cisplatin)

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8
Q

Complications of bladder carcinoma

A

Urinary retention
UTI
Recurrence
Metastasis

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9
Q

Types of renal carcinoma

A

Renal cell carcinoma (arises from the renal tubule)

Transitional cell carcinoma (arising from the renal pelvis)

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10
Q

Pathophysiology of renal cell carcinoma - what is secreted by the cell

A

Can secrete PTH (hypercalcaemia)
ACTH (Cushings like syndome)
EPO (polycythaemia)
renin (HTN)

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11
Q

Common metastases from renal carcinoma

A

Lymphoma, lung, breast, skin

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12
Q

Risk factors of renal carcinoma

A

Regular NSAID use
Obesity
Family Hx

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13
Q

Clinical presentation of renal carcinoma

A 
Haematuria
Abdominal mass
Lethargy
Anorexia
Weight loss
Abdo pain
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14
Q

Diagnosis of Renal carcinoma

A

IVU: Dye stains kidney -> passes into ureters.
Blurs the outline.
Ultrasonography: Solid or cystic
CT: Preoperative staging

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15
Q

Treatment of renal carcinoma

A

Surgical

Radio/chemo

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16
Q

Pathophysiology of prostatic carcinoma

A

Adenocarcinoma.
Androgen driven.
Mostly affects the lateral lobes (in constrast to BPH).
Can spread through lymphatics, haematogenously, local invasion.

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17
Q

Aetiology of prostatic carcinoma

A

Genetic (no specific gene).

Can develop from benign prostatic hyperplasia.

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18
Q

Epidemiology of prostatic carcinoma

A

Most common cancer in men

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19
Q

Clinical presentation of prostatic carcinoma

A

Serum PSA elevated.
Bladder outflow obstruction (I-PSS grading).
Occasionally; presents with metastases (usually to bone).

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20
Q

Diagnosis of prostatic carcinoma

A

DRE: hard irregular gland
Ultrasound
Serum PSA: raised (markedly if metastasis)

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21
Q

Treatment of prostatic carcinoma

A

Microscopic: Watchful waiting
Confined to gland: Prostatectomy or radiotherapy
Metastatic: Androgen suppression (surgical/chemical castration)

22
Q

Complications of prostatic carcinoma

A

Metastasis

Death

23
Q

Types of testicular carcinoma

A

Seminoma

Teratomas

24
Q

Clinical presentation of testicular carcinoma

A

Classic cancer symptoms
Painless lump in the testicle
Possible mestastasis to the lung

25
Q

Aetiology (RFs) of testicular cancer

A

Unknown

RF: Undescended testes, Family Hx

26
Q

Pathophysiology of seminoma

A

96% arise from germ cells

27
Q

Pathophysiology of teratomas

A

Composed of tissue not normally present at the site (teeth and stuff)

28
Q

Epidemiology of testicular carcinoma

A

Most common cancer in young men

29
Q

Diagnosis of seminoma

A

Ultrasound
CXR/CT: Tumour staging; check metastases
Serum conc
Of beta-hCG: Raised

30
Q

Treatment of seminoma

A

Surgery: Orchidectomy (offer sperm banking)
Metastasis: Radiotherapy (Chemo if advanced)

31
Q

Diagnosis of teratoma

A

No markers

CXR/CT: Tumour staging; check metastases

32
Q

Treatment of teratoma

A

Surgery: Orchidectomy (offer sperm banking) Metastasis: Chemotherapy

33
Q

Types of LUT stones

A

Bladder
Kidney
Ureteric

34
Q

Types of trauma in LUT

A

Penetrating

Blunt

35
Q

Types of infection in LUT

A

UTI
Pyelonephritis
TB

36
Q

Epidemiology of renal cancer

A

3% of all cancers
4000 deaths/yr
66% diagnosed accidentally

37
Q

Epidemiology of epididymitis (inflamed epididymus

A

Young males

Acute epididymitis mostly occurs in young males

38
Q

epididymitis cause

A

Most common: E. coli and Chlamydia. Organisms may -> Epididymis by retrograde spread from prostatic urethra & seminal vesicles or less commonly, through blood stream.

39
Q

Risks of epididymitis

A

UTI
Urethral instrumentation
STI

40
Q

What is hydrocele

A

excessive fluid in tunica vaginalis (serous space surrounding testis)

41
Q

Primary cause of hydrocele

A

Occur in absence of disease in testis. Tend to be large and tense. More common in young boys.

42
Q

Secondary cause of hydrocele

A

Represent reaction to testicular pathology (testicular tumours / infections / torsion; H of Morgagni Torsion).

43
Q

Risk factors of testicular tumours

A

Cryptorchidism
Family Hx
Previous testicular tumour
Poorly understood

44
Q

Epidemiology of testicular tumours

A

Most common tumours in males between 20 - 40, affecting 2 - 10 males / 100,000 / year.
92%: Malignant. Account for 1-2% of all male malignancies.
Incidence is increasing.

45
Q

Presentation of testicular tumours

A

80%: Painless lump in testis (hard/craggy, lies within testis, can be felt above, and does not transilluminate.)
Usually painless, short history
Often found incidentally.

Other presenting symptoms include:
HYDROCOELE: may contain bloodstained fluid
PAIN: Unexplained in one testis - May be mistaken for orchitis
METASTASES: Metastatic growths in Lung; Abdominal mass due to enlarged para-aortic lymph nodes; Cervical nodes.

46
Q

Investigations/management of testicular tumours

A 
USS same day
Tumour markers: 
AFP (1/2 life 5 days)
B-hcg (24-48hrs)
 LDH
CXR if respiratory symptoms
Staging CT
47
Q

What is Orchidectomy

A

Testis and spermatic cord excised. Bx and frozen section for assess further treatment.
If malignant testicular tumour.

48
Q

Treatment of seminoma

A

Radiosensitive

RadTx for all stages except IV (ChemoTx)

49
Q

Treatment of tetratoma

A

Cytotoxic chemotherpapy

50
Q

What cells do most cancers of the testicle develop from

A

Germ cells

51
Q

Types of germ cell tumours in men

A

Seminomas - slow growing, classic appearance
Non-seminomas - made up of embryonal carcinoma, yolk sac carcinoma, choriocarcinoma, and/or teratoma. Rapid growth/met. Respond well chemo.

Medicine Phase 2a GU (18 decks)

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