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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
Q

What cancer probability is associated with a PSA >10?

A

70%

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26
Q

What grading system is used for prostate cancer?

A

Gleason Grading

ISUP grading

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27
Q

How is a Gleason Score given to prostate cancer?

A

Level of differentiation in biggest area + level of differentiation in second biggest area

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28
Q

What are the 4 stages of prostate cancer?

A

Local disease
Locally advanced disease
Metastatic disease
Hormone refractory stage

29
Q

What investigations are used to stage localised prostate cancer?

A 
TRUS biopsy 
DRE 
PSA 
CT
MRI
30
Q

What investigation is used for distant staging?

A

CT

31
Q

What are the treatment options for localised prostate cancer?

A

Radiotherapy

Radical prostatectomy

32
Q

What is the treatment for locally advanced prostate cancer?

A

Hormone therapy followed by surgery
Hormone therapy followed by radiation
Hormone therapy alone
Intermitted hormone therapy

33
Q

What are the types of hormonal therapy for prostate cancer?

A

Surgical/chemical castration
LHRH analogue/antagonist
Anti-androgens
Oestrogens

34
Q

What is the prognosis of localised prostate cancer?

A

> 90% 15y survival

35
Q

What is the prognosis of locally advanced prostate cancer?

A

80-90% 5y survival

36
Q

What is the prognosis of metastatic prostate cancer?

A

3-5 years median

37
Q

What is the prognosis of castrate resistant prostate cancer?

A

18-22mo

38
Q

How does testicular cancer typically present?

A

Painless lump

39
Q

What are the less common presentations of testicular cancer?

A

Tender inflamed swelling
History of trauma
Symptoms/signs from nodal or distant metastasis

40
Q

What lymph nodes are associated with testicular cancer spread?

A

Pelvic lymph nodes

Para-aortic lymph nodes

41
Q

When does incidence of testicular cancer peak?

A

30s

42
Q

Which group is of highest risk of testicular cancer?

A

Whites
Testicular maldescent
Atrophic testis
Previous contralateral cancer

43
Q

What is the precursor lesion of testicular cancer?

A

Testicular Germ cell Neoplasia in-situ

44
Q

What tumour markers are associated with testicular cancer?

A

Alpha-fetoprotein
Beta-HCG
LDH

45
Q

AFP tumour marker is raised in what?

A

Teratoma

46
Q

BHCG tumour marker is raised in what?

A

Seminoma

47
Q

LDH tumour marker is raised in what?

A

Non-specific tumour burden

48
Q

How is testicular cancer diagnosed?

A

MSSU
Testicular ultrasound and CXR
Tumour markers

49
Q

What is the differential diagnosis of testicular lumps?

A

Infection
Epididymal cyst
Missed testicular torsion

50
Q

How is testicular cancer treated?

A

Radical orchidectomy

Biopsy of contralateral testis

51
Q

What are the two types of testicular cancer tumour?

A

Germ cell and non-germ cell tumour

52
Q

what are the main types of germ cell tumour?

A

Seminomatous (classical, spermatocytic, anaplastic)

Non-seminomatous (teratoma, yolk sack, choriocarcinoma)

53
Q

What are the main types of non-GCT testicular cancer?

A

Leydig
Sertoli
Lymphoma

54
Q

Seminoma is more common in which age group?

A

30-40y

55
Q

Non-seminomatous cancer is more common in which age group?

A

20-30y

56
Q

How are testicular cancers graded?

A

Aggressiveness
Low - high grade
Well - poorly differentiated

57
Q

How are testicular cancers staged?

A 
Spread 
Local
Regional
Distant 
(TNM)
58
Q

How is nodal staging assessed?

A

CT scan

59
Q

What is stage 1 testicular cancer?

A

Confined to testis

60
Q

What is stage 2 testicular cancer?

A

Infradiaphragmatic nodes involved

61
Q

What is stage 3 testicular cancer?

A

Supradiaphragmatic nodes involved

62
Q

What is stage 4 testicular cancer?

A

Extralymphatic disease

63
Q

How is low stage, negative tumour marker cancer treated?

A

Orchidectomy with:
Surveillance
Adjuvant radiotherapy
Prophylactic chemo

64
Q

How is nodal disease, persistent tumour marker testicular cancer treated?

A

Combination therapy

Lymph node dissection

65
Q

How are testicular cancer metastases treated?

A

First-line chemotherapy

Second-line chemotherapy

66
Q

What is the prognosis of stage 1 testicular cancer?

A

99% at 5y

67
Q

What is the prognosis of stage 2/3 testicular cancer?

A

96% at 5y

68
Q

What is the prognosis of stage 4 testicular cancer?

A

73% at 5y

RENAL PATHOLOGY (16 decks)

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