RCC an TCC Flashcards
What is a tcc
Calyceys, ureter, bladder, urethra, all transitional cels. The commonest type of cancer is transitional celll carcinoma- can occur anywhere in the lining
What is a RCC
Renal cell tumour - can be benign or malignant but most are malignancy. RCC though (malignant) is in body of kidney
How does rcc present?
Localised or advanced • Haematuria •Incidental finding on imaging – e.g. ultrasound or CT undertaken for another reason •(Rare – a palpable mass)
If advanced
•Large varicocele may be present (Right sided large varicoloured is suspicious - USS of scrotum - if there is a large varicoloured, should also do a scan or kidney)
•Pulmonary/tumour embolus
•Loss of weight/loss of appetite symptom from metastasis
•Hypercalcaemia (Paracrie effect - can present with nausea, vomiting abdominal pain )
How does tcc present
Localised or advanced
• Haematuria
• Incidental finding on imaging
– e.g. ultrasound or CT undertaken for another reason
If advanced
• Loss of weight/loss of appetite/symptom of metastasis
• DVT
• Lymphoedema
May need scan to differentiate DVT and lymhoedeama
How can haematuria b classified
Visible or non-visible
Non-visible:
- symptomatic or asymptomatic
Describe the differential diagnosis for haematuria
• Urological – Cancer • RCC • Bladder cancer (90% TCC) • Upper urinary tract TCC • Advanced prostate carcinoma – Other • Stones • Infection • Inflammation • Benign prostatic hyperplasia (large)
• Nephrological (Glomerular)
How are patients with haematuria Investigated?
• History – Smoking – Occupation – Painful or painless - Pain - look for infective or inflammatory causes. – Other LUTS – Family history • Examination – BP – Abdominal mass – Varicocele – Leg swelling – Assess prostate by DRE (male) • Size • Texture
Describe the investigations
Radiology
-Ultrasound
? CT
US - renal tumours, obstruction , hydronephrosis.. only proceed to CT if abnormal
Endoscopy
-Flexible cystoscopy
Look inside the bladder. Better for picking up smaller tumours in bladder than US. Scope into urethra.
Urine
- ? Culture & sensitivity
- ? Cytology
Bloods (Already checked in primary care)
-FBC -U&E
Descrbe the histology of rcc
S
Describe the epidemiology o rc
• 7th most common cancer in UK • 95% of all upper urinary tract tumours • Incidence and mortality are ↑ing • Mortality is projected to fall in the next decade • M:F 3:2 • White > non-white • 30% metastases on presentation • Aetiology
– Smoking (2x↑)
– Obesity
– Dialysis
How can cc spread
Prinepric spread -Local - going into fatarund kidney
Lymph node mets
INV spread to RA
Describe localised RCC treatment
– Surveillance (Some slow growing ones hardly change in size - just surveillance. Eg 4-5mm in 5y. Low risk of mets.)
– Excision
• Radical nephrectomy (Removal of kidney, adrenal, surrounding fat, upper ureter) - Open or Laparoscopic
• Partial nephrectomy - Open ofetn with Robotic assistance
– Ablation (Energy, eg microwave, freezing)
• Cryoablation
• Radiofrequency ablation
Desribe the metastatic rcc treatment
• Palliative
– Biological therapies
• Targeted therapies
– Those targeting angiogenesis are now 1st choice
» e.g Sunitinib, sorafenib, pazopanib
-ib (tyrosine kinase inhibitor) in this case VEGF. -ab (monoclonal antibody)
Describe the epidemiology of bladder tcc
• In UK, 8th most common cancer in men, 14th in women • Incidence is ↓ing • But presentation is often more advanced in women • Mortality is ↓ing but less so in women
• M:F 3:1 • White > non-white • Risk factors
– Smoking 4x ↑
– Occupational exposure (20 yr latent period)
• Rubber or plastics manufacture (Arylamines) • Handling of carbon, crude oil, combustion, smelting (Polyaromatic
hydrocarbons) • Painters, mechanics, printers, hairdressers
Desribe the initial definitive treatment of bladder tcc
TUR bladder tumour (TURBT)
•Superficial TURBT
•Separate deep TUR of muscle
•Single intravesical instillation of mitomycin C
Cutting with electric cutters - trying to get it flush with bladder wall. Chemo but not systemic.local side effects.
