Malignant tumours of GU tract Flashcards
Examples
Bladder carcinoma
Renal carcinoma (kidney)
Prostatic carcinoma
Testicular carcinoma
Pathophysiology of bladder carcinoma
> 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)
Aetiology of bladder carcinoma
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
Clinical presentation of bladder carcinoma
Painless haematuria.
Advanced disease may have voiding symptoms.
Classic cancer symptoms.
Epidemiology of bladder carcinoma
Smokers and dye factory workers
85% painless
24% malignant, 15 % present metastases
10yr survival in 50%
Diagnostic tests of bladder carcinoma
Transurethral Resection of Bladder Tumour
Cystoscopy: Examine for signs of tumour
Biopsy: Determine cell type, confirm diagnosis
Urine cytology: Rule out infection
Treatment of bladder carcinoma
Non-invasive: Transurethral resection
Invasive: Cystectomy (with orthotopic bladder substitute).
Chemotherapy (cisplatin)
Complications of bladder carcinoma
Urinary retention
UTI
Recurrence
Metastasis
Types of renal carcinoma
Renal cell carcinoma (arises from the renal tubule)
Transitional cell carcinoma (arising from the renal pelvis)
Pathophysiology of renal cell carcinoma - what is secreted by the cell
Can secrete PTH (hypercalcaemia)
ACTH (Cushings like syndome)
EPO (polycythaemia)
renin (HTN)
Common metastases from renal carcinoma
Lymphoma, lung, breast, skin
Risk factors of renal carcinoma
Regular NSAID use
Obesity
Family Hx
Clinical presentation of renal carcinoma
Haematuria Abdominal mass Lethargy Anorexia Weight loss Abdo pain
Diagnosis of Renal carcinoma
IVU: Dye stains kidney -> passes into ureters.
Blurs the outline.
Ultrasonography: Solid or cystic
CT: Preoperative staging
Treatment of renal carcinoma
Surgical
Radio/chemo
Pathophysiology of prostatic carcinoma
Adenocarcinoma.
Androgen driven.
Mostly affects the lateral lobes (in constrast to BPH).
Can spread through lymphatics, haematogenously, local invasion.
Aetiology of prostatic carcinoma
Genetic (no specific gene).
Can develop from benign prostatic hyperplasia.
Epidemiology of prostatic carcinoma
Most common cancer in men
Clinical presentation of prostatic carcinoma
Serum PSA elevated.
Bladder outflow obstruction (I-PSS grading).
Occasionally; presents with metastases (usually to bone).
Diagnosis of prostatic carcinoma
DRE: hard irregular gland
Ultrasound
Serum PSA: raised (markedly if metastasis)
Treatment of prostatic carcinoma
Microscopic: Watchful waiting
Confined to gland: Prostatectomy or radiotherapy
Metastatic: Androgen suppression (surgical/chemical castration)
Complications of prostatic carcinoma
Metastasis
Death
Types of testicular carcinoma
Seminoma
Teratomas
Clinical presentation of testicular carcinoma
Classic cancer symptoms
Painless lump in the testicle
Possible mestastasis to the lung
Aetiology (RFs) of testicular cancer
Unknown
RF: Undescended testes, Family Hx
Pathophysiology of seminoma
96% arise from germ cells
Pathophysiology of teratomas
Composed of tissue not normally present at the site (teeth and stuff)
Epidemiology of testicular carcinoma
Most common cancer in young men
Diagnosis of seminoma
Ultrasound
CXR/CT: Tumour staging; check metastases
Serum conc
Of beta-hCG: Raised
Treatment of seminoma
Surgery: Orchidectomy (offer sperm banking)
Metastasis: Radiotherapy (Chemo if advanced)
Diagnosis of teratoma
No markers
CXR/CT: Tumour staging; check metastases
Treatment of teratoma
Surgery: Orchidectomy (offer sperm banking) Metastasis: Chemotherapy
Types of LUT stones
Bladder
Kidney
Ureteric
Types of trauma in LUT
Penetrating
Blunt
Types of infection in LUT
UTI
Pyelonephritis
TB
Epidemiology of renal cancer
3% of all cancers
4000 deaths/yr
66% diagnosed accidentally
Epidemiology of epididymitis (inflamed epididymus
Young males
Acute epididymitis mostly occurs in young males
epididymitis cause
Most common: E. coli and Chlamydia. Organisms may -> Epididymis by retrograde spread from prostatic urethra & seminal vesicles or less commonly, through blood stream.
Risks of epididymitis
UTI
Urethral instrumentation
STI
What is hydrocele
excessive fluid in tunica vaginalis (serous space surrounding testis)
Primary cause of hydrocele
Occur in absence of disease in testis. Tend to be large and tense. More common in young boys.
Secondary cause of hydrocele
Represent reaction to testicular pathology (testicular tumours / infections / torsion; H of Morgagni Torsion).
Risk factors of testicular tumours
Cryptorchidism
Family Hx
Previous testicular tumour
Poorly understood
Epidemiology of testicular tumours
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.
Presentation of testicular tumours
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.
Investigations/management of testicular tumours
USS same day Tumour markers: AFP (1/2 life 5 days) B-hcg (24-48hrs) LDH CXR if respiratory symptoms Staging CT
What is Orchidectomy
Testis and spermatic cord excised. Bx and frozen section for assess further treatment.
If malignant testicular tumour.
Treatment of seminoma
Radiosensitive
RadTx for all stages except IV (ChemoTx)
Treatment of tetratoma
Cytotoxic chemotherpapy
What cells do most cancers of the testicle develop from
Germ cells
Types of germ cell tumours in men
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.
