renal, bladder and testicular cancer Flashcards
what common feature do renal and bladder cancers present with?
haematuria
what feature of haematuria is very worrying and why?
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
what should you ask about in the history with a pt with haematuria?
smoking associated symptoms (UTI, trauma, rash) - lees likely to be cancer instrumentation/catheters travel - schistosomiasis carcinogens - rubber and paint chemo eg cyclophosphamide FHx
what are the differentials for haematuria?
- infection: UTI, pylonephritis, TB
- trauma: penetrating vs blunt
- stones: KUB
- malignancy: anywhere in urinary tract
- nephrological: diabetes, nephropathy with proteinuria
name a surgical sieve and what it stands for
Congenital Vascular Infective Trauma Autoimmune Metabolic Inflammatory Neoplastic Neurological Degenerative Environmental Unknown
How else can the causes of haematuria be divided?
by anatomical location
kidneys, ureters, bladder, prostate, urethra, penis
and divide into malignancy, trauma, infection, stones for each area
which groups of people come under the suspected cancer referrals ie 2WW - 2 week wait to urology clinic
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
What group of people is offered a non-urgent referral to urology?
non visible haematuria recurrent or persistent unexplained UTI
what are the investigations for haematuria?
bloods:
- FBC
- U+E
- PSA + DRE
- glucose
MSU dip - microscopy, culture, sensitivity
cytology if available
imaging - USS/ CT,
flexible cystoscopy
why is a FBC done for haematuria?
to see how much blood they have lost - is it causing anaemia?
why is a PSA and DRE done for haematuria?
haematuria can be caused by an enlarged prostate
why is glucose done for haematuria?
recurrent UTIs and therefore haematuria can be the first presentation of diabebtes
when is USS done for haematuria?
if the pt has non-visible haematuria
If the pt has visible haematuria what imaging test is done?
CT urogram
also a flexible cystoscopy
Why is a flexible cystoscopy done?
imaging the bladder is not very good for looking at tumours in the bladder
How does bladder cancer present?
painless visible haematuria
irritative voiding/recurrent UTIs (CIS)
(but some people with non-visible haematuria may have bladder cancer)
what should be done before treatment is commenced for people with bladder cancer?
staging and MDT
What investigation is done to diagnose and stage bladder cancer?
Transuretheral Resection of Bladder Tumour
TURBT
what is the most common type of bladder cancer?
Transitional cell carcinoma 90%
What type of bladder cancer can Schistosomiasis and self catheterisation cause?
squamous cell carcinoma
What is bladder CIS?
bladder cancer in situ - it is poorly differentiated and mainly confined to the epithelium although 50% become muscle invasive
at what tumour stage do bladder cancers become muscle invasive?
T2
what treatments are offered for people with muscle invasive bladder cancer?
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
How are pts with Ta and T1 cancers treated?
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
