Other Urological Cancers

Question 1

Give 4 risk factors for testicular cancer

Answer 1

Aged 20-40 years 
Hx of undescended testis 
Phx of testicular cancer
Testicular CIS
FHx of testicular cancer
Klinefelter's syndrome 
Atrophic testis and infertility

Question 2

Give the 3 main types of testicular cancers

Answer 2

Seminoma
Teratoma (non-seminomatous germ cell tumour)
Mixed

Question 3

Give 3 clinical features of testicular cancer

Answer 3

Hard testicular lump
Infertility
Gynaecomastia
Advanced –> lumbar back pain, cough, SVCO, CNS symptoms

Question 4

How is testicular cancer investigated?

Answer 4

USS of testis 
Sperm count (+ storage) 
Tumour markers (AFP, HCG, LDH)

Chest x-ray
CT CAP
CT brain (if HCG+++)
Isotope brain scan

Question 5

How is a testicular carcinoma in situ managed?

Answer 5

Low dose radiotherapy

Question 6

How are low grade testicular cancers managed?

Answer 6

Radical orchidectomy
Adjuvant radiotherapy to para-aortic nodes
Adjuvant chemotherapy

Surveillance- annual CT of abdo and pelvis

Question 7

How is advanced testicular cancer managed?

Answer 7

Chemotherapy

Resection of residual tumour post chemo

Question 8

Why do testicular cancer patients require lifelong follow up?

Answer 8

High risk of micrometastases

Question 9

Give 4 risk factors for penile cancers

Answer 9

HPV 16 + 18 
Poor groin hygiene 
Phimosis
Carcinoma in situ
Smoking 
Immunosuppression

Question 10

What factor gives lifelong protection to penile cancer?

Answer 10

Neonatal circumcision

Question 11

What type of cancers are penile cancers?

Answer 11

Squamous cell carcinomas

Question 12

Give 4 common areas that penile cancer will metastasise to

Answer 12

Inguinal LNs
Pelvic LNs
Liver 
Lung 
Bone 
Skin

Question 13

Give 3 clinical features of penile cancer

Answer 13

Erythema
Warty lesion
Erosive destruction of the penis
Secondary infections

Question 14

How is penile cancer investigated?

Answer 14

Biopsy lesion
FNA suspicious lymph nodes
Advanced disease –> CT abdo + pelvis

Question 15

How is a penile carcinoma in situ managed?

Answer 15

Topical fluorouracil, laser therapy, cryotherapy, local excision

Question 16

How is early stage penile cancer managed?

Answer 16

Excision
Radiotherapy
Bilateral inguinal lymphadenectomy (if LN involvement)

Question 17

How is advanced penile cancer managed?

Answer 17

Chemotherapy

Question 18

Give 4 risk factors for bladder cancer

Answer 18

Smoking
Occupational risk –> rubber factory, textile dye exposure, gas works, sewage works)
Chronic bladder irritation –> recurrent infections, recurrent stones, long term catheter
Previous pelvic radiotherapy

Question 19

What type of cancer are >90% of bladder cancers?

Answer 19

Transitional cell carcinomas

Question 20

Where does bladder cancer typically metastasise to?

Answer 20

Lymph nodes
Lung
Liver
Bone

Question 21

How is bladder cancer investigated?

Answer 21

Bloods –> FBC, U&Es, LFTs, CRP, glucose
Urine dip
Cystoscopy + TURBT

Advanced disease –> chest x-ray, CT abdo pelvis, MRI abdo pelvis

Question 22

How is bladder cancer managed?

Answer 22

If superficial –> resected during TURBT biopsy

Muscle invasive –> radical cystoprostatectomy/anterior bladder exenteration, radiotherapy and adjuvant chemotherapy