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Renal Y2 > Renal and urological carcinomas > Flashcards

Renal and urological carcinomas Flashcards

1
Q

What is the most common cancer type in men UK?

A

Prostate cancer

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2
Q

Prostate cancers are always almost androgen-dependant. What does this mean?

A

Prostate cancer is usually androgen dependent meaning it relies on androgen hormones such as testosterone in order to grow.

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3
Q

What is the most common type of prostate cancer?

A

Multifocal adenocarcinoma

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4
Q

Prostate cancer usually arises in the transitional zone of the prostate. True/false?

A

False. Prostate cancer usually arises in the peripheral zone of the prostate. Meaning that it usually needs to be T2 stage in order to be felt (in PR examination) or detected.

Benign prostate hyperplasia usually arises in the transitional zone of the prostate.

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5
Q

What are some key risk factors for prostate cancer?

A

Tall stature
Increasing age
Afro - Caribbean origin
Anabolic steroids.

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6
Q

Advanced prostate cancer can metastasise. True/false?

A

True, commonly to the lymph nodes and bones.

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7
Q

BPH (benign prostate hyperplasia) is a pre-malignant condition of prostate cancer and also increases risk. True/false?

A

False. BPH is NOT a pre-malignant condition and does not increase risk however a patient can have both BPH and prostate cancer at the same time.

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8
Q

How does prostate cancer present?

A

May be asymptomatic, can also present with similar symptoms to BPH such as urinary hesitancy, frequency, nocturia and weak flow.

Other symptoms include:
* Haematuria
* Erectile dysfunction
* Systemic symptoms i.e. weight loss, night sweats etc indicating more advanced stages of disease.

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9
Q

What is PSA (prostate specific antigen)?

A

A glycoprotein that is present in high amounts within semen, some can be secreted into the blood however this is in small amounts.

High PSA in the blood can indicate underlying pathology.

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10
Q

PSA is specific to prostate cancer. True/false?

A

False, PSA can be used alongside other investigations such as clinical history and biopsy to diagnose prostate cancer.

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11
Q

What can cause a raised PSA?

A

BPH
Prostatitis (inflammation of prostate)
Prostate cancer
Recent ejaculation or PR exam
Vigorous exercise (typically cycling)

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12
Q

Characteristic prostate features for BPH during PR exam?

A

Smooth, symmetrical and soft.
Enlarged

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13
Q

Characteristic prostate features for prostate cancer during PR exam?

A

Asymmetrical, “bumpy” prostate.
Irregular
May be presence of hard nodule.

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14
Q

Characteristic prostate features for prostatitis during PR exam?

A

May be large, tender and warm.

Like infections in other areas of the body.

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15
Q

Types of prostate biopsies?

A

Trans urethral-guided biopsy
Transperineal biopsy

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16
Q

What are some risks that occur from prostate biopsies?

A

Pain (particularly lower abdominal, rectal or perineal pain).
Bleeding (blood in semen, stool or urine).
Infection
Urinary retention (due to swelling of prostate afterwards).

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17
Q

What does isotope bone scan look for?

A

Bony metastases

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18
Q

What is the gleason scoring system?

A

Used as grading specifically for prostate cancer to see what treatment is most appropriate.

Based on histological findings taken from the prostate.

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19
Q

Testicular cancer arises from the germ cells in the testes. What are the germ cells?

A

Germ cells are cells that produce gametes (sperm) in males.

20
Q

Testicular cancer mainly affects young men between the ages of 15-35. True/false?

A

True

21
Q

What are the two types of testicular cancer?

A

Seminomas
Non-seminomas (mainly teratomas).

22
Q

What is a major risk factor for testicular cancer?

A

Undescended testicles

23
Q

Other risk factors for testicular cancer?

A

Male infertility
Family history
Increased height

24
Q

What is the typical presentation of a patient with testicular cancer?

A

Young man between 15-35. Complaining of a slow growing painless lump.

25
Q

What characteristics will a testicular cancer lump have?

A

Painless (or even reduced sensation)
Hard
Irregular
No transillumination (not see-through when shining torch)
Not fluctuant (so doesn’t vary in size - only grows larger).

26
Q

Germ cell tumours of the testes are rarer than non-germ cell tumours. True/false?

A

False, germ cell tumours are a more common occurrence in the testes compared to non-germ cell tumours.

27
Q

What is the initial investigation for testicular cancer?

A

Scrotal ultrasound

28
Q

What tumour marker is raised in teratomas but NOT in pure seminomas?

A

Alpha-fetoprotein

29
Q

Beta-HCG is a tumour marker that can be raised in both seminomas and teratomas. True/false?

A

True

30
Q

What can a staging CT scan be used for?

A

Used to assess areas where the cancer may have spread to and what stage it is at.

31
Q

Common places for testicular cancer to metastasise to?

A

Lymph nodes
Lungs
Liver
Brain

32
Q

What system can be used to grade testicular cancers?

A

Royal marsden grading system

33
Q

What are the main risk factors for bladder cancer?

A

Increasing age and smoking

34
Q

What occupation increases the risk of transitional cell bladder cancer?

A

Rubber or dye factory workers

Due to presence of aromatic amines within the rubber and dye

35
Q

What is the most common type of bladder cancer?

A

Transitional cell carcinoma
(90%)

Squamous cell carcinoma (5%)

Rarer causes include adenocarcinomas etc (~2%)

36
Q

What is a cause of squamous cell bladder carcinoma and what countries is it most prevalent?

A

Schistosomiasis - disease prevalent in developing countries.

37
Q

What is MAIN SYMPTOM for bladder cancer?

A

Painless Haematuria (important to remember)

38
Q

How is bladder cancer diagnosed?

A

Cystoscopy (camera through the urethra into the bladder), can be used to visualise bladder cancers.

39
Q

Renal cell carcinoma is the most common type of kidney tumour. True/false.

A

True, it is a type of adenocarcinoma arising from the renal tubules.

40
Q

There are several subtypes of renal adenocarcinomas, what are they and which is the most common?

A

Clear cell (around 80%)
Papillary (around 15%)
Chromophobe (around 5%)

41
Q

What is Wilm’s tumour?

A

Wilm’s tumour (aka nephroblastoma) is a specific tumour in the kidney that affects children, especially under 5 years of age.

42
Q

What are risk factors for renal cell carcinoma

A

Smoking
Obesity
Von Hippel-Lindau disease
Tuberous sclerosis
End-stage renal disease

43
Q

Symptoms of renal cell carcinoma?

A

Haematuria
Vague loin pain
Systemic (non-specific) cancer symptoms such as weight loss, night sweats, fatigue etc.

44
Q

What are “cannonball metastases”?

A

Present in the lungs and are a classic feature of metastatic renal cell carcinoma. Clearly marked circular opacities that are present throughout the lung fields.

45
Q

What are paraneoplastic features?

A

Conditions/syndromes that usually occur due to the presence of a tumour.

46
Q

Paraneoplastic features of renal cell carcinoma?

A

Polycythaemia - due to unregulated secretion of erythropoietin.

Hypercalcaemia - due to hormone secretion that mimics parathyroid hormone + potential metastases.

Hypertension - due to various factors. Increased renin secretion, polycythaemia and physical compression.

Renal Y2 (3 decks)

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