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Year 3 > Renal Carcinoma > Flashcards

Renal Carcinoma Flashcards

1
Q

What are renal tumours?

A

Renal tumours are characterised by a presentation of haematuria, flank pain and a flank mass.

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2
Q

What is the histology of renal tumours?

A

Histologically, primary renal tumours are most commonly caused by a clear cell adenocarcinoma originating from the epithelial cells of the PCT in the parenchyma, which has both solid and liquid components and are septated.

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3
Q

What are the features of paraneoplastic syndrome?

A

Excess EPO production and angiogenesis and polycythaemia however this results in anaemia of chronic disease, which initially begins as normocytic and progresses onto microcytic anaemia as iron stores are used up. Excess PTH production results in hypercalcaemia and excess ACTH causing Cushing’ disease

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4
Q

What is the common metastases in renal carcinoma,a?

A

Secondary Metastasis can occur, causing:
-> the left renal vein to the gonads and result in left-sided varicocele (enlarged vein.)
-> cannonball lesion on the lungs
-> Lytic lesions on the bones
-> Painless lymphadenopathy
-> vascularised haemorrhagic nodules on the skin

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5
Q

What are the risk factors for renal cell carcinoma?

A

Risk factors for renal cell carcinoma is smoking, obesity, old age, male and exposure to lead, asbestos and petroleum products, dialysis, radiotherapy and chemotherapy.

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6
Q

What is the diagnosis of renal cell carcinoma?

A

Diagnosis of renal cell cancer is made through CT scan of the abdomen, ultrasound or MRI. A CT-TAP may be used, where it images the thorax, abdomen and pelvis when there is undiagnosed weight loss.

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7
Q

What is Von Hippel Laundau syndrome?

A

Von Hippel Laundau syndrome is a genetic disorder which increases the risk for renal carcinoma, where there are tumours called haemangioblasts formed of new blood vessels, associated with cyst formation in the kidneys. This also increases the risk of phaemochromocytoma.

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8
Q

What are the types of renal cell carcinoma?

A

Clear cell
Papillary
Chromophobe

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9
Q

What is clear cell carcinoma?

A

Clear cell carcinomas which make up majority of cases, where there are sporadic, unilateral tumours that are mitochondria rich and tumour cells are rounded and clear due to hig presence of glycogen and lipids.

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10
Q

What is papillary carcinoma?

A

Papillary carcinoma, which arises from the renal tubules and presents with finger-like growths and projections. Type 1 PC grows slower and has less spread compared to Type 2 PC.

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11
Q

What is type 1 papillary carcinoma?

A

Type 1 is associated with hereditary papillary carcinoma

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12
Q

What is type 2 carcinomas?

A

Type 2 is associated with hereditary leiomyatosis and aggressive papillary carcinoma syndrome.

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13
Q

What is the most common renal cell carcinoma in children?

A

Wilm’s tumour which is the most common type of kidney cancer in under 15’s and more common in girls, associated with a genetic mutation of WT1 gene, important for the development of the kidneys and the gonads.

This is followed by renal cell carcinoma and congenital mesoblastid nephroma.

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14
Q

What is congenital mesoblastic nephroma?

A

Congenital mesoblastic nephroma occurs within the first 3 months of life and is a unilateral cancer of the renal mesenchyme, which manifests with a abdominal mass most commonly, and in lesser cases, polyhydroamniosis, haematuria and hypertension.

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15
Q

What are the common sites of metastasis in renal cancers?

A

Renal cancers commonly metastasise to the lungs, lymph nodes, bone and the liver. They frequently tend to have paraneoplastic syndrome, with anaemia, hypercalcaemia and Stauufer syndrome.
-> Hypercalcaemia indicates bony metastasis due to osteolytic effects of excess ACTH and may lead to bone compression.

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16
Q

What is Stauffer syndrome?

A

Stauffer syndrome is where elevation of liver enzymes which indicate impaired bile flow in the abscence of obstruction.

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17
Q

What is the treatment of renal cell carcinoma?

A

Treatment of renal cell carcinoma is based on staging via the TNM system:
* surgical resectioning, especially in the earlier stages because chemotherapy and radiotherapy are generally ineffective
* Combination of nephroctemy and biological therapies are more ideal for late stage renal cancer involving metastasis such as IL-2 inhibitors, interferon-alpha inhibitors and tyrosine kinase inhibitors.

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18
Q

What is the most common type of bladder cancers?

A

Bladder cancers are commonly transitional cell carcinomas, majorly superficial and non-muscle invasive associated with smoking, occupation with exposure to aromatic amines and dyes

19
Q

Which medications can cause bladder cancer?

A

Cyclophosphamide, which causes haemorrhagic cystitis

Type 2 diabetes, due to the use of piaglitazone medication

20
Q

What is the presentation of bladder cancer?

A

Presentation of bladder cancer is painless haematuria, increased urinary frequency, urinary retention, dysuria, renal colic, fever, weight loss and blood clots in the urine.

21
Q

What are features of squamous cell carcinoma?

A

Squamous cell carcinomas are less common and linked to infection with schistosomiasis haematobomium parasite, HPV or chronic inflammation with catheters which causes chronic inflammation of the bladder wall, with squamous metaplasia -> dysplasia. Squamous cell carcinoma is linked with recurrent UTI’s.
Adenocarcinoma is more likely to metastasise and develops from the urachal of the bladder in the dome

22
Q

What are the types of bladder carcinomas?

A

The 3 types of bladder carcinomas are papillary tumours that are raised and projections and other group are sessile which are flat and superficial spreading tumours or in-situ tumours confined to the urothelium.

23
Q

What are the investigations for bladder cancer?

A

Investigations for bladder cancer includes bedside urinalysis for raised WCC associated with cancer, urine cytology, FBC including U & Es, imaging with ultrasound and cystoscopy.

24
Q

What is the most common subtype of bladder cancer?

A

Non-muscle invasive is the most common type; associated with papillary tumours and arising from hyperplasia or dysplasia. It is confined to the mucosa/submucosa and generally treated with transurethral resection.

25
Q

What are the features of muscle invasive bladder cancer?

A

Muscle invasive, assoicated with flat or sessil tumours and invades past the lamina propia and more likely to metastasis, treated with surgery or chemotherapy.

26
Q

What is the grading of bladder cancer?

A

Bladder cancer is graded based on
Tis is in situ (at the original location)
Ta is confined to the urothelium.
T1 invades the submucosa/lamina propia
T2a extends to the basement membrane.
T2b extends to the detrusor muscle.
T3 extends to the adventitia.
T4 exceeds to the adjacent organs and has a high rate of metastasis,

27
Q

What is the treatment of T0-T1 bladder cancer?

A

Treatment for T0 and T1a tumours is transurethral resection of the bladder, where a cystoscope is used to image the bladder and using diathermy with heat and electricity to destroy the tumour.

28
Q

What is the treatment of T2 and T3 tumours?

A

Treatment for invade T2 and T3 tumours is radical cystectomy to remove the entire bladder for curative purposes, and neoadjuvant chemotherapy with cisplatin.

29
Q

What is prostate cancer?

A

Prostate cancer is a malignancy of glandular origin where adenocarcinomas form in the peripheral zone of the prostate gland, commonly metastasising to the bones and lymph nodes. Prostate cancer is associated with mutations in BRCA1, BRCA2 and HOX-B13. Risk factors are family history, age and ethnicity with Afro-Caribbean being more likely, infection with chlamydia, gonorrhoea and syphyllis.

30
Q

How is grading for prostate cancer determined?

A

Grading for prostate cancer is obtained by performing a trans rectal prostate biopsy where there is a raised PSA and evaluating cells via the Gleason Grading system from grade 1-5, with grade 1 being normal arrangement and 5 being disorganised architecturally.

31
Q

What is the grading for prostate cancer?

A

Grade 1: individual discrete and well formed glands
Grade 2: most of the glands are well formed, with few being poorly differentiated
Grade 3: most are poorly formed glands which have a few well-formed
Grade 4: irregular masses of neoplastic formation with some poorly-formed glands
Grade 5: lacks gland formation

Two scores are given for the most predominant cell type and the second score for the second predominant cell type, for Grading being between 2-10.

32
Q

What are the symptoms for prostate cancer?

A

Symptoms for prostate cancer are mainly asymptomatic, obtained through incidental finding of a raised PSA or large mass on rectal examination.
Symptoms present may be similar to BPH, causing haematuria, dysuria and LUTS like frequency, urgency, nocturnal and intermittent incontinence. There may be sexual dysfunction associated with this too.

33
Q

What are the investigations for prostate cancer?

A

Investigations include ultrasound, blood test for PSA, multiparametric MRI and transrectal prostate biopsy.

34
Q

What is the treatment for prostate cancer?

A

Treatment for prostate cancer includes
Inhibiting testosterone production through castration, 5-alpha reductase inhibitors like finasteride
Prostatectomy
Radiotherapy and chemotherapy
Testing for the bone metastasis through DEXA scan

35
Q

What is the screening for prostate cancer?

A

Screening for prostate cancer is completed by annual PSA screening test and prostate examination, however there is no national screening programme due to PSA having a low specificity despite high sensitivity.

Raised PSA can occur due to trauma or inflammation of the prostate, infection, biopsy, catheter use and benign prostatic enlargement.

36
Q

What is testicular cancer?

A

Testicular cancer arises from germ cells in the testicles and are divided into teratomas and seminomas.

37
Q

What are teratomas?

A

Teratomas which arise from the germ cells and associated with:
-> raised beta HCG and alpha-fetoprotein
-> a normal lactate dehydrogenase.

38
Q

What are seminomas?

A

Seminomas which are more common and are malignant neoplasms which arises from the abnormality in the chromosomes of the precursors spermatogonia and more common in older age.

They are diagnosed with raised lactate dehydrogenase (LDH) and a normal beta HCG and alpha fetoprotein.

39
Q

What is the presentation of testicular cancer?

A

Testicular cancer presentation is a unilateral painless lump that is non-tender, hard, irregular and arises from the testicle without translumination. There may be weightloss and back pain indicating metastases.

40
Q

What are the risk factors for testicular cancer?

A

White male, younger age, cryptorchidism (undescended testes), Klinefelter syndrome, infertility and testicular atrophy secondary to trauma or infection.

41
Q

What is the most common site of metastasis for testicular cancer?

A

The most common site of metastasis is the lymph nodes, lungs, bones and liver.

42
Q

What are the investigations for testicular cancer?

A

Blood test for tumour markers like lactate dehydrogenase (glycolysis of tumour which can indicate tumour size and necrosis), alpha-fetoprotein due to teratoma containing yolk sac components and beta HCG (because cancer cells can turn into synctiotrophoblast)
Scrotal ultrasound and CT
Abdominal examination, prostate examination

43
Q

How are seminomas managed?

A

Seminomas are managed through orchidectomy, surveillance via CT scan, blood test for tumour markers and regular examination. Metastasis is managed through radiotherapy and chemotherapy, however more aggressive seminomas are treated with chemotherapy.

44
Q

How are teratomas managed?

A

Teratomas are managed through orchidectomy and chemotherapy and surveillance testing. Radiotherapies are not reccomended due to their low sensitivity for teratomas.

Year 3 (31 decks)

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