MET3 Revision: Urology II Flashcards
What are the 3 most common types of renal cell cancer? [3]
Clear cell (75%)
Papillary (10%)
Chromophobe (5%)
Clear cell renal cell cancer is commonly due to a mutation in which gene? [1]
VHL tumour supressor gene: occurs in Von Hippel-Lindau syndrome.
What are the classic triad of symptoms for renal cancer? [3]
Name two more important clinical signs [2]
Classic triad:
* Loin pain
* Haematuria
* Loin mass
Also important:
Scrotal varicocele: usually left sided due to obstruction of the left gonadal vein
Lower limb oedema: due to compression of the inferior vena cava
NB: 50% are asymptomatic
What investigations should you provide if suspect renal cancer? [4]
BP increased from increased renin
FBC:
- Polycythaemia from EPO secretion
- ESR
- U&E
- ALP
- LDH
Urine:
- RBC
Imaging:
- USS
- CT w contrast: definitive test
- MRI
Patients receiving which form of treatment increaese their risk of RCC? [1]
15% of haemodialysis patients develop RCC
What is the difference in renal cancer staging between 1-4? [4]
Stage 1: < 7cm; no spread
Stage 2: > 7cm; no spread
Stage 3: > 7cm; spread locally
Stage 4: Spread to abdomen; adrenal glands; lymph nodes
Treatment for localised renal cancer?: T1 [2] & T2 [1]
T1 tumours:
- < 3 cm: ablative therapies
- up to 7 cm: partial nephrectomy
T2:
Radical nephrectomy (open, laporoscopic, open)
Treatment for locally advanced disease: T3 & T4? [1]
Radical nephrectomy
Treatment for metastatic RCC? [6]
Debulking surgery
Adjuvent chemotherapy
Immunotherapy tyrosine kinase inhibitors:
* ipilimumab
* nivolumab
* Sunitinib: inhibitor of tyrosine kinase receptors
* Pazopanib: inhibitor of tyrosine kinase receptors
* Temsirolimus: inhibitor of the mammalian target of rapamycin (mTOR)
* Everolimus: inhibitor of the mammalian target of rapamycin (mTOR)
Where patients are not suitable for surgery, which les invasive procedures can be used to treat the RCC? [3]
Arterial embolisation,
- cutting off the blood supply to the affected kidney
Percutaneous cryotherapy,:
- injecting liquid nitrogen to freeze and kill the tumour cells
Radiofrequency ablation,
- putting a needle in the tumour and using an electrical current to kill the tumour cells
RCC is generally resistant to which treatment types? [2]
Radiotherapy and chemotherapy
What is the name of the score created to predict prognosis of RCC patients? [1]
Mayo prognostic risk score
Describe the spread of RCC [2]
Renal cell carcinoma tends to spread to the tissues around the kidney, within Gerota’s fascia. It often spreads to the renal vein, then to the inferior vena cava.
Describe characteristic finding of metastatic RCC on CXR [1]
Cannonball
Name 4 differential diagnosises of cannonball metastasis
- renal
- choriocarcinoma
less commonly, with prostate, bladder and endometrial cancer.
Explain why RCC causes each of the following cause of paraneoplastic syndrome
Polycythaemia
Hypercalcaemia
Hypertension
Stauffer’s syndrome
Polycythaemia:
- due to secretion of unregulated erythropoietin
Hypercalcaemia:
- due to secretion of a hormone that mimics the action of parathyroid hormone
Hypertension
- due to various factors, including increased renin secretion, polycythaemia and physical compression
Stauffer’s syndrome
- abnormal liver function tests (raised ALT, AST, ALP and bilirubin) without liver metastasis
Name 4 paraneoplastic syndromes that RCC causes
Polycythaemia
Hypercalcaemia
Hypertension
Stauffer’s syndrome
Describe what is meant by Stauffer syndrome
Stauffer syndrome: RCC paraneoplastic syndrome
Hepatosplenomegaly
+
Cholestatic LFTs (elevated bilirubin; ALP and GGT)
Clinical features of bladder cancer? [4]
Painless haematuria: most common symptom
recurrent UTIs
Dysuria
Frequency
Urgency
Suprapubic pain
Risk factors for bladder cancer? [5]
Smoking
Aromatic amines (rubber industry)
Chronic cystitis
Schisosomiasis
Pelvic irradtion
Describe NICE guidelines regarding haematuria that determines investigating for bladder cancer [2]
Painless haematuria:
Aged over 45 with unexplained visible haematuria, either without a UTI or persisting after treatment for a UTI. 2/3 samples positive for blood require investigation
Aged over 60 with microscopic haematuria (not visible but positive on a urine dipstick) PLUS:
Dysuria or;
Raised white blood cells on a full blood count
What investigations would you conduct for bladder cancer:
- All patients given? [1]
- NVH v VH? [2]
All patients given cytoscopy (rigid or flexible) - with biospy: diagnostic
NVH: USS renal tract
VH: CT urogram
Staging for bladder cancer is initially determined via histological biopsies made using which sampling technique? [1]
Subsequent staging of bladder cancer is determined via which methods? [3]
TURBT (Transurethral resection of bladder tumour):
- Muscle invasive
- Non-muscle invasive
Staging investigations:
* CT or MRI of pelvis
* Chest x-ray
* Bone scan
The management of bladder cancer may be classified according to which stages of bladder cancer? [3]
- Low risk non-muscle Invasive Bladder Cancer (NMIBC)
- Moderate risk muscle Invasive Bladder Cancer (MIBC)
- Metastatic Bladder Cancer