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Urology > Renal, bladder and testis cancer > Flashcards

Renal, bladder and testis cancer Flashcards

1
Q

which type of cancer accounts for 90% of renal cancers?

A

renal cell carcinoma

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2
Q

What is the mean age of diagnosis for renal cancer?

A

55 yrs

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3
Q

What is the name of the renal cancer that presents in children?

A

Wilms tumour

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4
Q

What are some risk factors for renal cancer?

A

smoking
obesity
HTN

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5
Q

What are the 5 common cancers which metastasise to bone?

A 
Kidney
Breast
Bronchus
Prostate
Thyroid
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6
Q

What are some features of renal carcinoma?

A

A lot of the time it is found incidentally.
Haematuria (50%)
Loin pain (40%)
Abdominal mass (25%)
Anorexia, malaise, weight loss, pyrexia of unknown origin

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7
Q

What percentage of patients have metastases on presentation of renal cancer?

A

25%

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8
Q

What is the gold standard imaging for renal cancer?

A

CT scan

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9
Q

Treatment for renal cell carcinoma

A

Partial nephrectomy is gold standard for small tumours confined to the kidney
Radical nephrectomy
Palliative options
RCC does NOT respond to radiotherapy.

Patients with unresectable or metastatic disease
- High dose IL-2 and anti-angiogenesis agents

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10
Q

Prognosis of RCC

A

Depends on SSIGN score

>10 score = 19.2% 10yr survival

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11
Q

What are the most common type of bladder tumours?

A

90% are transitional cell carcinomas from transitional epithelium (urothelium)
SCC = 5%
Adenocarcinoma = 2% rare

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12
Q

Are bladder tumours more common in men or women?

A

Men 5:2

8th most common cancer in men & very common in Sheffield

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13
Q

What age is a bladder tumour rare?

A

<50

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14
Q

Presentation of a bladder tumour?

A 
Painless haematuria (85%)
LUTS - frequency, urgency, nocturia
Recurrent UTIs
Voiding irritability
Mass in lower abdomen, infiltrating prostate on DRE
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15
Q

Things associated with bladder tumours?

A
  • Smoking
  • Aromatic amines (rubber industry)
  • Hairdressers, leather workers, drivers, chemical workers
  • Chronic cystitis
  • Schistosomiasis (increased risk of SCC)
  • Pelvic radiation
  • Drugs - phenacetin (not used anymore - analgesic), cyclophosphamide, pioglitazone
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16
Q

What are some investigations for haematuria?

A

Flexible cytoscopy - easy to perform, quick, 5% risk of UTI, well tolerated
Ultrasound KUB - less sensitive but safest
CT urogram - used for higher risk as involves radiation and contrast use
Urine cytology - rarely used. now

17
Q

Name causes of persistent NVH (common and less common urological and nephrological)

A 
Common urological
- BPH
- cancer
- stones disease
- infection
Less common urological
- Radiation cystitis
- urethral stricture
- medullary spongy kidney
Nephrological
- IgA nephropathy
- Thin basement membrane disease
- Glomerulonephritis
- Vasculitis
18
Q

What is the difference between staging and grading of a cancer?

A

Grading - how it looks microscopically

Staging - where the cancer has spread to or gone.

19
Q

Treatment of TCC of the bladder

A

Low grades - transurethral resection of bladder tumour (TURBT) is both diagnostic and therapeutic.
T2-T3 = radical cystectomy is the gold standard
T4 = usually palliative chem or radiotherapy

20
Q

What are some risks associated with transurethral resection of bladder tumour procedure?

A

Pain
Infection
Bladder perforation

21
Q

How often do we follow up on high risk and low risk bladder tumours?

A

High risk: cytoscopy every 3m for 2 yrs then every 6m

Low risk: cytoscopy follow up 9m then yearly.

22
Q

What is the most common procedure used for urinary diversion?

A

Ileal conduit

23
Q

Is it true that a testicular lump is cancer until proven otherwise?

A

Yes

24
Q

Acute, tender enlargement of the testis is what until proven otherwise?

A

Torsion

25
Q

At what age do epididymal cysts usually occur? Where are they found?

A

Develop in adulthood

Lie behind and above the testis

26
Q

What are the causes, features and treatment for epididymo-orchitis?

A

Causes
- Chlamydia <35yrs, E.coli, mumps, N. gonorrhoea, TB

Features

  • Sudden-onset tender swelling
  • Dysuria
  • Sweats or fever
  • First catch urine sample may contain urethral discharge
  • Possible infertility and symptoms may worsen before improving

Treat

  • If <35 = doxycycline
  • If gonorrhoea suspected add ceftriaxone
  • If >35, associated UTI common so try ciprofloxacin
  • Analgesia, scrotal support, drainage of any abscess
27
Q

What is a variocele?

A
  • Dilated veins of pampiniform plexus
  • Left side more commonly affected
  • Often visible as distended scrotal blood vessels that ‘feel like a bag of worms’
  • Patient may complain of dull ache
  • Subfertility association
28
Q

When do testicular tumours most commonly present?
What treatment are testicular tumours really sensitive to?
90% of them are what type of tumours?
Signs?
Risk factors?

A
  • Most common malignancy in men aged 20-45
  • 10% occur in undescended testes, even after orchidopexy
  • Most curable cancer - extremely sensitive to chemotherapy
  • Bilateral in 1-2%
  • 90% are germ cell tumours

Signs
- Typically painless, testicular lump found after trauma or infection
→ request ultrasound if anything strange going on in testicle
- Hard mass arising from testes, check lymph nodes, abdomen and lungs
- Secondary hydrocele
- Pain sometimes
- Dyspnoea (lung mets)
- Abdominal mass (enlarged nodes)

Risk factors

  • Undescended testes
  • Infant hernia
  • Infertility
  • Previous testicular cancer
  • HIV increases risk of seminoma
  • Positive family history increases risk
29
Q

Tests for testicular tumours?

What are some useful markers for testicular tumours?

A

Scrotal USS to be done on the day
CXR and CTAP
Excision biopsy
a-FP and b-hCG and LDH are useful markers and help monitor the treatment (LDH produced in tumour necrosis)

30
Q

Treatment for testicular tumours? What should we encourage to help prevent late presentation of testicular cancer?

A
  • Radical inguinal orchidectomy
    → definitive diagnosis and curative in 75%
  • Chemotherapy
    → Very sensitive to platinum based chemo, used for high risk or metastatic disease
  • Retroperitoneal lymph node dissection
    → In UK only used to de-bulk residual LN masses after chemo
  • Encourage regular self-examination (prevents late presentation)

Urology (12 decks)

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