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Urology/Renal > renal, bladder and testicular cancer > Flashcards

renal, bladder and testicular cancer Flashcards

1
Q

what common feature do renal and bladder cancers present with?

A

haematuria

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2
Q

what feature of haematuria is very worrying and why?

A

clots - suggest active bleeding and can form a plug causing retention

fresh blood without any other symptoms eg loin pain or signs of infection as this can suggest a tumour

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3
Q

what should you ask about in the history with a pt with haematuria?

A 
smoking 
associated symptoms (UTI, trauma, rash) - lees likely to be cancer 
instrumentation/catheters 
travel - schistosomiasis
carcinogens - rubber and paint
chemo eg cyclophosphamide
FHx
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4
Q

what are the differentials for haematuria?

A
  • infection: UTI, pylonephritis, TB
  • trauma: penetrating vs blunt
  • stones: KUB
  • malignancy: anywhere in urinary tract
  • nephrological: diabetes, nephropathy with proteinuria
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5
Q

name a surgical sieve and what it stands for

A 
Congenital
Vascular
Infective 
Trauma
Autoimmune
Metabolic
Inflammatory 
Neoplastic 
Neurological
Degenerative
Environmental 
Unknown
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6
Q

How else can the causes of haematuria be divided?

A

by anatomical location
kidneys, ureters, bladder, prostate, urethra, penis
and divide into malignancy, trauma, infection, stones for each area

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7
Q

which groups of people come under the suspected cancer referrals ie 2WW - 2 week wait to urology clinic

A

aged 45 or over and unexplained VISIBLE haematuria

aged 45 or over and have VISIBLE haematuria that persists or recurs after successful treatment of UTI

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8
Q

What group of people is offered a non-urgent referral to urology?

A

non visible haematuria recurrent or persistent unexplained UTI

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9
Q

what are the investigations for haematuria?

A

bloods:
- FBC
- U+E
- PSA + DRE
- glucose

MSU dip - microscopy, culture, sensitivity

cytology if available

imaging - USS/ CT,

flexible cystoscopy

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10
Q

why is a FBC done for haematuria?

A

to see how much blood they have lost - is it causing anaemia?

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11
Q

why is a PSA and DRE done for haematuria?

A

haematuria can be caused by an enlarged prostate

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12
Q

why is glucose done for haematuria?

A

recurrent UTIs and therefore haematuria can be the first presentation of diabebtes

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13
Q

when is USS done for haematuria?

A

if the pt has non-visible haematuria

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14
Q

If the pt has visible haematuria what imaging test is done?

A

CT urogram

also a flexible cystoscopy

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15
Q

Why is a flexible cystoscopy done?

A

imaging the bladder is not very good for looking at tumours in the bladder

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16
Q

How does bladder cancer present?

A

painless visible haematuria
irritative voiding/recurrent UTIs (CIS)
(but some people with non-visible haematuria may have bladder cancer)

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17
Q

what should be done before treatment is commenced for people with bladder cancer?

A

staging and MDT

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18
Q

What investigation is done to diagnose and stage bladder cancer?

A

Transuretheral Resection of Bladder Tumour

TURBT

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19
Q

what is the most common type of bladder cancer?

A

Transitional cell carcinoma 90%

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20
Q

What type of bladder cancer can Schistosomiasis and self catheterisation cause?

A

squamous cell carcinoma

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21
Q

What is bladder CIS?

A

bladder cancer in situ - it is poorly differentiated and mainly confined to the epithelium although 50% become muscle invasive

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22
Q

at what tumour stage do bladder cancers become muscle invasive?

A

T2

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23
Q

what treatments are offered for people with muscle invasive bladder cancer?

A

cystectomy - esp for younger pts
radiotherapy - instead of cystectomy for people who are not fit for surgery
chemo - also be used esp before surgery to shrink the size of the tumour

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24
Q

How are pts with Ta and T1 cancers treated?

A

cut away the tumour and keep them on regular flexible cystoscopies and can be done at 3 months, 9 months and 12 months and if it hasn’t come back at that time then you can discharge them

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25
Q

how is bladder cancer staged

A

Ta - just on the surface epithelium
T1 - gone through the lamina propria but hasn’t hit the muscle
T2 and above - muscle invasive
T3 - reached the pervescical fat
T4 - gone thorough the whole wall of the bladder

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26
Q

how is bladder cancer graded

A

G1 - well differentiated
G2- moderate
G3 - poorly differentiated
CIS - carcinoma in situ

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27
Q

what intervention do people with cis need

A

cystectomy

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28
Q

what are the risk factors for bladder cancer and why?

A

paraplegia - due to self catheterisation
smoking - as inhaled carcinogens are excreted in the urine
occupational carcinogens eg rubber, textiles, printing
drugs - aspirin and cyclophosphamide
bladder stones - cause irritation like schistosomiasis

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29
Q

what is the prognosis of bladder cancer

A

10 year survival is 50% - so not great

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30
Q

is renal cancer or bladder cancer more common?

A

renal cancer

31
Q

what is your chance of dying from renal cancer?

A

1 in 3

32
Q

how is renal cancer diagnosed?

A

picked up incidentally on scans for something else
some will have mets on presentation though:
- haematuria
flank pain
mass
weight loss
nodes

33
Q

What is the most common type of renal cancer?

A

95% are a renal cell carcinoma (other percentage made of transitional cell carcinoma)

34
Q

what are the stages of renal cancer ?

A

stage 1
stage 2
stage 3a,b,c
stage 4

35
Q

what is stage 1 renal cancer?

A

tumour less than 7%

limited to kidney

36
Q

what treatment would you offer sb with stage 1 renal cancer?

A

partial nephrectomy

radical nephrectomy

37
Q

what may some people need a partial nephrectomy rather than a radical nephrectomy?

A

eg in diabetes to save nephrons

38
Q

what is stage 2 renal cancer?

A

more than 7cm tumour

limited to the kidney

39
Q

what is a stage 3 renal tumour?

A

tumour in the major veins (renal vein, IVC, right atrium) or adrenal gland with an intact Gerota’s fascia (fibrous tissue layer above the perinephric fat)
or regional lymph nodes involved

40
Q

what are the management options for stage 3 cancer?

A

radical nephrectomy
adrenalectomy
lymph node dissection if needed

41
Q

what is stage 4 renal cancer?

A

tumour is outside the kidney - gone through Gerota’s fascia and elsewhere - distant mets

42
Q

what are the treatment options for stage 4 renal disease?

A

systemic treatment

cytoreductive nephrectomy

43
Q

what are the principles for examining a mass?

A

look, feel, move

44
Q

what is the sign of a true scrotal mass?

A

it is possible to get above it

45
Q

what must be excluded if a pt presents with an acutely painful scrotum?

A

testicular torsion

46
Q

what are the differentials of a testicular mass?

A

false scrotal reasons - inguinal hernia, varicocele

epididymitis
hydrocele 
testicular torsion 
orchitis - inflammation of the testis 
appendix testis torsion 
spermatocele - epididymal cyst
testicular rupture
47
Q

do people with testicular cancer present with haematuria?

A

no - it is not connected to the bladder

48
Q

in which scrotum is it more worrying to have a hydrocele and why?

A

right testicular vein drains directly into the IVC so there is no resistance there, but the left testicular vein drains into the the left renal vein at 90˚
a new varicocele on the left hand side that has come on really quick, could mean that they have a kidney tumour

49
Q

who tends to get acute epidiymitis?

A

young males with STIs (gonorrheaandchlamydia) and UTIs

old men who self catheterise and may get STI that goes into the epididymis

50
Q

how do STIs cause epidymitis?

A

retrograde spread from prostatic urethra to the seminal vesicle

51
Q

what is hydrocele?

A

XS fluid in the tunica vaginalis (serous space surrounding the testis)

52
Q

what is the cause of primary hydrocele?

A

processus vaginalis that hasn’t sealed up/ not obliterated

53
Q

what is the cause of secondary hydrocele?

A

mainly not known but can be a reaction to testicular pathology eg testicular tumours, infections, torsion etc

54
Q

name two types of testicular tumour

A

seminoma

non-seminoma - eg teratoma

55
Q

what aged men get testicular cancer?

A

age 20-40

56
Q

can women get prostate cancer?

A

no

57
Q

is testicular cancer incidence increasing or decreasing and are most of the cancers benign or malignant?

A

malignant -92%

incidence is increasing

58
Q

what are the risk factors for testicular cancer

A

Cryptorchidism = undescended testis
FHx
previous testicular tumour

59
Q

What procedure is done if a pt has testicular cancer?

A

early inguinal orchidectomy - testis and spermatic cord excised

60
Q

how does testicular cancer present?

A

painless lump in the testis
hard/craggy and can feel above it
does not transilluminate (as it is a solid mass - if it was a cyst it would transilluminate)
found incidentally
some may present with hydrocele, pain, mets in lung

61
Q

how does testicular cancer present?

A

painless lump in the testis
hard/craggy and can feel above it
does not transilluminate (as it is a solid mass - if it was a cyst it would transilluminate)
found incidentally
some may present with hydrocele, pain, mets in lung or enlarged lymph nodes

62
Q

if a young man comes in with cannonball mets in his lung what could it be?

A

testicular tumour that has metastasised

63
Q

what investigations would be done for a testicular mass?

A
  • ultrasound scan ON THE SAME DAY - as you want to operate on the on the same day
  • tumour markers - Alpha Fetoprotein and beta-human chorionic gonadotropin, lactate dehydrogenase, measure tumour markers on the same day and then a day after the operation
  • staging CT chest, abdo, pelvis
  • CXR - only if the pt has respiratory symptoms, done on the same day
64
Q

if someone has cannonball mets on XRAY what will they be offered before surgery?

A

chemo to reduce the size of the tumour

65
Q

what is the half-life of AFP and B-hcg?

A

AFP - 5 days

B-hcg - 24-48 hours

66
Q

What are seminomas very sensitive to?

A

radiotherapy

67
Q

which of seminomas and teratomas spreads more easily?

A

teratomas

68
Q

how is a teratoma treated and why?

A

chemo as less radiosensitive than seminomas

69
Q

How is treatment for testicular cancers monitored?

A

sequential CT and tumour markers

70
Q

from which cells in the testis do most testicular cancers come from?

A

germ cells - spermatogonia, spermatocytes ie the cells that go on to form the sperm

71
Q

how fast do seminomas grow?

A

slowly

72
Q

How fast do teratomas (or non-seminomas) grow

A

fast and can metastasise

73
Q

What is the 5 year survival rate like for a seminoma or teratoma?

A

good - worst is 70%

Urology/Renal (14 decks)

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