Renal, bladder and testis cancer Flashcards
which type of cancer accounts for 90% of renal cancers?
renal cell carcinoma
What is the mean age of diagnosis for renal cancer?
55 yrs
What is the name of the renal cancer that presents in children?
Wilms tumour
What are some risk factors for renal cancer?
smoking
obesity
HTN
What are the 5 common cancers which metastasise to bone?
Kidney Breast Bronchus Prostate Thyroid
What are some features of renal carcinoma?
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
What percentage of patients have metastases on presentation of renal cancer?
25%
What is the gold standard imaging for renal cancer?
CT scan
Treatment for renal cell carcinoma
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
Prognosis of RCC
Depends on SSIGN score
>10 score = 19.2% 10yr survival
What are the most common type of bladder tumours?
90% are transitional cell carcinomas from transitional epithelium (urothelium)
SCC = 5%
Adenocarcinoma = 2% rare
Are bladder tumours more common in men or women?
Men 5:2
8th most common cancer in men & very common in Sheffield
What age is a bladder tumour rare?
<50
Presentation of a bladder tumour?
Painless haematuria (85%) LUTS - frequency, urgency, nocturia Recurrent UTIs Voiding irritability Mass in lower abdomen, infiltrating prostate on DRE
Things associated with bladder tumours?
- 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
What are some investigations for haematuria?
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
Name causes of persistent NVH (common and less common urological and nephrological)
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
What is the difference between staging and grading of a cancer?
Grading - how it looks microscopically
Staging - where the cancer has spread to or gone.
Treatment of TCC of the bladder
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
What are some risks associated with transurethral resection of bladder tumour procedure?
Pain
Infection
Bladder perforation
How often do we follow up on high risk and low risk bladder tumours?
High risk: cytoscopy every 3m for 2 yrs then every 6m
Low risk: cytoscopy follow up 9m then yearly.
What is the most common procedure used for urinary diversion?
Ileal conduit
Is it true that a testicular lump is cancer until proven otherwise?
Yes
Acute, tender enlargement of the testis is what until proven otherwise?
Torsion
At what age do epididymal cysts usually occur? Where are they found?
Develop in adulthood
Lie behind and above the testis
What are the causes, features and treatment for epididymo-orchitis?
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
What is a variocele?
- 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
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?
- 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
Tests for testicular tumours?
What are some useful markers for testicular tumours?
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)
Treatment for testicular tumours? What should we encourage to help prevent late presentation of testicular cancer?
- 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)
