Renal/GU cancers

Question 1

Symptoms suggestive of urological cancers?

Answer 1

Appetite loss, weight loss, DVT

Dysuria with unexplained non-visible heamaturia in >60yrs

Visible haematuria without UTI at >45yrs

Haematuria with dysuria and raised WCC in >60s

Unexplained or recurrent UTIs in >60s

Penile lesions/masses

Erectile dysfunction

Testis enlargement/changes in shape.unexplained testicle symptoms

Question 2

Risk factors for bladder cancer?

Answer 2

Smoking and increased age
Aromatic amines (dye and rubber)

Question 3

Presentation of bladder cancer?

Answer 3

Painless haematuria

Question 4

NICE guidelines for referrals on recognising urological cancers?

Answer 4

2 week referral for:

45+ with unexplained visible haematuria, either without a UTI or persisting after UTI tc

60+ with microscopic haematuria PLUS dysuria or raised WBC on FBC.

Question 5

How to diagnose bladder cancer?

Answer 5

Cystoscopy, which can be flexible or rigid and is performed under local or general anaesthetic.

Screened with urine cytology

Question 6

Treatment options for bladder cancer?

Answer 6

Various options which will depend on whether the cancer is non-muscle-invasive.

Transurethral resection of bladder tumour
Intravesical chemotherapy
BCG vaccine into the bladder (immunotherapy)
Radical cystectomy

Question 7

Risk factors for prostate cancer?

Answer 7

Increasing age
Black ethnicity
Family hx

Question 8

Clinical presentation of prostate cancer?

Answer 8

Can be asymptomatic

Or present with lower urinary tract symptoms similar to BPH:
Hesitancy, frequency, weak flow, terminal dribbling, nocturia

Haematuria
Erectile dysfunction
Advanced disease: weight loss, bone pain, cauda equina)

Question 9

What are common causes of a raised PSA?

Answer 9

PSA is unreliable, giving high rate of false positives and negatives.

Can be raised in:
Prostate cancer
BPH
Prostatitis
UTIs
Vigorous exercise (cycling)
Recent ejaculation or prostate stimulation

Question 10

When to refer on when suspecting prostate cancer?

Answer 10

Urgent 2 week cancer referral if:

Prostate feels malignant (graggy, hard, irregular)

PSA raised above threshold for their age

Question 11

Investigations for suspected prostate cancer?

Answer 11

Multiparametric MRI of prostate is first line

If high clinical suspicion +/- score >3 on multiparametric MRI then do MRI guided prostate biopsy to diagnose:

Transrectal ultrasound guided biopsy
or
Transperineal biopsy

Isotope bone scan to look for bony metasteses

Question 12

Management for prostate cancer?

Answer 12

Watch and wait in early prostate cancer
External beam radiotherapy
Brackytherapy
Surgery

Hormone therapy: androgen receptor blockers (bicalutamide- must offer bisphosphonates), GnRH agonists

Question 13

Prevalence of testicular cancer and risk factors?

Answer 13

More common in young men 15-35 years

Risk factors:
Undescended testes, male infertility, family hx, increased height

Question 14

Clinical presentation of testicular cancer?

Answer 14

Painless lump on testicle
Occasionally presents with testicular pain

Lump is:
Non tender, arising for testicle. hard
Irregular, not fluctuant, no transillumination

Rarely gynaecomastia

Question 15

Investigations for suspected testicular cancer?

Answer 15

Urgent 2 week referral.
Scrotal ultrasound to confirm diagnoses

Tumour markers:
Alpha-fetoprotein
Beta-hCH
Lactate dehydrogenase

Staging CT scan to assess spread and stage of cancer

Question 16

Common metastasise for testicular cancer?

Answer 16

Lymphatics
Lungs
Liver
Brain

Question 17

Management for testicular cancer?

Answer 17

Guided by MDT, tx depends on grade and stage

Surgery to remove affected testicle
Chemo, radiotherapy
Sperm banking

Question 18

Prognosis for testicular cancer?

Answer 18

Prognosis for early testicular cancer is greater than 90% cure rate

metastatic disase is often curable.

Patients will require follow up monitoring for recurrence (monitoring tumour markers and imaging like CT scan and xray)

Question 19

What is Wilms Tumour? How does it present?

Answer 19

Specific type of tumour affecting the kidney in children under age of 5

Presents in child under 5 with abdominal mass, or signs like:
Abdo pain, haematuria, lethargy, fever, hypertension, weight loss

Question 20

How is Wilms tumour diagnosed and managed? Prognosis?

Answer 20

Initially investigated with abdo USS.
CT or MRI used to stage
Biopsy to identify histology for definite diagnosis.

Management:
Surgical excision of tumour along with affected kidney

Adjuvant tx may involve chemo or radiotherapy

Prognosis:
Early stage tumours have good change of cure (90%) but metastatic disease poorer prognosis.