Malignant tumours of the urinary tract Flashcards
Which age group are most commonly affected by kidney cancer?
people aged 50-70
affects twice as many men
What are the risk factors for kidney cancer?
smoking - double the incidence obesity, hypertension, unopposed oestrogen therapy chemical exposure - asbestos chronic renal failure genetics - familial cancers - von hippel lindau, hereditary clear cell carcinoma, hereditary papillary carcinoma - tuberous sclerosis -? other
What are the symptoms of kidney cancer?
haematuria
low back pain, not associated with injury
mass or lump in the abdomen
fatigue
weight loss
chronic fever
paraneoplastic syndrome - (polycythenia, hypercalcaemia, hypertension)
What imaging techniques are used to diagnose kidney cancer?
US
CT
MRI
CXR and bone scans
How are kidney cancers treated?
surgery
radiation therapy
chemotherapy
biologic therapy - interferon or immunotherapy
What surgeries are available for kidney cancer?
radical nephrectomy
- most pts undergo this
- remove the kidney, adrenal gland, surrounding tissue and nearby lymph node
Partial nephrectomy
- remove the cancer and some tissue around it
- prevent loss of kidney function
- may only have a single functioning kidney
What are the classifications of renal epithelial tumours in adults?
clear cell carcinoma (75%) papillary carcinoma (type I and II) -type I = less aggressive - type II = aggressive LN metastasis chromophobe cell carcinoma collecting duct carcinoma - rare but highly aggressive - arise from principal cells Unclassified Oncocytoma
What does a clear cell carcinoma look like?
large yellowish, haemorrhagic renal tumour
cystic changes
branching like appearance
What is the prognosis of clear cell carcinoma?
Grading = fuhmann- reflects biological behaviour -better prognosis the lower the grade
by grade 4 there are multi-nucleated cells - most aggressive
staging
What is the staging of renal cancer?
T1 = 7cm or less
T2 = more than 7cm
T3 = extends into major veins or invades adrenal gland but not beyond gerota’s fascia
T4 = invades beyond gerota’s fascia
N1 - single regional lymph node
N2 = metastasis in more than one regional lymph node
What are the other types of renal cancer?
angiomyolipoma (benign) lymphoma sarcoma metastasis inflammatory pseudo-tumour
What is an angiomyolipoma made up of?
mix of 3 components: - blood vessels - smooth muscle - fat => can cause haemorrhaging - need to be surgically removed
What is Wilm’s tumour?
renal cancer in children nephroblastoma - 6% of childhood cancers - most common type of kidney cancer in children - higher incidence in F younger than 5
What is the most common cancer of the urinary tract?
80-90% urothelial/transitional cell carcinoma
bladder cancer 2-3 times more common in men
What are the risk factors for urinary tract cancer?
smoking
repeated exposure to chemicals such as aromatic amines used in petroleum and other industries; dyes, leather, rubber, paint, organic chemicals
chronic bladder inflammation
diet high in sat fat
family history of bladder cancer
infection with schistosoma haematobium
treatment with certain drugs = cyclophosphamide, analgesic abuse
What are the symptoms of urinary tract cancer?
same as an infection of UT
- Haematuria, frequency, urgency, dysuria, pain
size and site of the tumour influences symptoms
How is cancer of the urinary tract diagnosed?
cytoscopy with biopsy or transurethral resection
- diagnosis, treatment
urine cytology - diagnosis and follow up
For advanced tumours what diagnostic techniques are used?
intravenous pyelogram (IVP), CT scan of the abdomen and pelvis US
How are urinary tract tumours classification ?
WHO 2004 non-invasive - benign papilloma - papillary urothelial neoplasm of low grade malignant potential - papillary TCC low grade - paillary TCC high grade
TCC used to be classified as invasive
What is the natural history of bladder cancer?
low grade cancer - papillary, multiple recurrences, 2-10% develop high grade
high grade cancer - papillary, invasive or both, develop metastase. high risk of progression (some are de novo but most develop from low grade) - genetically unstable (overexpression of oncogenes)
invasive cancer - high grade, 60% progression rate, 35% 10 year survival
carcinoma in situ - flat abnormality with malignant cells in surface urothelium
What are most bladder tumours?
most are papillary lesions
What is a grade 1 papillary TCC like?
central fibrovascular core lined by urothelium (thicker than normal)
grading is based on loss of polarity
What is the TNM staging of urothelial cancer?
T1= invades supepithelial connective tissue T2= invades muscle T3= invades perivesical/peripelvic/periuteric tissues T4= invades adjacent organs/perinephric fat
N1 = single lymph node <2cm N2= single node >2cm or multiple nodes<5cm N3= metastasis in LN >5cm
How is urothelial cancer treated?
conservative treatment for carcinoma in situ
- transurethral resection
- BCG therapy - or immunotherpay => for high grade superficial tumours
surgery
- transurethral resection
- partial or radical cystectomy, urethrectomy, nephrectomy
chemotherapy
radiation therapy