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RENAL PATHOLOGY > Prostate/testicular cancer > Flashcards

Prostate/testicular cancer Flashcards

1
Q

How many new cases of prostate cancer occur a year?

A

47,700 new cases/year

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2
Q

What is the most common cancer death in men?

A

Prostate cancer

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3
Q

How much does prostate cancer cost the NHS?

A

£800 million/year

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4
Q

What proportion of new cases of prostate cancer are >65?

A

75%

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5
Q

What proportion of new cases of prostate cancer are <50?

A

1%

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6
Q

What proportion of new cases of prostate cancer are <70?

A

45%

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7
Q

What are the risk factors for prostate cancer?

A 
Age
African/asian
BRCA1/2
HPC1
First degree relative
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8
Q

Cancer of the prostate is more likely to be in which part of the prostate?

A

Peripheral zone

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9
Q

What proportion of newly diagnosed prostate cancers are localised?

A

80%

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10
Q

How do most prostate cancers present?

A

Asymptomatic

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11
Q

What is the diagnostic triad of prostate cancer?

A

DRE
PSA
TRUS-guided prostate biopsy

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12
Q

What are the symptoms of local prostate disease?

A 
ASYMPTOMATIC
Weak stream
Hesitancy
Sensation of incomplete emptying
Frequency
Urgency
Urge incontinence
UTI
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13
Q

What are the symptoms of locally invasive prostate disease?

A 
Haematuria
Perineal/suprapubic pain
Impotence
Incontinence 
Obstruction symptoms
Renal failure
Haemospermia 
Tenesmus
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14
Q

What are the symptoms of distant metastatic prostate disease?

A 
Bone pain/sciatica 
Paraplegia --> spinal cord compression
Lymphoedema/adenopathy
Loin pain
Anuria
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15
Q

What are the symptoms of widespread metastatic prostate disease?

A

Lethargy
Weight loss
Cachexia

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16
Q

Why is prostate cancer not screened for?

A

Wilson-Junger criteria not met

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17
Q

How is prostate cancer typically found?

A

Ad-hoc PSA testing

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18
Q

What is the upper limit for PSA in <50s?

A

2.5ug/mL

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19
Q

How does PSA vary with age?

A

Increases with age

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20
Q

What is the upper limit for PSA in 50-60s?

A

3.5ug/mL

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21
Q

What is the upper limit for PSA in 60-70s?

A

4.5ug/mL

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22
Q

What is the upper limit for PSA in >70s?

A

6.5ug/mL

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23
Q

What factors can cause an elevated PSA?

A 
UTI
Prostate exam
Exercise
Trauma 
Instrumentation
BPH
Prostate cancer
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24
Q

What is the process for PSA testing?

A

If repeat needed - again in 3 weeks

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25
What cancer probability is associated with a PSA >10?
70%
26
What grading system is used for prostate cancer?
Gleason Grading | ISUP grading
27
How is a Gleason Score given to prostate cancer?
Level of differentiation in biggest area + level of differentiation in second biggest area
28
What are the 4 stages of prostate cancer?
Local disease Locally advanced disease Metastatic disease Hormone refractory stage
29
What investigations are used to stage localised prostate cancer?
``` TRUS biopsy DRE PSA CT MRI ```
30
What investigation is used for distant staging?
CT
31
What are the treatment options for localised prostate cancer?
Radiotherapy | Radical prostatectomy
32
What is the treatment for locally advanced prostate cancer?
Hormone therapy followed by surgery Hormone therapy followed by radiation Hormone therapy alone Intermitted hormone therapy
33
What are the types of hormonal therapy for prostate cancer?
Surgical/chemical castration LHRH analogue/antagonist Anti-androgens Oestrogens
34
What is the prognosis of localised prostate cancer?
>90% 15y survival
35
What is the prognosis of locally advanced prostate cancer?
80-90% 5y survival
36
What is the prognosis of metastatic prostate cancer?
3-5 years median
37
What is the prognosis of castrate resistant prostate cancer?
18-22mo
38
How does testicular cancer typically present?
Painless lump
39
What are the less common presentations of testicular cancer?
Tender inflamed swelling History of trauma Symptoms/signs from nodal or distant metastasis
40
What lymph nodes are associated with testicular cancer spread?
Pelvic lymph nodes | Para-aortic lymph nodes
41
When does incidence of testicular cancer peak?
30s
42
Which group is of highest risk of testicular cancer?
Whites Testicular maldescent Atrophic testis Previous contralateral cancer
43
What is the precursor lesion of testicular cancer?
Testicular Germ cell Neoplasia in-situ
44
What tumour markers are associated with testicular cancer?
Alpha-fetoprotein Beta-HCG LDH
45
AFP tumour marker is raised in what?
Teratoma
46
BHCG tumour marker is raised in what?
Seminoma
47
LDH tumour marker is raised in what?
Non-specific tumour burden
48
How is testicular cancer diagnosed?
MSSU Testicular ultrasound and CXR Tumour markers
49
What is the differential diagnosis of testicular lumps?
Infection Epididymal cyst Missed testicular torsion
50
How is testicular cancer treated?
Radical orchidectomy | Biopsy of contralateral testis
51
What are the two types of testicular cancer tumour?
Germ cell and non-germ cell tumour
52
what are the main types of germ cell tumour?
Seminomatous (classical, spermatocytic, anaplastic) | Non-seminomatous (teratoma, yolk sack, choriocarcinoma)
53
What are the main types of non-GCT testicular cancer?
Leydig Sertoli Lymphoma
54
Seminoma is more common in which age group?
30-40y
55
Non-seminomatous cancer is more common in which age group?
20-30y
56
How are testicular cancers graded?
Aggressiveness Low - high grade Well - poorly differentiated
57
How are testicular cancers staged?
``` Spread Local Regional Distant (TNM) ```
58
How is nodal staging assessed?
CT scan
59
What is stage 1 testicular cancer?
Confined to testis
60
What is stage 2 testicular cancer?
Infradiaphragmatic nodes involved
61
What is stage 3 testicular cancer?
Supradiaphragmatic nodes involved
62
What is stage 4 testicular cancer?
Extralymphatic disease
63
How is low stage, negative tumour marker cancer treated?
Orchidectomy with: Surveillance Adjuvant radiotherapy Prophylactic chemo
64
How is nodal disease, persistent tumour marker testicular cancer treated?
Combination therapy | Lymph node dissection
65
How are testicular cancer metastases treated?
First-line chemotherapy | Second-line chemotherapy
66
What is the prognosis of stage 1 testicular cancer?
99% at 5y
67
What is the prognosis of stage 2/3 testicular cancer?
96% at 5y
68
What is the prognosis of stage 4 testicular cancer?
73% at 5y

RENAL PATHOLOGY (16 decks)

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