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
What are the 2 main lesions of the prostate?
benign prostatic hypertrophy (transitional zone of prostate = adenoma)- increase in number of glands and also stroma
adenocarcinoma (peripheral zone mainly)
What are the symptoms and diagnosis of benign prostatic hyperplasia?
UTIs, urinary retention, leads to decrease in renal function and hydronephrosis
rectal exam and US
What are the treatments for BPH?
alpha blockers or/and transurethral resection of prostate
What is the incidence of prostate cancer?
6th most common cancer
- <1% below 50 increasing to 70% >70
black men at highest risk and men from far east lowest
high fat diet, androgen hormone and genetic RF
What are the symptoms of prostate cancer?
usually none
How can prostate cancer be diagnosed early?
PSA blood test - not totally specific to cancer (BPH, ptostatitis)
digital rectal exam - may be able to palpate nodules
How is prostate cancer formally diagnosed?
transrectal needle core biopsy on USS guidance - nowadays MRI targeted biopsies carried out
How is prostate cancer graded?
gleason grading
- 5 grade (1 = low and 5 = high) - now dont have grades 1 and 2 so 3 is the lowest
What does a gleason grade 3 pattern look like?
cells with large round nuclei and prominent nucleoli, loss of basal cell layer
What does a gleason grade 4/5 pattern look like?
loss of basal cell layer i tumour cells
immunohistochemistry with specific antibody for baseal
How is prostate cancer treated?
surgery
- radical prostectomy (remove prostate, seminal vesicles, nearby lymph nodes)
- survival at 10 yrs is 80%
- SE: urinary incontinence, sterility, erectile dysfunction
Hormone therapy
- reduces size of tumour in 80% but doesnt kill cancaer cells
- based on reducing the level of testosterone
Radiotherapy
- alternative to radical prostectomy
How is prostate cancer staged?
T1 = clinically inapparent tumour diagnosed on histology T2 = tumour within prostate T3 = tumour extends through capsule T4 = tumour invades adjacent structures N1 =metastasis in regional LN
